# Unequal bystander CPR after cardiac arrest in the community Bottleneck · id `cardio:bottleneck-bystander-cpr-gaps` · Cardiovascular Atlas · release `73130c34862e2d06` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Browse, condition area: Acute care and long-term living ## In plain language The authors of one study call bystander CPR essential for improving outcomes after cardiac arrest, but it is not given equally. In US registry data on witnessed cardiac arrests in neighborhoods that had a 1930s mortgage-risk grade, 37.2% of people received bystander CPR, with the rate falling from 41.8% in neighborhoods graded A by a 1930s mortgage-risk map to 35.8% in neighborhoods graded D. After adjustment, the odds of receiving bystander CPR were lower in grade C and D neighborhoods than in grade A. ## Technical summary The burden statement rests on one observational analysis of the CARES registry (PubMed 38851447, abstract only). The abstract's background says bystander CPR is essential for improving outcomes but that its use remains limited, particularly among racial and ethnic minorities; that sentence is background, not a result of the analysis. The analysis does not show that the neighborhood grade caused the difference and reports no survival figures. The authors suggest targeted CPR training in redlined neighborhoods, but the abstract names no program that does this. ## Claims, with the population each applies to ## Context: Witnessed non-traumatic out-of-hospital cardiac arrests in US census tracts with a historical redlining grade (CARES registry study) Recipient: Recipient not specified; Population: Witnessed out-of-hospital cardiac arrests (43,186 cases) in census tracts that the Home Owners' Loan Corporation graded A to D, drawn from 736,066 non-traumatic out-of-hospital cardiac arrests in the CARES registry across the United States.; Care setting: Out-of-hospital cardiac arrests reported to the CARES registry.; Geography: United States.; Life stage: The abstract gives no age limits.; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (registry analysis); the abstract gives no follow-up period. ### A study of data from the Cardiac Arrest Registry to Enhance Survival (CARES), covering 736,066 non-traumatic out-of-hospital cardiac arrests across the United States, looked at 43,186 witnessed arrests in census tracts that carried a Home Owners' Loan Corporation redlining grade (A signifying best, B still desirable, C declining, D hazardous). Of these, 37.2 percent received bystander CPR. Rates of bystander CPR declined across the grades, from 41.8 percent in grade A to 35.8 percent in grade D. In the fully adjusted model, the odds of receiving bystander CPR were significantly lower in grade C (odds ratio 0.89; 95 percent confidence interval 0.81 to 0.98; P=0.016) and grade D (odds ratio 0.86; 95 percent confidence interval 0.78 to 0.95; P=0.002) than in grade A. The authors conclude that redlining is associated with reduced contemporary rates of bystander CPR during out-of-hospital cardiac arrest and that targeted CPR training in redlined neighborhoods may be imperative. - Category: Burden - Evidence stage: Observational - Certainty: Certainty not assessed - Applies to: Recipient: Recipient not specified; Population: Witnessed out-of-hospital cardiac arrests (43,186 cases) in census tracts that the Home Owners' Loan Corporation graded A to D, drawn from 736,066 non-traumatic out-of-hospital cardiac arrests in the CARES registry across the United States.; Care setting: Out-of-hospital cardiac arrests reported to the CARES registry.; Geography: United States.; Life stage: The abstract gives no age limits.; Gestational age: Not reported; Postnatal age: Not reported; Follow-up: Not applicable (registry analysis); the abstract gives no follow-up period. - Limitations: Abstract only; the PMC copy is not in the Open Access subset and the full text was not read. This is an observational association between a 1930s neighborhood grade and CPR provision in witnessed arrests; the abstract does not show that the grade caused the difference and gives no figures for survival. Only arrests in census tracts with a grade were analyzed. The abstract's background says bystander CPR use is limited, particularly among racial and ethnic minorities; that is background and not a finding of this analysis. The abstract does not state an adjusted odds ratio for grade B. - Last checked: 2026-10-15 - Sources: 1. Supports: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: ArticleIdList, pmc. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Statement in the cited record. 2. Background: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, BACKGROUND, sentence 1. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Background stated in the abstract. 3. Background: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, BACKGROUND, sentence 2. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Background stated in the abstract. 4. Background: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, BACKGROUND, sentence 3. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Background stated in the abstract. 5. Background: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, BACKGROUND, sentence 4. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Background stated in the abstract. 6. Supports: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, METHODS, sentence 1, fragment 1 of 2. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Design, population or outcome definition in the abstract. 7. Supports: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, METHODS, sentence 1, fragment 2 of 2. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Design, population or outcome definition in the abstract. 8. Supports: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, METHODS, sentence 2, fragment 1 of 2. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Design, population or outcome definition in the abstract. 9. Supports: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, METHODS, sentence 2, fragment 2 of 2. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Design, population or outcome definition in the abstract. 10. Supports: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, METHODS, sentence 3, fragment 1 of 2. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Design, population or outcome definition in the abstract. 11. Supports: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, METHODS, sentence 3, fragment 2 of 2. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Design, population or outcome definition in the abstract. 12. Supports: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, METHODS, sentence 4. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Design, population or outcome definition in the abstract. 13. Supports: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, RESULTS, sentence 1. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Result stated in the abstract. 14. Supports: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, RESULTS, sentence 2, fragment 1 of 2. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Result stated in the abstract. 15. Supports: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, RESULTS, sentence 2, fragment 2 of 2. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Result stated in the abstract. 16. Supports: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, RESULTS, sentence 3, fragment 1 of 3. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Result stated in the abstract. 17. Supports: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, RESULTS, sentence 3, fragment 2 of 3. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Result stated in the abstract. 18. Supports: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, RESULTS, sentence 3, fragment 3 of 3. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: Result stated in the abstract. 19. Background: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, CONCLUSION, sentence 1. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: The authors' conclusion in the abstract. 20. Background: Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest (Publication, edition PubMed record (abstract and bibliographic data) fetched 2026-10-15 through NCBI E-utilities. The Resuscitation article has a PMC copy (PMC12046434) that PMC does not place in its Open Access subset, so only the PubMed abstract was read.) Locator: Abstract, CONCLUSION, sentence 2. Retrieved 2026-10-15T13:48:59Z. Source state: Current. Snapshot hash: ed527cae7de62c193e36bc1759f84cf5a18790b0411fcbdc3269c5c1e1d722e2. How it applies: The authors' conclusion in the abstract. ## Connected pages - The response that is unequal: Cardiopulmonary resuscitation (CPR) (`cardio:cpr`) - Filed under this front: Emergency and acute care (`cardio:front-emergency-and-acute-care`) - Related to: Deliver AEDs by drone before the ambulance arrives (`cardio:idea-drone-aed-delivery`) - Related to: CARES cardiac arrest registry (`cardio:cares-registry`) ## Provenance Content hash: ce1b92471d5c5e32e58dc6d16d9ac63374a30dccc78f009a7cd50ebe96a643b3 Last substantive edit: 2026-10-15 Evidence last checked: 2026-10-15