Incidence studies of sudden cardiac arrest and death in US competitive atheltes, military personnel and the young general population
| Study | Study design and population | Case identification | Denominator | Exertional SCD or all SCD? | SCD or all SCA/D? | Study years | Age range; number of cases | Annual incidence |
|---|---|---|---|---|---|---|---|---|
| Athletes | ||||||||
| Van Camp et al9 | Retrospective cohort; high school and college athletes | National Center for Catastrophic Sports Injury Research and Media Reports | Data from NCAA, NFHS, NAIA and NJCAA, added together with conversion factor (1.9 for high school and 1.2 for college) used to account for multisport athletes ‘based on discussions with representatives from the national organisations’. | Exertional | SCD | 1983–1993 | 13–24; N=160 | College + High School Overall 1:188 000 Male 1:134 000 Female 1:752 000 High school Overall 1:213 000 Male 1:152 000 Female 1:861 000 College Overall 1:94 000 Male 1:69 000 Female 1:356 000 |
| Maron et al10 | Retrospective cohort; Minnesota high school athletes | Catastrophic insurance claims | Minnesota State High School League (estimated using conversion factor of 2.3 to account for multisport athletes) | Exertional only during school sponsored sport | SCD | 1985–1997 | 16–17; N=3 | High school Overall 1:217 000 Male 1:129 000 Female 0 |
| Drezner et al11 | Retrospective survey; college athletes | Survey of NCAA Division I institutions (244/326 responded) | Reported number of athletes | All | SCD | — | N=5 | College Overall 1:67 000 |
| Maron et al12 | Retrospective cohort; amateur and competitive athletes | US Registry for Sudden Death in Athletes | An estimated 10.7 million participants per year ≤39 years of age in all organised amateur and competitive sports | All | SCA+SCD | 1980–2006 | 8–39; N=1046 | All athletes 1:164 000 |
| Drezner et al13 | Cross-sectional survey; high school athletes | Survey of 1710 high schools with AEDs | Reported number of student athletes | All cases occurring on campus | SCA+SCD | 2006–2007 | 14–17; N=14 | High school 1:23 000 (SCA+SCD) 1:64 000 (SCD) |
| Harmon et al14 | Retrospective cohort; college athletes | Parent Heart Watch database, NCAA Resolutions list, catastrophic insurance claims | Participation data from the NCAA | All | SCD | 2004–2008 | 18–26; N=37 | College Overall 1:43 000 Male 1:33 000 Female 1:76 000 Black 1:17 000 White 1:58 000 Male, black 1:13 000 Male, basketball 1:7000 Male, Division I basketball 1:3000 |
| Maron et al15 | Retrospective cohort; Minnesota high school athletes | US Registry for Sudden Death in Athletes | Minnesota State High School League statistics (estimated using conversion factor of 2.3 to account for multisport athletes) | All | SCD | 1986–2011 | 12–18; N=13 | High school Overall 1:150 000 Male 1:83 000 Female 0 |
| Roberts and Stovitz16 | Retrospective cohort; Minnesota high school athletes | Catastrophic insurance claims | Minnesota State High School League statistics (sum of unduplicated athletes 1993–1994 through 2011–2012 school years) | Exertional only during school sponsored sport | SCD | 1993–2012 | 12–19; N=4 | High school 1:417 000 (1993–2012) 1:909 000 (2003–2012) Female 0 |
| Maron et al17 | Retrospective cohort; college athletes | US Registry for Sudden Death in Athletes and NCAA resolutions list | Participation data from the NCAA | All | SCD | 2002–2011 | 17–26; N=64 | College Overall 1:63 000 Male 1:56 000 Female 1:333 000 Black 1:26 000 White 1:143 000 |
| Toresdahl et al18 | Prospective observational; high school students and student athletes | 2149 high schools monitored for SCA events on school campus | Reported number of students and student athletes | All cases occurring on school campus | SCA+SCD | 2009–2011 | 14–18; N=44 | Student non-athlete Overall 1:326 000 Male 1:286 000 Female 1:357 000 Student athlete Overall 1:88 000 Male 1:58 000 Female 1:323 000 |
