Health inequalities in out-of-hospital cardiac arrest incidence and bystander cardiopulmonary resuscitation rates in England 2018–23

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BACKGROUND: Out-of-hospital cardiac arrest (OHCA) outcomes vary due to various circumstances, including socioeconomic, geographic, and demographic disparities. Previous research identified high-risk areas in England determined by high OHCA incidence and low bystander cardiopulmonary resuscitation (BCPR) rates. This study updates the identification of these areas to continue to inform future public health interventions. METHODS: This is a retrospective analysis of observational data collected by the OHCA Outcomes registry; geocoded case locations linked to 2021 Census data. High-risk areas were identified as high incidence of EMS-resuscitated OHCAs and low BCPR rates. Return of spontaneous circulation (ROSC) and survival rates were also explored. Descriptive statistics compared case/neighbourhood characteristics of low/high-risk areas; temporal changes were assessed using the Wilcoxon signed-rank test. Spatial patterns were visualised using choropleth maps. RESULTS: Between 2018 and 2023, 165,701 OHCA patients were mapped to 2102 postcode districts. High-risk areas (N = 499) were more urban, deprived, and ethnically diverse, with lower shockable rhythm and public access defibrillation rates. About 71.2% of OHCAs received BCPR in high-risk areas (low-risk areas: 79.1%). However, ROSC (27.4% vs 26.5%) and survival (8.2% vs 7.9%) rates were slightly higher. Around 23.6% of postcode districts remain high-risk, although the geographic patterns have slightly shifted since 2013-2015. DISCUSSION/CONCLUSION: This analysis highlights persistent geographic and socioeconomic disparities in OHCA incidence, BCPR rates and survival across England that remain unchanged since 2015. Identifying local patterns in BCPR and understanding community-specific characteristics can guide more effective, equitable CPR training. Targeted, community-based interventions-especially in high-risk areas-are needed to reduce mortality.

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