This retrospective observational study examined geographic, socioeconomic, and demographic disparities in out-of-hospital cardiac arrest (OHCA) incidence and bystander CPR (BCPR) rates across 2,102 postcode districts in England from 2018–2023, using 165,701 EMS-resuscitated OHCA cases linked to 2021 Census data.
High-risk areas (23.6% of postcode districts, n=499) were more urban, deprived, and ethnically diverse; BCPR rates were lower (71.2% vs 79.1%), shockable rhythm and public access defibrillation rates were also lower. Despite this, ROSC (27.4% vs 26.5%) and survival (8.2% vs 7.9%) were marginally higher in high-risk areas. These disparities remain largely unchanged since 2015.
- Observational registry data limits causal inference. - Geographic patterns are described at the postcode-district level, which may mask finer local variation. - No adjustment for confounders (e.g., EMS response time, arrest aetiology) when comparing high- vs low-risk area outcomes.
Nearly 1 in 4 postcode districts in England remain high-risk for OHCA with low BCPR rates, concentrated in deprived, urban, and ethnically diverse communities — and this gap has not improved since 2015. Targeted, community-specific CPR training programs in these areas should be a public health priority.
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