Clinical paperImpact of neighbourhood socio-economic status on bystander cardiopulmonary resuscitation in Paris☆
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.
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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.