Cardiovascular mortality in Dutch men during 1996 European football championship: longitudinal population study
BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7276.1552 (Published 23 December 2000) Cite this as: BMJ 2000;321:1552
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Editor - Witte et al. found a significant increase in mortality from
coronary heart disease and stroke in a population of Dutch men aged 45
years or over on the day the Dutch team was eliminated by the French one
from the 1996 European football championship, compared to the five days
before and after the match (relative risk 1.51, 95% confidence interval
1.08 to 2.09) [1]. We reassessed this hypothesis using corresponding
French data.
This match had an audience of 4.7 million television viewers in France,
i.e. around 8 percent of the French population (Source: Médiamat-
Médiametrie. Base: ensemble individus âgés de 4 ans et plus). We performed
the same time-series analysis as Witte et al. on French mortality data
(Source: Service Commun N°8, INSERM) for the periods and personal
characteristics corresponding to the Dutch data, the cause of death being
classified according to ICD9 (410; 430-434;436-438).
We found that on the day of the match, mortality from all causes did not
increase among French men (601 vs. 640.6 cases; relative risk 0.94, 0.88
to 1.00) or women (566 vs. 606.2 cases; relative risk 0.93, 0.82 to 1.08)
compared to the five days before and after the match. In particular,
during the same period, mortality from myocardial infarction or stroke did
not increase in men (61 vs. 82.8 cases; relative risk 0.74, 0.58 to 1.02)
or women (83 vs. 86.6 cases; relative risk 0.96, 0.80 to 1.21). On the day
of the football match, 61 deaths from myocardial infarction or stroke were
reported, and on the day after the match, 104 deaths. Dutch results were
not confirmed by the French data, and we therefore question the causal
relationship found by Witte et al. between the football match and
cardiovascular mortality. We cannot exclude the possibility that the
authors would have reached another conclusion, had they used larger time-
windows. Furthermore, how many of the 41 reported persons dead from
myocardial infarction or stroke actually watched the match?
During and after the World Football Cup held in France from June 10 to
July 12, 1998, we set up an electronic sentinel disease surveillance to
estimate, in real time, the incidence of vasovagal attacks, panic
disorders, violence-related diseases, acute alcohol abuse, attacks of
asthma and traumatic injuries. The incidence of these diseases might have
been affected by increased stress, possibly caused by an important
football match. However, overall analysis of our data for the French
population showed no relevant variation in the pathologies surveyed [2]
and showed that at the population level, the effects of the amount of
stress induced by important sporting events on health are probably minor.
Of course, the level of population exposure to the "risk factor" (i.e.
watching the match on TV) was not the same in the France and Dutch
populations (8 vs. 60%), which may have affected people's behaviour as
regards alcohol consumption, smoking and collective excitement. In
addition, the match resulted in a nil-nil draw, and France won on penalty
kicks. The result of a match may also have its effects.
Further studies
are needed to establish whether the findings regarding the Dutch
population are the result of chance or whether we are in the presence of
another "French paradox"[3].
1. Witte DR, Bots ML, Hoes AW, Grobbee DE Cardiovascular mortality in
Dutch men during 1996 European football Championship: longitudinal
population study. BMJ 2000;321:1552-54
2. Hanslik T, Espinoza P, Boelle PY, Cantin-bertaux D, Gallichon B,
Quendez S, et al. Sentinel monitoring of general community health during
the 1998 world football cup. Rev Epidemiol Sante Publique 2001 (April
2001, In press).
3. Renaud, S. and M. de Lorgeril, Wine, alcohol, platelets, and the French
paradox for coronary heart disease. Lancet, 1992. 339(8808): p. 1523-6.
We thank the Service Commun N°8, INSERM for providing the mortality
data, and Médiamat-Médiametrie for providing the audience of French
television viewers.
Competing interest : None.
