Department of Geography and Institute for Behavioral Science, University of Colorado at Boulder, 260 UCB, Boulder, CO 80309, USA.
Resuscitation. 2013 Jun;84(6):752-9. doi: 10.1016/j.resuscitation.2013.01.007. Epub 2013 Jan 11.
Despite evidence to suggest significant spatial variation in out-of-hospital cardiac arrest (OHCA) and bystander cardiopulmonary resuscitation (BCPR) rates, geographic information systems (GIS) and spatial analysis have not been widely used to understand the reasons behind this variation. This study employs spatial statistics to identify the location and extent of clusters of bystander CPR in Houston and Travis County, TX.
Data were extracted from the Cardiac Arrest Registry to Enhance Survival for two U.S. sites - Austin-Travis County EMS and the Houston Fire Department - between October 1, 2006 and December 31, 2009. Hierarchical logistic regression models were used to assess the relationship between income and racial/ethnic composition of a neighborhood and BCPR for OHCA and to adjust expected counts of BCPR for spatial cluster analysis. The spatial scan statistic was used to find the geographic extent of clusters of high and low BCPR.
Results indicate spatial clusters of lower than expected BCPR rates in Houston. Compared to BCPR rates in the rest of the community, there was a circular area of 4.2km radius where BCPR rates were lower than expected (RR=0.62; p<0.0001 and RR=0.55; p=0.037) which persist when adjusted for individual-level patient characteristics (RR=0.34; p=0.027) and neighborhood-level race (RR=0.34; p=0.034) and household income (RR=0.34; p=0.046). We also find a spatial cluster of higher than expected BCPR in Austin. Compared to the rest of the community, there was a 23.8km radius area where BCPR rates were higher than expected (RR=1.75; p=0.07) which disappears after controlling for individual-level characteristics.
A geographically targeted CPR training strategy which is tailored to individual and neighborhood population characteristics may be effective in reducing existing disparities in the provision of bystander CPR for out-of-hospital cardiac arrest.
尽管有证据表明院外心脏骤停（OHCA）和旁观者心肺复苏（BCPR）的发生率存在显著的空间差异，但地理信息系统（GIS）和空间分析尚未广泛用于了解这种差异的原因。本研究采用空间统计学方法，确定了德克萨斯州休斯顿和特拉维斯县旁观者 CPR 的位置和范围。
从 2006 年 10 月 1 日至 2009 年 12 月 31 日，从美国两个地点——奥斯汀-特拉维斯县急救医疗服务和休斯顿消防局的心脏骤停登记处提取数据。使用分层逻辑回归模型评估社区收入和种族/民族构成与 OHCA 中 BCPR 的关系，并调整 BCPR 的预期计数进行空间聚类分析。使用空间扫描统计来发现 BCPR 高低的地理范围聚类。
结果表明，休斯顿的 BCPR 率低于预期的空间聚类。与社区其他地区的 BCPR 率相比，存在一个半径为 4.2 公里的圆形区域，BCPR 率低于预期（RR=0.62；p<0.0001 和 RR=0.55；p=0.037），当调整个体水平的患者特征（RR=0.34；p=0.027）、社区种族（RR=0.34；p=0.034）和家庭收入（RR=0.34；p=0.046）时仍然存在。我们还发现奥斯汀存在 BCPR 率高于预期的空间聚类。与社区其他地区相比，有一个半径为 23.8 公里的区域，BCPR 率高于预期（RR=1.75；p=0.07），在控制个体水平特征后消失。
针对个人和社区人口特征量身定制的地理目标 CPR 培训策略可能有助于减少院外心脏骤停旁观者 CPR 提供方面现有的差异。
