Abstract 280: Association of Bystander CPR Rates with County-Level Median Household Income in Pennsylvania

Abstract

Background: Each year, >300,000 people suffer from out-of-hospital cardiac arrest (OHCA) in the U.S. Studies have shown that bystander CPR (BCPR) can greatly increase a victim’s chance of survival, yet the frequency of BCPR may vary as a byproduct of various demographic factors. Over 10,000 OHCAs occur in Pennsylvania each year across 67 counties. Objective: We sought to determine the association of bystander CPR rate with county-level median household income, as well as related factors, such as education level, persons below poverty status, and population density. Methods: Data were obtained from the Cardiac Arrest Registry to Enhance Survival (CARES) for Pennsylvania from 1/2012-12/2013 to determine rate of BCPR and return of spontaneous circulation (ROSC) by county. Demographic information regarding education level, median household income and population density were obtained from 2010 U.S. Census data. Counties were grouped into quartiles by lowest to highest rates of BCPR. Results from the lowest-performing were compared to the highest-performing quartile, with statistical analysis using STATA v11 (StataCorp, College Station, Texas). Results: A total of 7137 cases were included distributed across 47 counties. Mean age of patients was 63.7 years, 40.1% were female, and VF/VT was the initial rhythm in 19.7%. Median BCPR rate for the lowest-performing quartile was 7% (IQR 0%-26.5%). Median BCPR rate for the highest-performing quartile was 50.4% (IQR 46.95%-56%). Median ROSC rate for the lowest-performing quartile was 1.5% (IQR 0%-20%). Median ROSC rate for the highest-performing quartile was 23.3% (IQR 20.8%-33.3%). Median household income in the lowest-performing quartile was significantly lower than in the highest-performing quartile ($43611 ± $5038 v $50225 ± $6661, p = 0.023). Education level, persons below poverty status, and population density were not shown to have a significant association with BCPR rate. BCPR rate was positively associated with ROSC rate (p=0.001). Conclusions: BCPR rates are significantly higher in counties with higher median household income. Higher BCPR rates are associated with higher rates of ROSC. These findings have important implications for statewide public health efforts to improve arrest survival.