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Sudden death risk in older athletes: increasing the denominator
  1. D S Tunstall Pedoe
  1. Correspondence to:
 Dr Tunstall Pedoe
 Cardiac Department, St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, UK;

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Excluding the older athlete should be a last resort

Publicity and campaigning surrounding the tragedy of sudden death in young athletes (incidence 1 in 200 000 young athletes per year)1 has rather overshadowed the mortality risk of older competitors aged >30.

Population studies show that death rates during sports participation increase dramatically with age2 as the incidence of coronary heart disease increases. Is this just coincidental, or is the sport triggering the deaths? The highest overall mortality (numbers dying—“the numerator”) is in recreational sports favoured by the middle aged and elderly, such as fishing and lawn bowls. This is because of the large numbers of participants and their lengthy exposure (time spent participating in the sport) (“the denominator”) in assessing comparative risk. The latter will vary with different populations of participants.

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Lack of information about the denominator means that in most sports and recreational activity the exposure risk cannot be calculated and so compared. Collecting the death statistics without the denominator is almost meaningless, and can lead to illogical deductions, for instance that recreational fishing is more dangerous than hang gliding.

“His death had seriously held up play, and the ambulance had damaged the grass.”

Many sports have their share of older coronary prone participants. I recall visiting a golf club many years ago the day after a sudden coronary death on the 12th fairway. Members felt that it was very inconsiderate …

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