Elsevier

Resuscitation

Volume 110, January 2017, Pages 107-113
Resuscitation

Clinical paper
Impact of neighbourhood socio-economic status on bystander cardiopulmonary resuscitation in Paris

https://doi.org/10.1016/j.resuscitation.2016.10.028Get rights and content

Abstract

Background

No European data currently describe the relation between neighbourhood socio-economic status (SES) and rates of out-of-hospital cardiac arrest (OHCA) bystander cardiopulmonary resuscitation (CPR). This study aims to analyse this effect with a robust deprivation index.

Methods

Data about all OHCA in Paris were collected prospectively between 2000 and 2010. A geographical neighbourhood unit was assigned to each case. Median household income, and rates of blue-collar workers, unemployment, and adults without high school diplomas were selected as SES characteristics and used to classify neighbourhoods as low SES or higher SES. We analysed the relationship between neighbourhood SES characteristics and the probability of receiving bystander CPR.

Results

Of the 4009 OHCA with mappable addresses recorded, 777 (19.4%) received bystander CPR. Compared to OHCA who did not receive bystander CPR, those receiving CPR were significantly more likely to have occurred in public locations, have had a witness to their OHCA, and not to have collapsed in a low SES neighbourhood, or in a neighbourhood with a median household income in the lowest quartile and with rates of no high school diplomas and blue-collar workers in the highest quartile. In the multilevel analyses, bystander CPR provision was significantly less frequent in low than in higher SES neighbourhoods (OR 0.85; 95% confidence interval [CI] 0.72–0.99).

Conclusion

In the city of Paris, OHCA victims were less likely to receive bystander CPR in low SES neighbourhoods. These first European data are consistent with observations in North America and Asia.

Introduction

Out-of-hospital cardiac arrest (OHCA), with a global survival rate around 7%, is a major public health concern.1 Early bystander cardiopulmonary resuscitation (CPR) is associated with higher survival rates for OHCA victims.2, 3 Despite major efforts over the past decade in research, public information campaigns, financial investment, and new regulations to encourage bystander CPR initiation and early defibrillation, bystander CPR rates remain low in many communities.2, 4, 5, 6

Socio-economic status (SES) is a well-known determinant of health outcomes, coronary disease incidence, and mortality.7, 8, 9 Recent studies in North America and Asia report lower bystander CPR rates in deprived areas. These studies defined deprivation by various criteria, including household income, racial and ethnic composition, and real estate prices.10, 11, 12, 13, 14 Nonetheless, a robust deprivation index that reflects various dimensions of SES (occupation, income, and education level) is required to confirm that people with OHCA in deprived areas are less likely to receive bystander CPR.9, 15 Moreover, no European data describe the effect of neighbourhood SES on this type of bystander CPR.

The city of Paris provides an excellent setting for testing this hypothesis because of its wide socio-economic disparities.16 This study was therefore conducted in Paris and sought to determine the relation between low SES neighbourhood and bystander CPR initiation rates.

Section snippets

Study setting

We analysed data from a prospective registry of all OHCA attended by emergency medical services (EMS) personnel in Paris, France between January 2000 and July 2010. Detailed information about this registry has been previously reported.17 The city of Paris is densely populated with 2,275,000 inhabitants, and the EMS is a two-tiered response system: a basic life support tier provided by firefighters of the Brigade de Sapeurs Pompiers de Paris, who can apply automated external defibrillation

OHCA characteristics according to bystander CPR status

During the study period, 8234 OHCA occurred in Paris; 5296 were considered for resuscitation, and 4176 OHCA were presumed to have a cardiac cause. The global incidence of cardiac arrest was 36 cases per 100,000 population per year. Complete addresses and bystander CPR status were available for 4009 OHCA that were finally geocoded and included in this analysis (Fig. 1): 777 (19.4%) received bystander CPR in the field.

Table 1 reports OHCA characteristics according to bystander CPR. Bivariate

Discussion

Our results demonstrate for the first time an association between neighbourhood SES and bystander CPR in Paris, a major urban area in Europe. Individuals with OHCA were less likely to receive bystander CPR in low SES neighbourhoods, even after adjustment for differences in OHCA characteristics. These results are consistent with those from studies in North America, Taiwan, Singapore, and Korea.10, 11, 12, 13, 14, 21, 25

We used various socio-economic variables known to reflect different

Conclusion

In Paris, people collapsing with Out-of-hospital cardiac arrest are less likely to receive bystander cardiopulmonary resuscitation in low socio-economic status neighbourhoods. Further analyses are needed to understand the determinants of these disparities. Specific public health strategies for cardiopulmonary resuscitation training in the most vulnerable communities should be implemented.

Conflict of interest statement

None declared.

Funding

This work was supported by the French Institute of Health and Medical Research, French Society of Cardiology. The funding source had no role in the design and conduct of the study; data collection, analysis, and interpretation; preparation, review, and approval of the manuscript; or the decision to submit the paper for publication.

Ethical approval

This prospective study was conducted according to the Declaration of Helsinki, after IRB (Committee for the Protection of Human Subjects in Biomedical Research and French data protection committee) approval.

Acknowledgments

The authors would like to thank Vincent Lanoe, Caroline Barnes, Aurelien Bidot, Antoine Labouze, and Guillaume Prang for their valuable help during the study.

References (40)

  • A.J. Sayegh et al.

    Does race or socioeconomic status predict adverse outcome after out of hospital cardiac arrest: a multi-center study

    Resuscitation

    (1999)
  • T.J. Iwashyna et al.

    Neighborhoods matter: a population-based study of provision of cardiopulmonary resuscitation

    Ann Emerg Med

    (1999)
  • S. Moon et al.

    Disparities in bystander CPR provision and survival from out-of-hospital cardiac arrest according to neighborhood ethnicity

    Am J Emerg Med

    (2014)
  • R.W.M. Pijls et al.

    A text message alert system for trained volunteers improves out-of-hospital cardiac arrest survival

    Resuscitation

    (2016)
  • N. Kuramoto et al.

    Public perception of and willingness to perform bystander CPR in Japan

    Resuscitation

    (2008)
  • W. Bougouin et al.

    Characteristics and prognosis of sudden cardiac death in Greater Paris

    Intensive Care Med

    (2014)
  • I. Hasselqvist-Ax et al.

    Early cardiopulmonary resuscitation in out-of-hospital cardiac arrest

    N Engl J Med

    (2015)
  • C. Malta Hansen et al.

    Association of bystander and first-responder intervention with survival after out-of-hospital cardiac arrest in North Carolina, 2010–2013

    JAMA

    (2015)
  • G.T.E. Nichol

    Regional variation in out-of-hospital cardiac arrest incidence and outcome

    JAMA

    (2008)
  • C. Sasson et al.

    Predictors of survival from out-of-hospital cardiac arrest a systematic review and meta-analysis

    Circ Cardiovasc Qual Outcomes

    (2010)
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    A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2016.10.028.

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