Study Reveals Need to Close Racial Disparity Gap in Bystander CPR For Children

Raina M. Merchant, M.D., M.S.H.P., FAHARaina M. Merchant, M.D., M.S.H.P., FAHA; Associate Professor of Emergency Medicine, University of Pennsylvania

White children in prosperous neighborhoods are more likely to get bystander CPR than black children in socioeconomically disadvantaged neighborhoods, according to data published today in the Journal of the American Heart Association.

Researchers uncovered the disparity by using the Cardiac Arrest Registry to Enhance Survival database to analyze about 7,000 incidents of out-of-hospital cardiac arrest (OHCA) in 2013-17, 61% of which were in infants. Among their findings:
  • Only 48% of all children with OHCA got bystander CPR.
  • White children were more likely than children of other races/ethnicities to receive bystander CPR.
  • Black children in predominantly black and socioeconomically disadvantaged neighborhoods had the lowest rates of bystander CPR.
The researchers also compared outcomes by four neighborhood racial and socioeconomic characteristics: high prevalence of unemployment (>10% unemployment); low income (median household income <$50,000); low education (<80% high school education); and high proportion of black residents (>80%). Based on these measures:
  • White children in neighborhoods with none of these characteristics were nearly twice as likely to receive bystander CPR as black children in neighborhoods with all four characteristics.
  • Black children in neighborhoods with none of the four characteristics were as likely to receive bystander CPR as white children in neighborhoods with three of the characteristics.

These data highlight that predominantly non-white, lower-income and lower education neighborhoods are high-priority areas for CPR training.

Innovative ways to close the gap

Parents, who most commonly perform bystander CPR in children, are typically highly motivated to provide health and safety for their children. So they might be more likely to learn CPR — and help close the racial disparity gap — with innovative methods such as:
  • Communicating information about the disparities in bystander CPR rates, along with resources for CPR training, in consumer-friendly language through social media or within health-related, parent-targeted mobile apps.
  • Training parents before a newborn is released from the hospital or during a routine pediatric office visit (as noted by the study authors).
  • Partnering with home visiting organizations that promote early childhood development by supporting and engaging families, particularly those at risk. These programs are generally accessible and affordable for families and have improved clinical and behavioral health outcomes.
  • Integrating CPR training into early intervention services, which are publicly funded and available in every state to provide free or reduced-cost services for eligible children.

These multi-sector partnerships can help to address social determinants of health and barriers and facilitators to healthy behaviors — and help bridge the disparity gap.