Gender, Socioeconomic Status, Race, and Ethnic Disparities in Bystander Cardiopulmonary Resuscitation and Education-A Scoping Review

Audrey L Blewer; Blair L Bigham; Samantha Kaplan; Marina Del Rios; Marion Leary

doi:10.3390/healthcare12040456

Gender, Socioeconomic Status, Race, and Ethnic Disparities in Bystander Cardiopulmonary Resuscitation and Education-A Scoping Review

Healthcare (Basel). 2024 Feb 10;12(4):456. doi: 10.3390/healthcare12040456.

Authors

Audrey L Blewer^{1

2}, Blair L Bigham^{3

4}, Samantha Kaplan⁵, Marina Del Rios⁶, Marion Leary⁷

Affiliations

¹ Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC 27710, USA.
² Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA.
³ Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5R 0A3, Canada.
⁴ Scarborough Health Network Research Institute, Toronto, ON M1P 2T7, Canada.
⁵ Duke University Medical Center Library & Archives, Duke University School of Medicine, Durham, NC 27710, USA.
⁶ Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA.
⁷ School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA.

Abstract

Background: Social determinants are associated with survival from out-of-hospital sudden cardiac arrest (SCA). Because prompt delivery of bystander CPR (B-CPR) doubles survival and B-CPR rates are low, we sought to assess whether gender, socioeconomic status (SES), race, and ethnicity are associated with lower rates of B-CPR and CPR training.

Methods: This scoping review was conducted as part of the continuous evidence evaluation process for the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care as part of the Resuscitation Education Science section. We searched PubMed and excluded citations that were abstracts only, letters or editorials, and pediatric studies.

Results: We reviewed 762 manuscripts and identified 24 as relevant; 4 explored gender disparities; 12 explored SES; 11 explored race and ethnicity; and 3 had overlapping themes, all of which examined B-CPR or CPR training. Females were less likely to receive B-CPR than males in public locations. Observed gender disparities in B-CPR may be associated with individuals fearing accusations of inappropriate touching or injuring female victims. Studies demonstrated that low-SES neighborhoods were associated with lower rates of B-CPR and CPR training. In the US, predominantly Black and Hispanic neighborhoods were associated with lower rates of B-CPR and CPR training. Language barriers were associated with lack of CPR training.

Conclusion: Gender, SES, race, and ethnicity impact receiving B-CPR and obtaining CPR training. The impact of this is that these populations are less likely to receive B-CPR, which decreases their odds of surviving SCA. These health disparities must be addressed. Our work can inform future research, education, and public health initiatives to promote equity in B-CPR knowledge and provision. As an immediate next step, organizations that develop and deliver CPR curricula to potential bystanders should engage affected communities to determine how best to improve training and delivery of B-CPR.

Keywords: bystander cardiopulmonary resuscitation; cardiopulmonary resuscitation education; disparities; ethnicity; gender; race.

Publication types

Review

Grants and funding

This research received no external funding.