title: Association of neighborhood characteristics with incidence of out-of-hospital cardiac arrest and rates of bystander-initiated CPR: implications for community-based education intervention.
abstract: OBJECTIVE
  A 10-fold regional variation in survival after out-of-hospital cardiac arrest (OHCA) has been reported in the United States, which partly relates to variability in bystander cardiopulmonary resuscitation (CPR) rates. In order for resources to be focused on areas of greatest need, we conducted a geospatial analysis of variation of CPR rates.
  
  
  METHODS
  Using 2010-2011 data from Durham, Mecklenburg, and Wake counties in North Carolina participating in the Cardiac Arrest Registry to Enhance Survival (CARES) program, we included all patients with OHCA for whom resuscitation was attempted. Geocoded data and logistic regression modeling were used to assess incidence of OHCA and patterns of bystander CPR according to census tracts and factors associated herewith.
  
  
  RESULTS
  In total, 1466 patients were included (median age, 65 years [interquartile range 25]; 63.4% men). Bystander CPR by a layperson was initiated in 37.9% of these patients. High-incidence OHCA areas were characterized partly by higher population densities and higher percentages of black race as well as lower levels of education and income. Low rates of bystander CPR were associated with population composition (percent black: OR, 3.73; 95% CI, 2.00-6.97 per 1% increment in black patients; percent elderly: 3.25; 1.41-7.48 per 1% increment in elderly patients; percent living in poverty: 1.77, 1.16-2.71 per 1% increase in patients living in poverty).
  
  
  CONCLUSIONS
  In 3 counties in North Carolina, areas with low rates of bystander CPR can be identified using geospatial data, and education efforts can be targeted to improve recognition of cardiac arrest and to augment bystander CPR rates.
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA. Electronic address: emil.fosbol@duke.edu.
authors.forename: Emil L
authors.initials: EL
authors.lastname: Fosbøl
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Dupre
authors.affiliation: School of Natural Resources and Environment, University of Michigan, Ann Arbor, MI, USA; Nicholas School of the Environment, Duke University, Durham, NC, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Strauss
authors.affiliation: Mecklenburg Emergency Medical Services Agency, Charlotte, NC, USA.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Swanson
authors.affiliation: Wake County Department of Emergency Medical Services, Raleigh, NC, USA.
authors.forename: Brent
authors.initials: B
authors.lastname: Myers
authors.affiliation: Emory University School of Medicine, Rollins School of Public Health, Atlanta, GA, USA.
authors.forename: Bryan F
authors.initials: BF
authors.lastname: McNally
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Monique L
authors.initials: ML
authors.lastname: Anderson
authors.affiliation: St. Michael's Hospital, University of Toronto, Toronto, Canada.
authors.forename: Akshay
authors.initials: A
authors.lastname: Bagai
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Monk
authors.affiliation: Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: J Lee
authors.initials: JL
authors.lastname: Garvey
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Duke University Health System, Durham, NC, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Bitner
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: James G
authors.initials: JG
authors.lastname: Jollis
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Granger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000193:education* / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D058996:Quality Improvement; D012042:Registries; D012111:Residence Characteristics; D018570:Risk Assessment; D016019:Survival Analysis
keywords: Bystander cardiac pulmonary resuscitation; OHCA; Out-of-hospital cardiac arrest