Comilla Sasson, MD, MS; Carla C. Keirns, MD, PhD, MS; Dylan Smith, PhD; Michael Sayre, MD; Michelle Macy, MD, MS; William Meurer, MD; Bryan F. McNally, MD, MPH; Arthur L. Kellermann, MD, MPH; Theodore J. Iwashyna, MD, PhD; CARES (Cardiac Arrest Registry to Enhance Survival) Study Group
Sasson C, Keirns CC, Smith D, Sayre M, Macy M, Meurer W, et al. Small Area Variations in Out-of-Hospital Cardiac Arrest: Does the Neighborhood Matter?. Ann Intern Med. 2010;153:19-22. doi: 10.7326/0003-4819-153-1-201007060-00255
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Published: Ann Intern Med. 2010;153(1):19-22.
The incidence and outcomes of out-of-hospital cardiac arrest vary widely across cities. It is unknown whether similar differences exist at the neighborhood level.
To determine the extent to which neighborhoods have persistently high rates of cardiac arrest but low rates of bystander cardiopulmonary resuscitation (CPR).
Multilevel Poisson regression of 1108 cardiac arrests from 161 census tracts as captured by the Cardiac Arrest Registry to Enhance Survival (CARES).
Fulton County, Georgia, between 1 October 2005 to 30 November 2008.
Incidence of cardiac arrest, by census tract and year and by rates of bystander CPR.
Adjusted rates of cardiac arrest varied across neighborhoods (interquartile range [IQR], 0.57 to 0.73 per 1000 persons; mean, 0.64 per 1000 persons [SD, 0.11]) but were stable from year to year (intraclass correlation, 0.36 [95% CI, 0.26 to 0.50]; P < 0.001). Adjusted bystander CPR rates also varied by census tract (IQR, 19% to 29%; mean, 25% [SD, 10%]).
Analysis was based on data from a single county.
Surveillance data can identify neighborhoods with a persistently high incidence of cardiac arrest and low rates of bystander CPR. These neighborhoods are promising targets for community-based interventions.
Robert Wood Johnson Foundation Clinical Scholars Program, National Institutes of Health, and Centers for Disease Control and Prevention.
The frequency of out-of-hospital cardiac arrest varies greatly across larger geographic areas, such as cities, but we do not know whether the variation also exists across neighborhoods.
In 161 census tracts in Fulton County, Georgia (including Atlanta), during the 3-year period that ended in November 2008, the frequency of cardiac arrest varied from 0.04 to 2.11 per 1000 persons, rates were stable from year to year, and the frequency of bystander cardiopulmonary resuscitation varied from 0% to 100%.
These results are from a single county.
Neighborhoods with more cardiac arrests and fewer bystander cardiopulmonary resuscitations are promising targets for community-based interventions.
Triangles represent higher-gain census tracts. CPR = cardiopulmonary resuscitation.
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