title: Regions of High Out-Of-Hospital Cardiac Arrest Incidence and Low Bystander CPR Rates in Victoria, Australia.
abstract: BACKGROUND
  Out-of-hospital cardiac arrest (OHCA) remains a major public health issue and research has shown that large regional variation in outcomes exists. Of the interventions associated with survival, the provision of bystander CPR is one of the most important modifiable factors. The aim of this study is to identify census areas with high incidence of OHCA and low rates of bystander CPR in Victoria, Australia.
  
  
  METHODS
  We conducted an observational study using prospectively collected population-based OHCA data from the state of Victoria in Australia. Using ArcGIS (ArcMap 10.0), we linked the location of the arrest using the dispatch coordinates (longitude and latitude) to Victorian Local Government Areas (LGAs). We used Bayesian hierarchical models with random effects on each LGA to provide shrunken estimates of the rates of bystander CPR and the incidence rates.
  
  
  RESULTS
  Over the study period there were 31,019 adult OHCA attended, of which 21,436 (69.1%) cases were of presumed cardiac etiology. Significant variation in the incidence of OHCA among LGAs was observed. There was a 3 fold difference in the incidence rate between the lowest and highest LGAs, ranging from 38.5 to 115.1 cases per 100,000 person-years. The overall rate of bystander CPR for bystander witnessed OHCAs was 62.4%, with the rate increasing from 56.4% in 2008-2010 to 68.6% in 2010-2013. There was a 25.1% absolute difference in bystander CPR rates between the highest and lowest LGAs.
  
  
  CONCLUSIONS
  Significant regional variation in OHCA incidence and bystander CPR rates exists throughout Victoria. Regions with high incidence and low bystander CPR participation can be identified and would make suitable targets for interventions to improve CPR participation rates.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Lahn D
authors.initials: LD
authors.lastname: Straney
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Faculty of Health Science, Curtin University, Perth, Western Australia, Australia.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Bray
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Ben
authors.initials: B
authors.lastname: Beck
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Faculty of Health Science, Curtin University, Perth, Western Australia, Australia; St John Ambulance Western Australia, Perth, Western Australia, Australia.
authors.forename: Judith
authors.initials: J
authors.lastname: Finn
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Intensive Care Unit, The Alfred Hospital Melbourne, Victoria, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Bernard
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia.
authors.forename: Kylie
authors.initials: K
authors.lastname: Dyson
authors.affiliation: Ambulance Victoria, Melbourne, Victoria, Australia.
authors.forename: Marijana
authors.initials: M
authors.lastname: Lijovic
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
mesh_terms: D001315:Australia / Q000453:epidemiology; D001499:Bayes Theorem; D016887:Cardiopulmonary Resuscitation; D016208:Databases, Factual; D004632:Emergency Medical Services; D006801:Humans; D015994:Incidence; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology*; D011446:Prospective Studies; D012042:Registries