Purpose of the Study:
The community in which a person sustains an out-of-hospital cardiac arrest (OHCA) influences the likelihood that they will receive bystander CPR (BCPR) and ultimately survive. The aim of this research was to identify high risk communities in England with a high OHCA/low BCPR incidence to enable targeted strategies to be designed and implemented.
Materials and Methods:
Analysis was based on OHCA events that occurred between 2013 and 2015 in England, where resuscitation was commenced or continued by EMS personnel. OHCA location was geocoded where possible; postcode district (POD) was used as proxy for neighbourhood. Neighbourhood-level variables were linked to each geocoded address with the use of 2011 Census data. The associations between individual-level and neighbourhood-level characteristics and BCPR was assessed by hierarchical regression analysis.
Results:
A total of 67,219 cases were included in this analysis. OHCA incidence showed a Poisson distribution in relation to population density (POPD). On average the ethnic composition of the OHCA location was 84.3% white. Incidence increased significantly with deprivation from 7.0% in least deprived areas to 12.3% in most deprived areas. BCPR rate of bystander-witnessed events decreased significantly with POPD from 75.5% (<100/hectare) to 60.9% (>10,000/hectare; p<0.05). There was a significant difference between areas with highest and lowest deprivation (63.0% vs 67.9%; p<0.05). The OR for receiving BCPR for every 1% increase in white ethnic population was 1.007 (95%CI=1.007-1.008), whereas for non-white ethnic groups the OR was 0.993 (0.992-0.993). A total of 56 PODs were identified where the OHCA incidence was >169/100000 and BCPR rate <39%; many included the coastline.
Conclusions:
The most deprived areas of England have a high OHCA incidence and low BCPR rate. We have identified several high risk areas of England, that could be targeted for future initiatives; a special focus should be given to holiday destinations and town/city centres.

Identification of Characteristics of Neighbourhoods with High Incidence of Out-of-Hospital Cardiac Arrest and Low Bystander Cardiopulmonary Resuscitation Rates