Socioeconomic Factors Impact Bystander CPR & AED Use

Why Poorer Communities Struggle with Bystander CPR and AED Use

A recent study published in the American Heart Association’s journal Circulation and conducted by researchers at The University of Texas Health Sciences Center at Houston found marked underutilization and low awareness of AEDs and CPR in marginalized communities. These findings further highlight an important, long-standing gap that targeted resuscitation and quality CPR training could help to fill.

Out-of-hospital cardiac arrest (OHCA) is a leading cause of death across the United States. However, large inequalities in OCHA care and survival rates have long been a serious issue for communities of color, as well as poorer communities. So, the team of scientists behind this study sought to formally measure and better understand racial and socioeconomic disparities in OHCA care and outcomes in order to direct outreach efforts to train and equip communities to help fight back against cardiac arrest.

Factors Behind Lower Bystander CPR/AED Rates

The researchers based their analysis on a data sample of over 18,400 out-of-hospital cardiac arrests (OHCA) across a four-year span in various neighborhoods in Texas. Neighborhoods assessed in the study represent more than 9 million Texans (roughly 30% of the state’s population) who are served by 13 EMS agencies in 15 counties.

The outcomes in each neighborhood that the researchers wanted to assess most were: 

• AED use by bystanders,
• bystander CPR rates, and 
• survival to hospital discharge. 

Key Findings

The researchers found that: 

• Black neighborhoods reported lower usage of AEDs than white neighborhoods.
• Bystander CPR rates were similar between white and Black neighborhoods.
• Latinx communities showed lower rates of both AED use and bystander CPR compared to white neighborhoods.
• Low income neighborhoods and higher unemployment rates were associated with lower rates of AED use and timely bystander CPR. 

How Social Determinants Impact Health in Marginalized Communities

Where a person is born, lives, learns, works, plays, worships, and ages all influence wide range of health, functioning, and quality-of-life outcomes and risks. These variables are called social determinants of health. In the last few years, cardiology researchers have begun formally exploring the barriers to heart health that social determinants can create for underserved communities who are marginalized due to race, age, gender, sexuality, class, ability, and other factors. 

Racial Disparities

The Black community generally experiences significantly higher incidences of cardiac arrest than other races. But in majority Black neighborhoods, AED use was at 3.2% compared to 11.2% of witnessed Sudden Cardiac Arrests (SCA) in white neighborhoods. 

Meanwhile, Latinx neighborhoods had a 4.9% rate of AED use. Latinx neighborhoods also had a lower rate of CPR delivery (38%) than that of white neighborhoods (47.5%). The chances of survival to discharge among Latinx victims was also lower (8.6%) than that of white victims (11.2%). 

Socioeconomic Barriers

All neighborhoods in the study have frighteningly low AED use rates. However, at 8.4%, lower income neighborhoods were shown to have lower bystander AED use compared to higher income neighborhoods which had a rate of 11.9%. Neighborhoods with low high school graduation rates used AEDs 6% less often in the face of OCHA than neighborhoods with higher graduation rates did. Finally, bystanders in neighborhoods with higher unemployment rates used an AED to help someone experiencing OCHA 1% less often than bystanders in neighborhoods with lower unemployment rates did. 

Bystander CPR was between 39.7% and 41.1% in poorer, lower graduation and higher unemployment neighborhoods. Meanwhile, bystander CPR rates were between 45.5 and 46.9% in communities on the opposite end of the socioeconomic spectrum. Survival to hospital discharge rates were also .5% lower for lower income neighborhoods compared to those in higher income areas, which were only at 10.5% survival to begin with.

Factors that Limit Bystander CPR and AED Use

This particular study did not investigate reasons for the discrepancies it identified. However, some potential factors include:

• Living in underserved areas. Response time by EMS and the trip to the hospital may be longer for patients of OHCA in certain areas. Research shows that longer EMS response times decrease survival rates and outcomes for OHCA patients. One study indicated that health resources, such as accident and emergency care and fire stations, are less accessible in disadvantaged neighborhoods.
• An uneven distribution of resources. Areas that employ individuals with higher salaries tend to have greater AED access. One could assume that the same holds true for access to AED and CPR training.
• Training access issues. Awareness and access to training among underserved communities lags behind that of wealthier, white communities. This suggests that organizations who offer trainings for CPR and AED use should be targeting underserved communities in culturally competent ways.
• Language barriers. Speaking English also has an effect on communities understanding what an AED is, who can use them, and how. According to the 2020 census, about 22% of US residents use a language other than English as their first language, but currently, AED instructions are predominately only available in English. And most CPR/AED classes are taught in English. This could partially explain higher instances of unfamiliarity, reluctance, or inability to use AEDs among various groups across the country, tragically impacting rates of SCA survival. One study even suggests that 25% of Latinx people in the US have never heard of AEDs. 

The Role of Bystander CPR and AED Use in the Chain of Survival

High-quality CPR and AED use have been identified as two key links in the chain of survival for victims of cardiac arrest. Yet, awareness of AEDs and how to use them has continued to be low across all communities. But the disparities noted in this study are still alarming. 

Sudden Cardiac Arrest is a pervasive issue that affects people of all ages, genders, sexualities, religions, socioeconomic backgrounds, abilities, races, and ethnicities. Considering the breadth and depth of the issue, the disparities in chances of SCA survival identified in this recent study are unacceptable. The scientists call for an increase in outreach, culturally-appropriate training, and AED availability in affected communities. 

Avive: Building a More Equitable Future in Healthcare

Our 4 Minute City™ Program aims to provide better SCA and AED awareness in all communities. In 4 Minute Cities, AED deployment will be driven by data. Our AED placement models will take into account income, gender, and race, ensuring they will be placed where they are needed most. 

We are dedicated to empowering bystanders with the tools and knowledge they need to save someone in their community from SCA. This recent research has helped show organizations like us where and how to direct our efforts.

Learn more about our 4 Minute City initiative in the video below.

Avive Resources for CPR and AED Use

AEDs

• AED State Laws
• AED Comparison Tool
• Learn more about how to use an AED
• AED Placement Best Practices
• AED Pad Placement

CPR

• 10 Reasons Why CPR is Important
• How to do CPR
• Hands-only CPR
• High-quality CPR