title: Characteristics of sudden arrhythmic death in a diverse, urban community.
abstract: BACKGROUND
  Sudden cardiac death (SCD) remains a major public health problem; however, its true burden remains unknown with widely variable estimates of its incidence. We aimed to examine the contemporary epidemiology and autopsy characteristics of SCD in an ethnically diverse community.
  
  
  METHODS
  Three physicians reviewed all deaths of individuals aged ≥20 years reported to the San Francisco medical examiner in 2007 for presentations fitting World Health Organization (WHO) SCD criteria-within 1 hour of symptom onset (witnessed) or within 24 hours of being observed alive and symptom free (unwitnessed). After comprehensive review of medical examiner investigation, WHO SCDs were classified as sudden arrhythmic death (SAD) or nonarrhythmic death. Coronary artery disease (CAD) and cardiac mass were evaluated in all SADs undergoing autopsy and compared with demographically similar accidental trauma control deaths.
  
  
  RESULTS
  We identified 252 WHO SCDs; 145 were SADs. Men had a 2.2-fold higher SAD rate (P < .0005). Blacks had a 3.15-fold higher SAD rate compared with whites (P = .003). Significant CAD was present in 38.9% of SADs and associated with higher SAD risk compared with control deaths (OR 2.58, 95% CI 1.12-5.97, P = .026). Mean cardiac mass was linearly associated with risk for SAD in cases without significant CAD (OR 2.06 per 100 g, 95% CI 1.43-2.98, P < .0005).
  
  
  CONCLUSIONS
  In a diverse, urban population, SAD incidence varied substantially by gender and race. Significant CAD accounted for far fewer SADs than previous studies but remained associated with a 2.6-fold higher risk as compared with control deaths. These findings may reflect the evolving contemporary epidemiology of SCD.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Steinhaus
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Ellen
authors.initials: E
authors.lastname: Moffatt
authors.forename: Amy P
authors.initials: AP
authors.lastname: Hart
authors.forename: Philip
authors.initials: P
authors.lastname: Ursell
authors.forename: Zian H
authors.initials: ZH
authors.lastname: Tseng
mesh_terms: D000059:Accidents / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000401:mortality*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000208:ethnology / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D014505:Urban Population; D014947:Wounds and Injuries / Q000401:mortality; D055815:Young Adult