L Toubiana
Researcher
T Hanslik
Internal medicin
L Letrilliart
Medical epidemiologist
INSERM Unit 444, Saint-Antoine Medicine Faculty, Paris VI University,
Paris, France
Competing interests: No competing interests
Editor - Witte et al (BMJ 2000;321:1552-4) find that mortality from
acute myocardial infarction and stroke was increased in Dutch men on the
day of an important football match compared with the preceding and
following days. No corresponding increase in mortality occurred in women.
Neurobiological features are suggested by reports linking anxiety to
dopamine abnormalities lateralized to the right hemisphere. This
hypothesis is supported by optimal response organisation and working
memory at intermediate dopamine tone in a mediofrontostriatal activation
system,
and deactivation of the right hemisphere, a state marker of depression,
that promotes dominance of the left hemisphere associated with cardiac
dysrhythmia, vasoconstriction, aggressive response and a higher metabolic
rate in men.
These findings prompt neurochemical and pharmacotherapeutic
investigation of the role of asymmetric brain functions in the triggering
of cardiovascular deaths in men and adaptation to stress in disease
management.
Reference
Friedman EH, Coats AJS. Neurobiology of exaggerated heart rate
oscillations during two types of meditation (letter). Int J Cardiol
2000;73:199.
Ernest H. Friedman, MD
1831 Forest Hills Boulevard,
East Cleveland, OH 44112
Competing interests: No competing interests
influence of the television broadcast of the 1998 football world cup on emergency calls in France
Dear sir,
We read with interest the paper from Witte and coll. about the influence
of the television broadcast of the football matches on cardiovascular
mortality in the Dutch population [1]. The results of this study could be
discussed, in particular because hebdomadal rhythms that could influence
heart disease were not took into account (comparing the days before and
after 22 June1996) [1, 2]. Furthermore, because television broadcasts
occured in the evening, heart events could have happened a few hours
later, or even the following day.
To answer a similar question, we
prospectively studied the activity of a French Emergency Medical Aid
Service (SAMU) during the 1998 French World Cup [3}. In our area, the
Seine-Saint-Denis, situated to the east of Paris, the SAMU, answers more
than 100,000 calls for emergency assistance per year for a population of
1,4 million. We first set up a reference of the time distribution of the
emergency calls for the year 1997 and the first five months of the year
1998. This distribution, established regarding 170,000 calls was neither
significantly influenced by the day of the week nor the month of the year
(Figure). To study the influence of the football matches broadcasts we
compared this reference with the time flow of calls observed at the time
of each 64 matches of the World Cup. None but one of the 64 television
broadcasts influenced the flow of calls to the SAMU. Only the television
broadcast of the World Cup final, won by the French team, modified to a
significant degree the time flow of calls which decreased at the end of
the broadcast (p = 0,048) and increased thereafter (p = 0,046) (Figure).
We found no significant changes in age and sex ratio in the caller
population. Changes in the flow of calls was not sufficient to provide any
significant differences in emergency calls for cardiovascular events or
any other type of event. During the final, the viewer number was evaluated
at 23 millions, approximately 41% of the French population.
We reached the
conclusion that, only an event of completely exceptional matter was likely
to modify the time flow of calls to an Emergency Medical Aid Service. In
the study from Witte and coll. the mortality rate was influenced by an
event watched on the TV by 60% of the population. Our study, showing
changes in flow of emergency calls at the end of a major match supports
their conclusion that stress could be a triggering factor for cardiac
events.
1 - Cardiovascular mortality in Dutch men during 1996 European
football championship: longitudinal population study. Witte DR, Bots ML,
Hoes AW, Grobbee DE. Br Med J 2000;321:1552-1554
2 - Hebdomadal rhythms of the heart. Martin C. Br Med J 2000;321:1542-1543
3 – Emergency medicine in France. Nikkanen HE, Pouges C, Jacobs LM. Ann
Emerg Med 1998 ;31 :116 - 120
Competing interests: No competing interests