Neighborhoods matter: A population-based study of provision of cardiopulmonary resuscitation
Neighborhoods matter: A population-based study of provision of cardiopulmonary resuscitation
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DOI：
10.1016/s0196-0644(99)80047-x
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发表时间：
1999-10-01
影响因子：
6.2
通讯作者：
Becker, LB
中科院分区：
文献类型：
--
作者：
Iwashyna, TJ;Christakis, NA;Becker, LB
研究目的：不提供心肺复苏（CPR）——旁观者未能为心脏骤停受害者提供心肺复苏——仍然是一个有据可查的与高死亡率相关的公共卫生问题。未能提供心肺复苏的多变量数据有限。考虑到社区对解释许多行为的独立贡献，我们提出了以下问题：社区特征是否会影响不提供 CPR 的可能性？特别是，我们试图确定在提供 CPR 方面最成功的地区的特征。方法：我们对前瞻性收集的 4,379 名心脏骤停患者队列进行了多变量逻辑回归分析，该队列在个人层面上与美国人口普查的邻里数据相关联。这些心脏骤停代表了 1987 年和 1988 年芝加哥市所有的院外心脏骤停。结果：在多变量分析中，居住在心脏骤停更常见的社区的心脏骤停患者接受心肺复苏的可能性明显更高。在种族融合社区被捕的患者最有可能获得心肺复苏，其次是白人为主的社区，而黑人为主的社区的心肺复苏率最低。社会经济地位、老年人数量和社区职业特征似乎都不会影响心肺复苏的提供。在个人层面上，家庭逮捕和中年黑人居民（相对于老年黑人和全白人居民）的逮捕不太可能接受心肺复苏。结论：社区之间不提供心肺复苏的比率存在显着差异；这种变化与邻里特征有关。结合个人和社区数据可以识别与未能提供心肺复苏相关的重要因素。
Study objective: Cardiorespiratory resuscitation (CPR) nonprovision-the failure of bystanders to provide CPR to cardiac arrest victims-remains a well-documented public health problem associated with significant mortality. Multivariate data an failure to provide CPR are limited. Given the established independent contributions of neighborhoods to explaining many behaviors, we asked the following questions: Do neighborhood characteristics affect the likelihood of CPR nonprovision? In particular, we sought to identify the characteristics of areas that have had the most success in providing CPR.Methods: We performed multivariable logistic regression analysis of a prospectively collected cohort of 4,379 cardiac arrests linked at an individual level to neighborhood data from the US Census. These arrests represent all out-of-hospital cardiac arrests in the City of Chicago in 1987 and 1988.Results: In multivariate analysis, patients who had cardiac arrests who lived in neighborhoods where cardiac arrests were more common were significantly more likely to receive CPR. Patients with arrests in racially integrated neighborhoods were most likely to be provided with CPR, followed by those in predominately white neighborhoods, with the lowest rates of CPR provision in predominately black neighborhoods. Neither the socioeconomic status, number of elderly, nor the occupational characteristics of the neighborhood appeared to influence CPR provision. At the individual level, in-home arrests and arrests among middle-aged black residents (relative to older black and all white residents) were less likely to receive CPR.Conclusion: Substantial variation in rates of CPR nonprovision exists between neighborhoods; the variation is associated with neighborhood characteristics. Combining individual and neighborhood data allows identification of important factors associated with the failure to provide CPR.