French cardiovascular mortality did not increase during 1996 European football championship

EDITOR—Witte et al found a significant increase in mortality from coronary heart disease and stroke in Dutch men aged ≥45 on the day that the Dutch team was eliminated by the French from the 1996 European football championship compared with 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.

The match had an audience of 4.7 million television viewers in France (around 8% of the French population). We performed the same time series analysis as Witte et al on French mortality data for the periods and personal characteristics corresponding to the Dutch data, the cause of death being classified according to ICD-9 (international classification of diseases, ninth revision, codes 410; 430-434; 436-438).

The table shows that, on the day of the match, mortality from all causes did not increase among French men or women compared with that on the five days before and after the match. In particular, mortality from myocardial infarction or stroke did not increase. On the day of the match 61 deaths from myocardial infarction or stroke were reported; on the day after the match 104 such deaths were reported.

The Dutch results were not confirmed by the French data, and we therefore question Witte et al's conclusion; they might have reached another conclusion had they used larger time windows. Furthermore, how many of the 41 people reported 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 electronic sentinel disease surveillance to estimate the incidence of various conditions in the French population. The incidence of the conditions we looked at might be affected by increased stress, possibly caused by an important football match.

Analysis of our data showed no relevant variation in the disorders surveyed. At the population level the effects of stress induced by important sporting events on health are probably minor.2 The level of population exposure to the risk factor (watching the match on television) was not the same in the French and Dutch populations (8% v 60%); this 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 in the Dutch population are the result of chance or whether this is another French paradox.3

We thank Médiamat-Médiametrie for providing the total audience of French television viewers and the Service Commun No 8, INSERM, for providing the mortality data.