Response to Letter Regarding Article, “Sudden Deaths in Young Competitive Athletes: Analysis of 1866 Deaths in the United States, 1980–2006”
We appreciate the comments of Corrado et al with respect to our 27-year registry,1 which provides absolute numbers for sudden deaths occurring in young US athletes. The authors are correct in asserting (as we have) that there are limitations in collecting data for such registries—ie, it is not possible to identify each sudden death occurring in young athletes in the United States without mandated national reporting (which, in fact, does not exist in any country). However, on the basis of the intensive methods used to identify and track these deaths, we have every reason to believe that our data over the past several years represent a reasonable estimate of this low–event rate phenomenon.
That these sudden deaths are unquestionably (and fortunately) rare, relative to the number of participants, is substantiated in a variety of athletic events, including the marathon, and in high school and college sports.2–4 Our Minnesota data for high school athletes place the risk of sudden death at 1:217,000 per year.4 To argue, as Corrado et al have, that sudden deaths in young athletes are somehow common is inconsistent with virtually all available data, with the exception of the extraordinarily high sudden death rate in 1979–1981 in the Veneto region of Italy (>4 deaths/100,000 per year).5 Notably, Veneto is a unique geographic area (only 9% of the Italian population) in which the most common cause of sudden death in young athletes has been arrhythmogenic right ventricular cardiomyopathy.
The reason that the Italian model for mass screening of athletes (with routine electrocardiograms) is not likely to be exported to the United States is not necessarily the low event rate, nor even cost, but rather that a national mandatory screening strategy (preferentially offered to athletes) would be impractical and unrealistic with respect to our current healthcare system and practice patterns.
Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation. 2009; 119: 1085–1092.
Redelmeier DA, Greenwald JA. Competing risks of mortality with marathons: retrospective analysis. BMJ. 2007; 335: 1275–1277.