Small area variations in out-of-hospital cardiac arrest: does the neighborhood matter?
BACKGROUND
The incidence and outcomes of out-of-hospital cardiac arrest vary widely across cities. It is unknown whether similar differences exist at the neighborhood level.


OBJECTIVE
To determine the extent to which neighborhoods have persistently high rates of cardiac arrest but low rates of bystander cardiopulmonary resuscitation (CPR).


METHODS
Multilevel Poisson regression of 1108 cardiac arrests from 161 census tracts as captured by the Cardiac Arrest Registry to Enhance Survival (CARES).


METHODS
Fulton County, Georgia, between 1 October 2005 to 30 November 2008.


METHODS
Incidence of cardiac arrest, by census tract and year and by rates of bystander CPR.


RESULTS
Adjusted rates of cardiac arrest varied across neighborhoods (interquartile range [IQR], 0.57 to 0.73 per 1000 persons; mean, 0.64 per 1000 persons [SD, 0.11]) but were stable from year to year (intraclass correlation, 0.36 [95% CI, 0.26 to 0.50]; P < 0.001). Adjusted bystander CPR rates also varied by census tract (IQR, 19% to 29%; mean, 25% [SD, 10%]).


CONCLUSIONS
Analysis was based on data from a single county.


CONCLUSIONS
Surveillance data can identify neighborhoods with a persistently high incidence of cardiac arrest and low rates of bystander CPR. These neighborhoods are promising targets for community-based interventions.


BACKGROUND
Robert Wood Johnson Foundation Clinical Scholars Program, National Institutes of Health, and Centers for Disease Control and Prevention.
University of Michigan, Ann Arbor, Michigan, USA. comilla@umich.edu
Comilla
C
Sasson
Carla C
CC
Keirns
Dylan
D
Smith
Michael
M
Sayre
Michelle
M
Macy
William
W
Meurer
Bryan F
BF
McNally
Arthur L
AL
Kellermann
Theodore J
TJ
Iwashyna
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D004632:Emergency Medical Services; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006323:Heart Arrest / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016012:Poisson Distribution; D017062:Small-Area Analysis