Unequal bystander CPR after cardiac arrest in the community

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.

  • Bottleneck
  • In this atlas

Overview

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.

Scope

Witnessed non-traumatic out-of-hospital cardiac arrests in US census tracts that had a historical redlining grade, from one study of CARES registry data. The abstract gives no age limits.

Stage
Before help arrives: the minutes after a witnessed cardiac arrest outside hospital
Why it is severe
The abstract's background says bystander CPR is essential for improving outcomes but its use remains limited, particularly among racial and ethnic minorities.

Burden

  • Burden Observational Certainty not assessed

    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.

    Applies to Recipient not specified
    • 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.
    • Out-of-hospital cardiac arrests reported to the CARES registry.
    • United States.
    • 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.
    Certainty method
    Not assessed
    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
    Next evidence check due
    Not scheduled
    Sources and citations (20)
    1. Supports Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (PubMed disclaimer, fetched 2026-10-15 as ck-pubmed-disclaimer.html, hash only). Short factual quotations under 25 words, with the citation. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) for PubMed and other NLM records.
    2. Background Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (PubMed disclaimer, fetched 2026-10-15 as ck-pubmed-disclaimer.html, hash only). Short factual quotations under 25 words, with the citation. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) for PubMed and other NLM records.
    3. Background Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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    4. Background Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (PubMed disclaimer, fetched 2026-10-15 as ck-pubmed-disclaimer.html, hash only). Short factual quotations under 25 words, with the citation. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) for PubMed and other NLM records.
    5. Background Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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    6. Supports Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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    7. Supports Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (PubMed disclaimer, fetched 2026-10-15 as ck-pubmed-disclaimer.html, hash only). Short factual quotations under 25 words, with the citation. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) for PubMed and other NLM records.
    8. Supports Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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    9. Supports Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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    10. Supports Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (PubMed disclaimer, fetched 2026-10-15 as ck-pubmed-disclaimer.html, hash only). Short factual quotations under 25 words, with the citation. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) for PubMed and other NLM records.
    11. Supports Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (PubMed disclaimer, fetched 2026-10-15 as ck-pubmed-disclaimer.html, hash only). Short factual quotations under 25 words, with the citation. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) for PubMed and other NLM records.
    12. Supports Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (PubMed disclaimer, fetched 2026-10-15 as ck-pubmed-disclaimer.html, hash only). Short factual quotations under 25 words, with the citation. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) for PubMed and other NLM records.
    13. Supports Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (PubMed disclaimer, fetched 2026-10-15 as ck-pubmed-disclaimer.html, hash only). Short factual quotations under 25 words, with the citation. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) for PubMed and other NLM records.
    14. Supports Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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    15. Supports Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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    16. Supports Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (PubMed disclaimer, fetched 2026-10-15 as ck-pubmed-disclaimer.html, hash only). Short factual quotations under 25 words, with the citation. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) for PubMed and other NLM records.
    17. Supports Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (PubMed disclaimer, fetched 2026-10-15 as ck-pubmed-disclaimer.html, hash only). Short factual quotations under 25 words, with the citation. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) for PubMed and other NLM records.
    18. Supports Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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      Reuse basis
      PubMed record fetched through NCBI E-utilities. Only the hash of the bytes is kept, because publisher copyright may apply to the abstract (PubMed disclaimer, fetched 2026-10-15 as ck-pubmed-disclaimer.html, hash only). Short factual quotations under 25 words, with the citation. Public text is quote, following Ben's decision of 2026-10-13 (medical-atlas-core issue 2) for PubMed and other NLM records.
    19. Background Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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    20. Background Historical neighborhood redlining and bystander CPR disparities in out-of-hospital cardiac arrest

      Publication · Resuscitation · 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. · Published 2024-06-06 · DOI: 10.1016/j.resuscitation.2024.110264 · PMID: 38851447 · PMCID: PMC12046434

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Current efforts

None stated in this record.

Record details

Record id
cardio:bottleneck-bystander-cpr-gaps
Content hash
ce1b92471d5c5e32e58dc6d16d9ac63374a30dccc78f009a7cd50ebe96a643b3