b'2021 CARES Annual Report 43 43 In a subsequent analysis, Sasson et al.14 found a direct relationship between the median income and racial composition of a neighborhood and the probability that a person with out-of-hospital cardiac arrest received bystander-initiated CPR. This association was most apparent in low-income black neighborhoods, where the odds of receiving bystander-initiated CPR were approximately 50% lower than in high-income non- Figure 3. Unadjusted rates of survival outcomes by categories of neighborhood race and income. black neighborhoods Figure from Sasson C et al. Association of neighborhood characteristics with bystander-initiated CPR. N Engl J Med. 367(17):1607-15. (Figure 3). Reprinted with permission. Building on this research, Chan et al.15 leveraged CARES data to examine the differences in rates of survival to discharge and favorable neurological outcomes among adults by neighborhood race and income. The analysis revealed similar trends to those described by Sasson et al. - patients with an out-of-hospital cardiac arrest in majority Black neighborhoods were 12% less likely to survive to discharge and 24% less likely to survive without severe neurological disability than those in predominantly White neighborhoods. In addition, rates of survival to discharge and favorable neurological survival were both lower in low- and middle-income neighborhoods as compared with high-income neighborhoods (Figure 4). Disparities in bystander CPR provision were also observed in the pediatric sub-population. Naim et. al16 studied the association between pediatric cardiac arrest victims age, race/ethnicity, and neighborhood racial and socioeconomic factors with outcomes. Bystander CPR was 27% more common in high-income neighborhoods (median household income $50,000) compared with low-income neighborhoods (median household income $50,000), 33% more common in low-unemployment neighborhoods (unemployment 10%) compared with high-unemployment neighborhoods (unemployment 10%), and 50% moreFigure 4. Unadjusted rates of survival outcomes by categories of common in high-education (high school degree 80%)neighborhood race and income. compared with low-education neighborhoods (high schoolFigure from Chan et al. Association of Neighborhood Race and Income With Survival After Out of Hospital Cardiac Arrest. J Am Heart Assoc. 9:e014178.degree 80%). 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. 14Sasson C, Magid DJ, Chan P, Root ED, McNally BF, Kellermann AL, Haukoos JS. Association of neighborhood characteristics with bystander-initiated CPR. N Engl J Med. 367(17):1607-15. 15Chan P, McNally B, Vellano K, Tang Y, Spertus JA. Association of Neighborhood Race and Income With Survival After Out of Hospital Cardiac Arrest. J Am Heart Assoc. 9:e014178.16Naim MY, Burke RV, McNally BF, Song L, Griffis HM, Berg RA, Vellano K, Markenson D, Bradley RN, Rossano JW. Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report From the Cardiac Arrest Registry to Enhance Survival Surveillance Registry. JAMA Pediatr. 171(2):133-141.'