Imagine this scenario: a middle-aged man clutches his chest and falls to the ground in a grocery store parking lot. He's unconscious and seems to be in the throes of cardiac arrest. There are people in the parking lot around him and almost all of them saw him fall.
Will someone give this man cardiopulmonary resuscitation? Well, that may depend on the type of neighborhood he's in.
A new study published Wednesday in the New England Journal of Medicine found that the rate of bystander-initiated CPR varies according to the characteristics of the neighborhood where the cardiac arrest occurred. If the man in the above scenario collapsed in a high-income, non-African-American neighborhood, the odds that someone would give him CPR are higher than if he fell in a low-income or predominantly African-American neighborhood.
Dr. Comilla Sasson is an assistant professor in the department of emergency medicine at the University of Colorado Denver and the study's lead author. She says if a person has a cardiac arrest in a white, higher-income neighborhood, the chance someone will stop and give CPR is roughly 55 percent.
But, "take that person and move that person to the other side of the street to a lower-income neighborhood. Thirty-five percent of people would actually stop and do something. Same person, same cardiac arrest situation ... almost two-fold difference."
To reach their conclusion, Sasson and her team reviewed data on 14,225 cardiac arrests that happened outside of hospitals in 29 different areas around the country between Oct. 1, 2005, and Dec. 31, 2009. Among the records they reviewed, 4,068 patients were given CPR by a bystander, which Sasson defined as "any person who was not part of the 911 response team."
The team classified neighborhoods as being "predominantly white" or "predominantly black" if the neighborhood population was at least 80 percent of either race; neighborhoods without that majority were labeled "integrated." Low-income and high-income neighborhoods were distinguished as having a median household income either above or below $40,000.
"It didn't matter if you were black or white," says Dr. Sasson. "It mattered where the neighborhood was where you had your heart stop."
Why is this happening? Sasson attributes the findings to a lack of education and awareness. She believes most people living in these neighborhoods don't know how to initiate CPR or when it's appropriate to administer it.
"If you think about the way we're currently giving CPR training, it's classes for babysitters, trainers ... and they're expensive," says Sasson.
Focus group data conducted by Sasson's team bear out those concerns. Residents in some Columbus, Ohio, neighborhoods included in the study where there was a negligible rate of bystander-initiated CPR, said there were safety concerns around helping someone who appeared to be unconscious. How did they know if the person had cardiac arrest or was drunk? What if they were faking, hoping to mug the person who stopped to help them? Could a bystander get in trouble, or get sued, if they didn't do CPR well enough?
Sasson says addressing these concerns and teaching people CPR on a community level could go a long way in changing this trend.
"We have to get past a point of documenting racial health disparities and get to the point of fixing them," says Sasson. "It is completely unacceptable at this point not to fix this because it's cheap, it's easy and it doesn't take a lot of resources to do."