Competing risks of mortality with marathons: retrospective analysis
BMJ 2007; 335 doi: https://doi.org/10.1136/bmj.39384.551539.25 (Published 20 December 2007) Cite this as: BMJ 2007;335:1275All rapid responses
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Redelmeier and Greenwald (R&G) make a convincing case that the
mortality risk associated with marathon running is low. However, their
conclusions about associated road traffic accidents (that road closures
associated with marathons leads to a reduction in motor vehicle
fatalities) are less convincing. Of course, closing roads to vehicles will
stop accidents on those roads at those times, the key issue is whether the
road closures merely shift the accidents to other places and times. R&G
observe that “analysis of counties outside the course that compared
observed and expected crash deaths during hours of road closure should no
countervailing increase in fatal crashes”. However, the rate of fatalities
in road traffic accidents per county per day is so low that picking up
even a moderate change would be very difficult, as R&G’s own analysis
reveals: despite his large sample the confidence internal for their
analysis above spans changes from a decrease of 6% to an increase of 7%. A
similar problem arises with their failure to find a shift in time. As well
as this methodological problem, there is a problem of identifying the
underling mechanism. If road closures related to marathons actually cause
a reduction rather than just a distribution of road fatalities, then we
must ask how does this reduction occur? Is it because people cancel their
journeys to stay home and watch coverage of the marathon on TV? It seems
more likely that the marathon would encourage more journeys (among
participants and spectators) than it stops. It seems unlikely that the
marathon would lead to safer driving, indeed the re-routing of drivers to
unfamiliar roads is more liable to increase risk of accident. Thus, if R&G
are correct that marathons lead to a reduction rather than a
redistribution of road traffic accidents, perhaps the reason is because
marathon runners are intrinsically dangerous drivers and the key function
to society of marathons is to keep these people off our roads for a few
hours!
Competing interests:
None declared
Competing interests: No competing interests
Comparing marathon deaths with Road Traffic Accident Deaths
Redelmeier and Greenwald (R and G) have some interesting
retrospectively collected data on large US marathons but have neglected
mention of the London marathon death risk data collected prospectively
over the last 27 years which has been compared with different forms of
vehicular road usage risk in Europe and published in BJSM and
elsewhere.(refs 1,2,3,4)
We have found that on a "time of exposure basis" running the London
marathon has a comparable death risk to many daily activities. It has a
smaller death risk than riding a motorbicycle but has about three time
greater risk than cycling for the same length of time amd about 10-12
times greater risk than exposure while being a motorist.
These calculations are based on an average assumed exposure of 6 hours to
the marathon and its environs and the
comparison is made with European Transport statistics .
Our current data gives a slightly higher death rate from cardiac
causes (8 in 676000 ) compared to the US figures of 0.8 per 100,000 and
also includes data on successful cardiac resuscitation (6) and 3 non
cardiac deaths. Cardiac arrest occured at the finish in less than one
third of cases and was distributed from 6 miles onwards.
The mortality on US roads is given by R and G as 12 deaths per 42 kms
per 1000 hours, an extraordinary figure even if the 1000 was supposed to
be 100,000. Their derived figures seem as mythical as their comment that
runnng a marathon can lead to suddden death "as documented 2500 years
ago". There is no contemporaneous account of Pheidippides death after the
battle of Marathon The first allusion to it is 600 years later in Roman
histories. Pheidippides is said by Herodotus the Greek historian in his
history of the battle written within a life span of the event to have run
from Athens to Sparta and back to try and get help for the Athenians and
Herodotus says Pheidippides met the god Pan on the way. Herodotus makes
no mention of his death after running from Marathon to Athens less than a
fifth of the distance. A myth should not be the basis of a scientific
dscussion.
Whatever the true US road death figures, marathon running.has a
comparatively low but not negligible risk but encourages a healthy life
style and if we aim to keep death off the roads perhaps we should
encourage more people to run to work but if possible along car free
routes eg canal tow paths.
.
1. Tunstall Pedoe, D. S. . "Sudden cardiac death in sport:spectre or
preventable risk?" Br J Sports Med 2000 34(2): 137-40.
2.Tunstall Pedoe, D. S. . "Sudden death risk in older athletes: increasing
the denominator." Br J Sports Med 200438(6): 671-2.
3. Tunstall Pedoe,DS (2000) “Morbidity and mortality in the London
Marathon “p 197-207in “Marathon Medicine” editor Dan Tunstall Pedoe RSM
press London 2000
4Tunstall Pedoe DS. Marathon cardiac deaths : the London experience.
Sports Med.2007 2;37(4-5):448-50.
Competing interests:
None declared
Competing interests: No competing interests