| Drezner et al19 | Retrospective cohort; Minnesota high school athletes | Public media reports | Minnesota State High School League statistics (sum of unduplicated athletes 2003–2004 through 2011–2012 school years) | All | SCA+SCD | 2003–2012 | 14–18; N=13 | High school Overall 1:71 000 Female 0 Male, basketball 1:21 000 |
| Harmon et al20 | Retrospective cohort; high school athletes from seven states | Public media reports | Participation data from the NFHS | All | SCA+SCD | 2007–2013 | 14–18; N=109 | High school Overall 1:67 000 Male 1:45 000 Female 1:238 000 Male, basketball 1:37 000 |
| Harmon et al21 | Retrospective cohort; college athletes | Parent Heart Watch database, NCAA resolutions list, catastrophic insurance claims | Participation data from the NCAA | All | SCD | 2003–2013 | 17–26; N=79 | College Overall 1:53 000 Male 1:38 000 Female 1:122 000 Black 1:21 000 White 1:68 000 Football 1:36 000 Male, soccer 1:24 000 Male, black 1:16 000 Male, basketball 1:9000 Male, black, basketball 1:5300 Male, Div. I basketball 1:5200 |
| Military | ||||||||
| Eckart et al23 | Retrospective cohort; military recruits | Mandatory reporting of all deaths to the Department of Defense registry with autopsy data | Department of Defense | All | SCD | 1977–2001 | 18–35; N=108 | Military recruits 1:15 000 (cardiac) 1:9000 (cardiac+idiopathic) |
| Eckart et al24 | Retrospective cohort; active military personnel | Mandatory reporting of all deaths to the Department of Defense registry with autopsy data | Department of Defense statistics | All | SCD | 1998–2008 | 18–35; N=298 | Military personnel Male Age <20 1:30 000 20–24 1:41 000 25–29 1:30 000 30–35 1:25 000 Female Age <20 120 000 20–24 1:92 000 25–29 1:161 000 30–35 1:147 000 |
| General population | ||||||||
| Atkins et al26 | Prospective population cohort study | EMS database of out-of-hospital cardiac arrest | Population statistics | All | SCA+SCD | 2005–2007 | 12–19; N=114 | 1:27 000 |
| Chugh et al27 | Prospective population based | Data from EMS, medical examiner and area hospitals | Population statistics from Multnomah County, Oregon | All | SCA+SCD | 2002–2005 | 10–14; N=2 | 1:59 000 |
| Cooper et al28 | Retrospective cohort | Automated data from four health plans | Computerised health records | All | SCA+SCD | 1986–2005 | 2–24; N=33 | 1:78 000 |
| Meyer et al29 | Prospective population based | EMS cardiac arrest database over 30 years | Population statistics from King County, Washington | All | SCA+SCD | 1980–2009 | 14–35; N=305 | Age 14–24 1:69 000 Age 25–35 1:23 000 |
| Farioli et al25 | Retrospective cohort | US Fire Administration and the National Institute for Occupational Safety and Health Fire Fighter Fatality Investigation and Prevention Program | Current population survey of the number of US career firefighters | All | SCD | 1998–2012 | 18–34; N=14 | Age 18–24 1:19 000 Age 25–34 1:26 000 |
| Maron et al30 | Retrospective cohort | Records of the Medical Examiner | Data from the Minnesota Department of Education, National Center for Education Statistics and the Minnesota State High School League for Hennepin County, Minnesota | All | SCD | 2000–2014 | 14–23; N=27 | Non-athlete 1:39 000 Athlete 1:121 000 |
AED, automated external defibrillator; EMS, emergency medical services; NAIA, National Association of Intercollegiate Athletics; NCAA, National Collegiate Athletic Association; NFHS, National Federation of State High School Associations; NJCAA, National Junior College Athletic Association; SCA/D, sudden cardiac arrest and death; SCA, sudden cardiac arrest; SCD, sudden cardiac death.