Geospatial Analysis for Targeting Out-of-Hospital Cardiac Arrest Intervention

• Published in: American journal of preventive medicine 2013-08, Vol.45 (2), p.137-142
• Main Authors: Raun, Loren H., PhD, Jefferson, Larry S., MD, Persse, David, MD, Ensor, Katherine B., PhD
• Format: Article
• Language: English
• Subjects: Adult; African Americans; Biological and medical sciences; Black American people; Bystanders; Cardiopulmonary Resuscitation - methods; Cardiopulmonary Resuscitation - statistics & numerical data; Censuses; Community based programmes; Emergency Medical Services - statistics & numerical data; Female; Health Planning - organization & administration; Humans; Internal Medicine; Logistic Models; Male; Medical sciences; Miscellaneous; Mortality; Myocardial infarction; Out-of-Hospital Cardiac Arrest - ethnology; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - prevention & control; Outcome Assessment (Health Care); Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Relative risks; Risk Factors; Survival Rate; United States - epidemiology
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2013.03.013

Background Bystander cardiopulmonary resuscitation (BCPR) provides an opportunity for decreasing cardiac mortality. Rates of out-of-hospital cardiac arrest (OHCA) in which resuscitation was performed vary within cities and across demographics. Purpose To identify contiguous geographic census tracts with high OHCA, low BCPR rates and high-risk demographics to effectively target culturally appropriate community-based intervention planning. Methods In 2012, a cohort of 11,389 emergency medical services (EMS) OHCA cases from Houston TX (2004–2011) was linked to census tracts. Multivariable logistic regression analyses were used to identify demographics of contiguous geographic census tracts with the highest OHCA rates. Within these tracts, BCPR rates were evaluated. The combination of information was used to develop a plan to better target interventions. Results Contiguous census tracts of high OHCA rates were identified; the average rate per 100,000 within versus outside the identified tracts is 106.0 (SD 23.7) to 55.8 (SD 19.7). Tracts with a low BCPR rate (37.7%) relative to a high OHCA rate were identified. In a separate analysis, individuals at highest relative risk of OHCA were found to be African Americans, to have low income or education levels, and to be older individuals. For every 1% increase in African Americans in a census tract, there is an increase of 2.7% in the relative risk of the census tract belonging to a high-OHCA-rate region (95% CI=2.0%, 3.5%). Conclusions Geospatial analysis can provide important information on the contiguous areas of high OHCA rates and low BCPR rates with the aim of more effectively targeting interventions and ultimately decreasing cardiac deaths.