Harvard: People who suffer heart attacks or cardiac arrests in the vicinity of an ongoing major marathon are more likely to die within a month due to delays in transportation to nearby hospitals, according to newly published research from Harvard Medical School. The delays, the researchers say, likely stem from widespread street closures during major races that can hamper transportation in an emergency. Writing in the April 13 issue of the New England Journal of Medicine, the study authors call for citywide strategies that ensure unhampered access for medical crews in a certain radius of major races and other large public gatherings, such as sporting events or parades.
Previous studies have examined death rates among marathon runners to
assess the risk of endurance training, but this is believed to be the
first study to analyze the impact of such races on those living nearby
due to causes that have nothing to do with the physical exertion of
running a marathon.
“We have traditionally focused medical preparedness and emergency
care availability to address the needs of race runners, but our study
suggests that effects of a marathon may spread well beyond the course of
the event and affect those who live or happen to be nearby,” said the
study’s senior author, Anupam Jena, the Ruth L. Newhouse Associate
Professor of Health Care Policy at Harvard Medical School.
The investigators examined 10 years’ worth of patient records
analyzing death rates among older Americans, 65 years of age and over,
within 30 days of having a heart attack or a cardiac arrest near a major
marathon across 11 U.S. cities. Researchers compared death rates among
patients hospitalized on the day of the race with those hospitalized
five weeks prior or five weeks after the race. Additionally, the
researchers divided patients by zip code, comparing death rates among
those living near the marathon and those living in zip codes well
outside of the event’s radius and unaffected by street closures.
Patients admitted to a hospital on race day were nearly 15 percent
more likely to die within a month of suffering a heart attack or cardiac
arrest compared with those admitted on a nonmarathon day or in a
hospital outside of the marathon’s zip code(s).
That spike translated into a nearly 4 percent difference in the
number of deaths. In other words, the researchers say, for every 100
patients with heart attack or cardiac arrest, three to four more people
died within a month in the group admitted to a hospital on race day if
they happened to go to a hospital near the race course.
The research also showed that ambulance transport was delayed by an
average of 4.4 minutes on marathon days, 32 percent longer travel time
compared with transports not delayed by marathons. Additionally, nearly a
quarter of patients in the study got themselves to the hospital without
an ambulance. While there is no record of the amount of time private
transportation took, the authors suspected that many such trips would
have been slow on marathon days.
While the study findings do not establish cause and effect between
street closures and greater mortality, the researchers point out that
many studies have shown that even very small delays in getting care
could make the difference between life and death.
“When it comes to treating people in the throes of a heart attack,
minutes do matter. Heart muscle dies quickly during a heart attack, so
current guidelines call for rapid intervention, preferably within an
hour or so of diagnosing a heart attack, to salvage cardiac muscle
function,” said Jena, who is also a physician at Massachusetts General
As runners speed through the streets of the nation’s most popular
marathons, traffic around race routes slows to a crawl. Marathon
organizers make every effort to ensure safe and smooth passage for
runners, but large public gatherings—such as major sporting events,
parades or Independence Day fireworks—can cause major traffic snags.
So, the HMS researchers wondered what kind of unintended consequences
these sprawling, 26.2-mile events might have on the health of people
who live near the race course.
The findings suggest that between three and four preventable deaths
likely occur each year among older residents who suffer heart attacks
and cardiac arrests during marathons across the eleven cities studied.
“Marathons and other large, popular civic events are an important
part of the fabric of life in our big cities, and they bring people a
lot of pride and joy,” Jena said. “But the organizers of these events
need to take these risks to heart when they are planning their events,
and find better ways to make sure that the race’s neighbors are able to
receive the lifesaving care that they need quickly.”
The races included in the analysis took place between 2002 and 2012
in Boston, Chicago, Honolulu, Houston, Los Angeles, Minneapolis, New
York City, Orlando, Philadelphia, Seattle and Washington, D.C.
To rule out other possible explanations for the spike in mortality,
the researchers checked to see whether patients were sent to different
hospitals, whether they traveled longer distances, whether out of town
spectators or race participants skewed the mix of patients, whether
people waited until their conditions were more severe before calling for
an ambulance, or whether staffing levels or the type of treatment used
on marathon days were different from usual, and they found no evidence
to support any of these possibilities.
The researchers say that their findings suggest that citywide
strategies for emergency medical preparedness need to do more to account
for the risks to nonparticipants whose emergency medical care may be
“When cities host big marathons, or when people participate in races,
they don't think that there might be a chance that a person not taking
part in the race could die because of the event,” Jena said. “These
findings don’t mean we shouldn't have large public events, but hopefully
our research will shine some light on the problem and suggest ways that
planners can better provide for the health and safety of the people who
N. Clay Mann, professor in the Department of Pediatrics at the
University of Utah School of Medicine and director for research at the
Intermountain Injury Control Research Center; Leia N. Wedlund, a student
at Harvard University; and Andrew Olenski, a research assistant in the
HMS Department of Health Care Policy, were co-authors of this study.
This research was supported with funding from the Office of the
Director, National Institutes of Health (NIH Early Independence Award,