title: Rates of cardiopulmonary resuscitation training in the United States.
abstract: OBJECTIVE
  Prompt bystander cardiopulmonary resuscitation (CPR) improves the likelihood of surviving an out-of-hospital cardiac arrest. Large regional variations in survival after an out-of-hospital cardiac arrest have been noted.
  
  
  OBJECTIVE
  To determine whether regional variations in county-level rates of CPR training exist across the United States and the factors associated with low rates in US counties.
  
  
  METHODS
  We used a cross-sectional ecologic study design to analyze county-level rates of CPR training in all US counties from July 1, 2010, through June 30, 2011. We used CPR training data from the American Heart Association, the American Red Cross, and the Health & Safety Institute. Using multivariable logistic regression models, we examined the association of annual rates of adult CPR training of citizens by these 3 organizations (categorized as tertiles) with a county's geographic, population, and health care characteristics.
  
  
  METHODS
  Completion of CPR training.
  
  
  METHODS
  Rate of CPR training measured as CPR course completion cards distributed and CPR training products sold by the American Heart Association, persons trained in CPR by the American Red Cross, and product sales data from the Health & Safety Institute. RESULTS During the study period, 13.1 million persons in 3143 US counties received CPR training. Rates of county training ranged from 0.00% to less than 1.29% (median, 0.51%) in the lower tertile, 1.29% to 4.07% (median, 2.39%) in the middle tertile, and greater than 4.07% or greater (median, 6.81%) in the upper tertile. Counties with rates of CPR training in the lower tertile were more likely to have a higher proportion of rural areas (adjusted odds ratio, 1.12 [95% CI, 1.10-1.15] per 5-percentage point [PP] change), higher proportions of black (1.09 [1.06-1.13] per 5-PP change) and Hispanic (1.06 [1.02-1.11] per 5-PP change) residents, a lower median household income (1.18 [1.04-1.34] per $10 000 decrease), and a higher median age (1.28 [1.04-1.58] per 10-year change). Counties in the South, Midwest, and West were more likely to have rates of CPR training in the lower tertile compared with the Northeast (adjusted odds ratios, 7.78 [95% CI, 3.66-16.53], 5.56 [2.63-11.75], and 5.39 [2.48-11.72], respectively).
  
  
  CONCLUSIONS
  Annual rates of US CPR training are low and vary widely across communities. Counties located in the South, those with higher proportions of rural areas and of black and Hispanic residents, and those with lower median household incomes have lower rates of CPR training than their counterparts. These data contribute to known geographic disparities in survival of cardiac arrest and offer opportunities for future community interventions.
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Monique L
authors.initials: ML
authors.lastname: Anderson
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Margueritte
authors.initials: M
authors.lastname: Cox
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
authors.affiliation: Department of General Internal Medicine, University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington, Seattle.
authors.forename: Graham
authors.initials: G
authors.lastname: Nichol
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Thomas
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Paramita
authors.initials: P
authors.lastname: Saha-Chaudhuri
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Emil L
authors.initials: EL
authors.lastname: Fosbol
authors.affiliation: American Heart Association, Dallas, Texas.
authors.forename: Brian
authors.initials: B
authors.lastname: Eigel
authors.affiliation: Health & Safety Institute, Eugene, Oregon.
authors.forename: Bill
authors.initials: B
authors.lastname: Clendenen
authors.affiliation: Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000193:education*; D003430:Cross-Sectional Studies; D005260:Female; D006266:Health Education / Q000706:statistics & numerical data*; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014481:United States