Black and Hispanic people less likely to receive CPR from bystanders

  • A new study shows that Black and Hispanic individuals are less likely than their white counterparts to receive cardiopulmonary resuscitation (CPR) from a bystander after having a cardiac arrest at home or in a public place.
  • These differences may partly explain lower survival rates in Black and Hispanic individuals who have a cardiac arrest in out-of-hospital settings.
  • The disparities, the study found, were not influenced by the racial composition of neighborhoods, suggesting that increasing CPR training in Black and Hispanic communities may not be adequate to address the problem.

Black and Hispanic individuals are less likely than white individuals to receive CPR from a bystander upon experiencing a cardiac arrest outside a hospital, a recent study analyzing nationwide data suggests.

Moreover, the study found a lower number of bystanders administered CPR to Black and Hispanic individuals in both predominantly white neighborhoods and Black/Hispanic majority and integrated communities.

The study’s lead author Dr. Paul Chan, professor of medicine at the University of Missouri, told Medical News Today:

“These findings raise questions about whether simply increasing CPR training in Black and Hispanic communities is sufficient, as Black and Hispanic individuals with a cardiac arrest in Black/Hispanic communities were still less likely to receive potentially life-saving CPR than white individuals in these communities.”

The study will be presented at the upcoming American College of Cardiology conference.

Bystander CPR and survival rates

A cardiac arrest occurs when the heart suddenly stops beating, resulting in the disruption of blood supply to the body.

According to an American Heart Association report in 2019, almost 1,000 individuals experienced a cardiac arrest outside of a hospital each day in the United States. Moreover, the survival rate for individuals who experience an out-of-hospital cardiac arrest (OHCA) is less than 10%.

Immediately receiving CPR from a bystander before emergency medical services (EMS) personnel arrives can increase the likelihood of survival by 2-3 times.

Previous studies (1, 2) have shown that Black and Hispanic individuals have worse survival outcomes after an OHCA than white individuals.

Racial differences in the rates of CPR by a bystander or onlooker could potentially contribute to these differences in survival outcomes after OHCA.

The present study aimed to compare the bystander CPR rates in Black and Hispanic individuals with their white counterparts.

Racial disparities in bystander CPR

In the present study, the researchers used data from a large national registry, the Cardiac Arrest Registry Enhancing Survival (CARES). The CARES registry contains nationwide data on out-of-hospital cardiac arrests, including where the event occurred, patient outcomes, and demographic data.

Via CARES, the researchers obtained data on over 110,000 OHCAs witnessed by a bystander.

The researchers found that Black and Hispanic individuals were 26% less likely to receive CPR from a bystander than white individuals when the OHCA occurred at home.

Similarly, when the witnessed OHCA occurred in a public place, Black and Hispanic individuals had a 41% lower likelihood of receiving CPR from a bystander than their white counterparts.

Neighborhood characteristics

The researchers also examined whether the neighborhood’s racial composition where the cardiac event occurred influenced the bystander CPR rates among different racial groups.

They found that Black and Hispanic individuals were less likely to receive CPR from a bystander than white individuals at home or in public, regardless of the neighborhoods being predominantly white, Black/Hispanic, or integrated.

Previous studies suggest that individuals who experience a cardiac arrest in a high-income neighborhood are more likely to receive bystander CPR. However, neighborhood income levels did not influence the racial disparities in the bystander CPR rates in the present study.

Potential reasons for disparities

Although the researchers did not investigate the reasons behind these racial disparities, they think the differences in CPR training rates and racial bias may underlie these differences.

For instance, lower rates of CPR training among Black and Hispanic communities due to constraints of cost and time and difficulties accessing training locations could partly explain these results.

Language barriers and fear of police may also deter bystanders belonging to racially minoritized groups from making a 911 call and performing dispatcher-assisted CPR.

Implicit or explicit bias could also explain the lower bystander CPR rates in Black and Hispanic individuals.

“Organizations [that] conduct CPR training to the lay public (American Heart Association and American Red Cross) will first need to make CPR training more accessible to low-income and non-white communities. This includes waiving training fees and conducting training in non-traditional settings (e.g., Black churches, Hispanic community centers),” said Dr. Chan.

“Second, dispatcher-assisted CPR when 9-1-1 is called should be made universally available, particularly in poor and non-white communities where bystander CPR rates are lowest,” he continued.

“Third, we need to diversify mannequins and individuals portrayed in media and training materials of CPR. Many of these use white mannequins or white bystanders in their photos, and we need to diversify the representation of these to ensure that the importance of bystander CPR reaches people who are not white,” he added.

The researchers noted that despite these disparities, their results show that rates of bystander CPR across all racial groups remain low.

“We still have a long way to go in getting the message out that people need to start CPR and not just call 911,” Dr. Chan said.

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