Public Release: 

Poorer, rural counties have lower CPR training rates

The JAMA Network Journals

Cardiopulmonary resuscitation (CPR) training appears to be lower in more rural counties, those with higher proportions of black and Hispanic residents and lower household incomes, and in the South, Midwest and West, according to a study by Monique L. Anderson, M.D., of the Duke Clinical Research Institute, Durham, N.C. and colleagues.

Prompt bystander CPR improves the likelihood of surviving an out-of-hospital cardiac arrest (OCHA), and there are large regional variations in survival after them, according to the study background. Low training rates in counties may account for more infrequent use of bystander CPR.

Researchers analyzed CPR training in 3,143 counties with 13.1 million people in the U.S., using data from the American Heart Association (AHA), the American Red Cross (ARC), and the Health & Safety Institute (HSI). Researchers looked at the association between annual rates of CPR training completion and a county's geographic, population and health care characteristics.

According to study results, counties with the lowest rates of CPR training (less than 1.29 percent) were more likely to have a higher proportion of rural areas, black and Hispanic residents, a lower median household income, a higher median age, and fewer physicians. Counties in the South, Midwest and West were also more likely to have lower rates of CPR training than those in the Northeast.

"Future research should be directed toward understanding whether targeted and intensive CPR training will narrow existing disparities in rates of bystander CPR and OHCA survival in these vulnerable communities," the authors conclude. "With regard to rural areas, more studies are needed on interventions that target the entire chain of survival."


(JAMA Intern Med. Published online November 18, 2013. doi:10.1001/jamainternmed.2013.11320. Available pre-embargo to the media at

Editor's Note: Authors made conflict of interest disclosures. This study was funded by an award from the AHA-Pharmaceutical Roundtable (PRT) and by David and Stevie Spina. Please see article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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