Small area variations in out-of-hospital cardiac arrest: Does the neighborhood matter?

Comilla Sasson*, Carla C. Keirns, Dylan Smith, Michael Sayre, Michelle Lea Macy, William Meurer, Bryan F. McNally, Arthur L. Kellermann, Theodore J. Iwashyna

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

72 Scopus citations


Background: 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. Objective: To determine the extent to which neighborhoods have persistently high rates of cardiac arrest but low rates of bystander cardiopulmonary resuscitation (CPR). Design: Multilevel Poisson regression of 1108 cardiac arrests from 161 census tracts as captured by the Cardiac Arrest Registry to Enhance Survival (CARES). Setting: Fulton County, Georgia, between 1 October 2005 to 30 November 2008. Measurements: Incidence of cardiac arrest, by census tract and year and by rates of bystander CPR. Results: 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%]). Limitation: Analysis was based on data from a single county. Conclusion: 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. Primary Funding Source: Robert Wood Johnson Foundation Clinical Scholars Program, National Institutes of Health, and Centers for Disease Control and Prevention.

Original languageEnglish (US)
Pages (from-to)19-22
Number of pages4
JournalAnnals of internal medicine
Issue number1
StatePublished - Jul 6 2010

ASJC Scopus subject areas

  • Internal Medicine


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