Socioeconomic disparities in the knowledge of basic life support techniques

Objectives: Substantial disparities exist in health measures between different socioeconomic groups, including mortality. We hypothesized that a difference in knowledge of life-saving basic life support (BLS) techniques between groups may also contribute.

Methods: A 34-question survey was administered to a convenience sample of patients 18 and older presenting to an urban ED in Boston. Patients who were intoxicated, prisoners, critically or mentally ill, had an insurmountable language barrier or victims of abuse were excluded. Trained research assistants collected the data. An inactivated automated external defibrillator (AED) device was utilized to test identification of the device and its correct usage.

Results: 440 patients were considered for inclusion. 163 patients met exclusion criteria, leaving 277 eligible patients. 59 patients refused, and 218 patients (78.7%) completed the survey instrument. Overall, 144 (66.7% (95% CI 60.1-72.6%)) felt confident recognizing the signs of a heart attack. 93 (42.9% (95% CI 36.5-49.5%)) recognized that heart attack symptoms were different in men and women. 112 (51.3% (95% CI 44.8-57.9%)) were trained to do CPR. Patients were more likely to be trained in CPR if English is their first language (OR 2.25 (1.18-4.28) p=0.012) or if they earned >$40,000 per year (OR 2.15 (1.17-3.95) p=0.013). Recognition of the AED was more common in those who completed college (OR 2.70 (1.52-4.78) p=0.0005), were white (OR 1.78 (1.03-3.08) p=0.036), had English as the 1st language (OR 3.33 (1.63-6.81) p=0.0005), earned >$40,000 per year (OR 3.21 (1.70-6.06) p=0.0002) or had private insurance (OR 2.32 (1.33-4.04) p=0.003). Demonstration of correct usage of the AED was more common in patients who completed college (OR 1.91 (1.09-3.32) p=0.022) and had private insurance (OR 2.19 (1.26-3.82) p=0.005). No differences were detected between the genders, age > or < than 50, or patients who have a PCP.

Conclusions: Multiple socioeconomic disparities exist in the knowledge of BLS techniques. This study describes these disparities, and presents an opportunity to target education and potentially reduce mortality for these specific groups.