• HoAndrew Fu WahAFW0000-0003-4338-3876Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.Prehospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore., Priscilla Zi Yin Ting, Jamie Sin Ying Ho, Stephanie Fook-Chong, Nur Shahidah, Pin Pin Pek, Nan Liu, Seth Teoh, Ching-Hui Sia, Daniel Yan Zheng Lim, Shir Lynn Lim, Ting Hway Wong, OngMarcus Eng HockMEHDepartment of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore., and Pan-Asian Resuscitation Outcomes Study Clinical Research Network.
• Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.
• Prehosp Emerg Care. 2023 Jan 1; 27 (2): 205212205-212.

ObjectiveUnderstanding the social determinants of bystander cardiopulmonary resuscitation (CPR) receipt can inform the design of public health interventions to increase bystander CPR. The association of socioeconomic status with bystander CPR is generally poorly understood. We evaluated the relationship between socioeconomic status and bystander CPR in cases of out-of-hospital cardiac arrest (OHCA).MethodsThis was a retrospective cohort study based on the Singapore cohort of the Pan-Asian Resuscitation Outcomes Study registry between 2010 and 2018. We categorized patients into low, medium, and high Singapore Housing Index (SHI) levels-a building-level index of socioeconomic status. The primary outcome was receipt of bystander CPR. The secondary outcomes were prehospital return of spontaneous circulation and survival to discharge.ResultsA total of 12,730 OHCA cases were included, the median age was 71 years, and 58.9% were male. The bystander CPR rate was 56.7%. Compared to patients in the low SHI category, those in the medium and high SHI categories were more likely to receive bystander CPR (medium SHI: adjusted odds ratio [aOR] 1.48, 95% CI 1.30-1.69; high SHI: aOR 1.93, 95% CI 1.67-2.24). High SHI patients had higher survival compared to low SHI patients on unadjusted analysis (OR 1.79, 95% CI 1.08-2.96), but not adjusted analysis (adjusted for age, sex, race, witness status, arrest time, past medical history of cancer, and first arrest rhythm). When comparing high with low SHI, females had larger increases in bystander CPR rates than males.ConclusionsLower building-level socioeconomic status was independently associated with lower rate of bystander CPR, and females were more susceptible to the effect of low socioeconomic status on lower rate of bystander CPR.

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