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  3. Law enforcement duties and sudden cardiac death among police officers in United States: case distribution study
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Research

Law enforcement duties and sudden cardiac death among police officers in United States: case distribution study

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g6534 (Published 18 November 2014) Cite this as: BMJ 2014;349:g6534
  1. Vasileia Varvarigou, visiting scientist and medical resident12,
  2. Andrea Farioli, postdoctoral research fellow134,
  3. Maria Korre, PhD student13,
  4. Sho Sato, undergraduate student)3,
  5. Issa J Dahabreh, assistant professor56,
  6. Stefanos N Kales, associate professor13
  1. 1Environmental and Occupational Medicine and Epidemiology, Harvard School of Public Health, Boston, MA, USA
  2. 2Department of Internal Medicine, St Elizabeth’s Medical Center, Tufts Medical School, Brighton, MA, USA
  3. 3Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
  4. 4Department of Medical and Surgical Sciences, DIMEC, University of Bologna, Bologna, Italy
  5. 5Center for Evidence-based Medicine, School of Public Health, Brown University, Providence, RI, USA
  6. 6Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA
  1. Correspondence to: S N Kales, Department of Environmental Health, Cambridge Hospital, Macht Building 427, 1493 Cambridge Street, Cambridge, MA 02139, USA skales{at}hsph.harvard.edu
  • Accepted 6 October 2014

Abstract

Objective To assess the association between risk of sudden cardiac death and stressful law enforcement duties compared with routine/non-emergency duties.

Design Case distribution study (case series with survey information on referent exposures).

Setting United States law enforcement.

Participants Summaries of deaths of over 4500 US police officers provided by the National Law Enforcement Officers Memorial Fund and the Officer Down Memorial Page from 1984 to 2010.

Main outcome measures Observed and expected sudden cardiac death counts and relative risks for sudden cardiac death events during specific strenuous duties versus routine/non-emergency activities. Independent estimates of the proportion of time that police officers spend across various law enforcement duties obtained from surveys of police chiefs and front line officers. Impact of varying exposure assessments, covariates, and missing cases in sensitivity and stability analyses.

Results 441 sudden cardiac deaths were observed during the study period. Sudden cardiac death was associated with restraints/altercations (25%, n=108), physical training (20%, n=88), pursuits of suspects (12%, n=53), medical/rescue operations (8%, n=34), routine duties (23%, n=101), and other activities (11%, n=57). Compared with routine/non-emergency activities, the risk of sudden cardiac death was 34-69 times higher during restraints/altercations, 32-51 times higher during pursuits, 20-23 times higher during physical training, and 6-9 times higher during medical/rescue operations. Results were robust to all sensitivity and stability analyses.

Conclusions Stressful law enforcement duties are associated with a risk of sudden cardiac death that is markedly higher than the risk during routine/non-emergency duties. Restraints/altercations and pursuits are associated with the greatest risk. Our findings have public health implications and suggest that primary and secondary cardiovascular prevention efforts are needed among law enforcement officers.

Footnotes

  • We thank the National Law Enforcement Officers Memorial Fund and Officer Down Memorial Page for providing information on police officer deaths. We thank William J Johnson (National Association of Police Organizations), Stephen Fender, George Sherrill, Kevin Summers (Fraternal Order of Police), Sam Cabral, and the International Union of Police Associations for supporting surveys of time spent on law enforcement duties. We also thank Byron Wallace (University of Texas at Austin) for providing help with data abstraction and coding. We express our deepest appreciation to the police chiefs, police departments, and frontline police officers for their collaboration with the surveys and their service to the public.

  • Contributors: VV contributed to the design of the study, acquisition of data, interpretation of data, and drafting the manuscript. AF contributed to the analysis and interpretation of data. MK contributed to the analysis and interpretation of data, and drafting the manuscript. SS contributed to the design of the study and acquisition of data. IJD contributed to the design of the study, acquisition of data, analysis and interpretation of data, and drafting the manuscript. SNK conceived the idea and the design of the study, contributed to obtaining funding, acquisition of data, analysis and interpretation of data, and drafting the manuscript. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. All authors revised the manuscript critically for important intellectual content. SNK is guarantor.

  • Funding: Research support was provided by a pilot project grant awarded by the Harvard-NIOSH Education and Research Center Grant No 2 T42 OH008416-08 and the Monica Odening ’06 Internship and Research Fund in Mathematics (Hamilton College).

  • Competing interests: All authors have completed the ICMJE uniform disclosure form and declare that SNK served as paid expert witness, independent medical examiner, or both, in workers’ compensation and disability cases, including cases involving law enforcement.

  • Ethical approval: Not required.

  • Data sharing: The data on police officer deaths and case histories are available online. Statistical code is available from the corresponding author.

  • Transparency declaration: The corresponding author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; no important aspects of the study have been omitted; and any discrepancies from the study as planned have been explained.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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