Black children, as well as Hispanic kids and other ethnic minorities, are less likely to receive bystander CPR during an out-of-hospital cardiac arrest (OHCA) than their white counterparts, according to a Journal of the American Heart Association study published July 10. Disparities were especially severe for those living in socioeconomically disadvantaged neighborhoods.
The rate of pediatric OHCA survival is poor in the U.S., first author Maryam Y. Naim, MD, and colleagues wrote in JAHA, with just 1 in 10 children making it to hospital discharge. A recent analysis of the CARES (Cardiac Arrest Registry to Enhance Survival) database suggested bystander CPR (BCPR) increases those kids’ odds of survival, but the same study revealed some racial and ethnic disparities in pediatric BCPR.
“White children were much more likely to receive BCPR compared with black and Hispanic children, and black children were less likely to have neurologically favorable survival compared with white children,” Naim, a pediatric cardiac intensive care physician at the Children’s Hospital of Philadelphia, et al. wrote. “A similar racial and ethnic disparity in BCPR and outcome in OHCA has been observed in adult studies. However, there is ongoing controversy whether this disparity exists at all, is on the basis of race alone, or associated with socioeconomic or neighborhood characteristics.”
Naim and her team drew from the CARES registry to identify 7,086 pediatric non-traumatic OHCAs that occurred between 2013 and 2017, 60% of which took place in boys and 61% of which were in infants. Around 31% of victims were white, 31% were black, 10.5% were Hispanic and 3% were of another ethnicity.
The researchers found that of the thousands of OHCAs they considered, 3,399 children—48% of the study group—received CPR from a bystander. Compared to white children, black kids were 41% less likely to receive BCPR, Hispanic kids were 22% less likely to receive BCPR and other ethnic groups were 6% less likely to receive BCPR.
The authors noted a strong connection between BCPR rates and certain demographics. Black children living in majority black neighborhoods with high unemployment, low rates of education and low median incomes were almost half as likely as white kids to receive bystander CPR (59.6% in white children vs. 32.1% in black children).
“These data suggest a need for focused intervention in low-income, non-white, low-education neighborhoods where a public health strategy, such as targeted CPR training, can be undertaken to enhance BCPR provision and improve outcomes in pediatric OHCA,” Naim et al. wrote.
The authors said parents and family members are the most common administrators of BCPR in pediatric cases, “and are in general highly interested in improving the health of their children.” That means they’re also good targets for public health interventions like CPR training.
“Using data from these neighborhoods, based on their race/ethnicity characteristics, may facilitate improved design and implementation of CPR programs,” Naim and colleagues said. “Engaging such communities with the help of community leaders, development of free BCPR education programs and programs in Spanish will likely improve BCPR rates.”