Article Text

Socioeconomic factors and outcomes from exercise-related sudden cardiac arrest in high school student-athletes in the USA
  1. Jared Schattenkerk1,
  2. Kristen Kucera2,
  3. Danielle F Peterson3,
  4. Robert A Huggins4,
  5. Jonathan A Drezner5
  1. 1 University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
  2. 2 Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  3. 3 Department of Orthopaedic Surgery, Oregon Health & Science University School of Medicine, Portland, Oregon, USA
  4. 4 Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, Connecticut, USA
  5. 5 Department of Family Medicine, Center for Sports Cardiology, University of Washington, Seattle, Washington, USA
  1. Correspondence to Professor Jonathan A Drezner, University of Washington Department of Family Medicine, Center for Sports Cardiology, Seattle, WA 98195-0005, USA; jdrezner{at}uw.edu

Abstract

Objective Minority student-athletes have a lower survival rate from sudden cardiac arrest (SCA) than non-minority student-athletes. This study examined the relationship between high school indicators of socioeconomic status (SES) and survival in student-athletes with exercise-related SCA.

Methods High school student-athletes in the USA with exercise-related SCA on school campuses were prospectively identified from 1 July 2014 to 30 June 2018 by the National Center for Catastrophic Sports Injury Research. High school indicators of SES included the following: median household and family income, proportion of students on free/reduced lunch and percent minority students. Resuscitation details included witnessed arrest, presence of an athletic trainer, bystander cardiopulmonary resuscitation and use of an on-site automated external defibrillator (AED). The primary outcome was survival to hospital discharge. Differences in survival were analysed using risk ratios (RR) and univariate general log-binomial regression models.

Results Of 111 cases identified (mean age 15.8 years, 88% male, 49% white non-Hispanic), 75 (68%) survived. Minority student-athletes had a lower survival rate compared with white non-Hispanic student-athletes (51.1% vs 75.9%; RR 0.67, 95% CI 0.49 to 0.92). A non-significant monotonic increase in survival was observed with increasing median household or family income and with decreasing percent minority students or proportion on free/reduced lunch. The survival rate was 83% if an athletic trainer was on-site at the time of SCA and 85% if an on-site AED was used.

Conclusions Minority student-athletes with exercise-related SCA on high school campuses have lower survival rates than white non-Hispanic athletes, but this difference is not fully explained by SES markers of the school.

  • resuscitation
  • sports
  • cardiovascular diseases
  • defibrillators

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @rob_huggins_6, @DreznerJon

  • Contributors JS, KLK and JAD were responsible for the conception and design of the study, data acquisition and analysis, and drafting and revision of the manuscript. DFP and RAH were involved with data acquisition and analysis and provided critical revisions to the manuscript. All authors approve the final version and are accountable for all aspects of the work. JAD is the guarantor and responsible for the overall content.

  • Funding Supported by the National Center for Catastrophic Sports Injury Research (University of North Carolina at Chapel Hill), funded in part by the National Collegiate Athletic Association, the National Federation of State High School Associations, the American Football Coaches Association, the National Athletic Trainers’ Association, the National Operating Committee on Standards for Athletic Equipment and the American Medical Society for Sports Medicine. JS also received support from the University of Rochester School of Medicine and Dentistry, Research Training Program for his work on this study.

  • Competing interests JAD is editor-in-chief of BJSM.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.