Bystander-initiated CPR in an Asian metropolitan: does the socioeconomic status matter?
OBJECTIVE
To determine the association of neighborhood socioeconomic status (SES) with bystander-initiated cardiopulmonary resuscitation (CPR) and patient outcomes of out of hospital cardiac arrests (OHCAs) in an Asian metropolitan area.


METHODS
We performed a retrospective study in a prospectively collected cohort from the Utstein registry of adult non-traumatic OHCAs in Taipei, Taiwan. Average real estate value was assessed as the first proxy of SES. Twelve administrative districts in Taipei City were categorized into low versus high SES areas to test the association. The primary outcome was bystander-initiated CPR, and the secondary outcome was patient survival status. Factors associated with bystander-initiated CPR were adjusted for in multivariate analysis. The mean household income was assessed as the second proxy of SES to validate the association.


RESULTS
From January 1, 2008 to December 30, 2009, 3573 OHCAs received prehospital resuscitation in the community. Among these, 617 (17.3%) cases received bystander CPR. The proportion of bystander CPR in low-SES vs. high-SES areas was 14.5% vs. 19.6% (p<0.01). Odds ratio of receiving bystander-initiated CPR in low-SES areas was 0.72 (95% confidence interval: [0.60-0.88]) after adjusting for age, gender, witnessed status, public collapse, and OHCA unrecognized by the online dispatcher. Survival to discharge rate was significantly lower in low-SES areas vs. high-SES areas (4.3% vs. 6.8%; p<0.01). All results above remained consistent in the analyses by mean household income.


CONCLUSIONS
Patients who experienced an OHCA in low-SES areas were less likely to receive bystander-initiated CPR, and demonstrated worse survival outcomes.
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan.
Wen-Chu
WC
Chiang
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan.
Patrick Chow-In
PC
Ko
Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States.
Anna Marie
AM
Chang
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Wei-Ting
WT
Chen
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Sot Shih-Hung
SS
Liu
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Yu-Sheng
YS
Huang
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan.
Shey-Ying
SY
Chen
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chien-Hao
CH
Lin
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Ming-Tai
MT
Cheng
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Kah-Meng
KM
Chong
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Hui-Chih
HC
Wang
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Chih-Wei
CW
Yang
Taipei City Fire Department, Taiwan.
Mao-Wei
MW
Liao
Taipei City Fire Department, Taiwan.
Chen-Hsiung
CH
Wang
Taipei City Fire Department, Taiwan.
Yu-Chun
YC
Chien
Department of Health, Taipei City Government, Taiwan.
Chi-Hung
CH
Lin
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Health, Taipei City Government, Taiwan.
Yueh-Ping
YP
Liu
Taipei City Hospital, Chung-Shaw Branch, Taiwan.
Bin-Chou
BC
Lee
Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan.
Kuo-Long
KL
Chien
Graduate Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University, Taipei, Taiwan. Electronic address: mslai@ntu.edu.tw.
Mei-Shu
MS
Lai
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: mattma.tw@gmail.com.
Matthew Huei-Ming
MH
Ma
D000368:Aged; D016887:Cardiopulmonary Resuscitation; D005260:Female; D005392:First Aid; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D012189:Retrospective Studies; D012923:Social Class; D013624:Taiwan; D014505:Urban Population
Cardiopulmonary resuscitation (CPR); Education; Emergency medical system (EMS); First responder; Neighborhood; Socioeconomic status (SES)