title: Deaths in international travelers arriving in the United States, July 1, 2005 to June 30, 2008.
abstract: BACKGROUND
  The Centers for Disease Control and Prevention's (CDC) Quarantine Activity Reporting System (QARS), which documents reports of morbidity and mortality among travelers, was analyzed to describe the epidemiology of deaths during international travel.
  
  
  METHODS
  We analyzed travel-related deaths reported to CDC from July 1, 2005 to June 30, 2008, in which international travelers died (1) on a U.S.-bound conveyance, or (2) within 72 hours after arriving in the United States, or (3) at any time after arriving in the United States from an illness possibly acquired during international travel. We analyzed age, sex, mode of travel (eg, by air, sea, land), date, and cause of death, and estimated rates using generalized linear models.
  
  
  RESULTS
  We identified 213 deaths. The median age of deceased travelers was 66 years (range 1-95); 65% were male. Most deaths (62%) were associated with sea travel; of these, 111 (85%) occurred in cruise ship passengers and 20 (15%) among cargo and cruise ship crew members. Of 81 air travel-associated deaths, 77 occurred in passengers, 3 among air ambulance patients, and 1 in a stowaway. One death was associated with land travel. Deaths were categorized as cardiovascular (70%), infectious disease (12%), cancer (6%), unintentional injury (4%), intentional injury (1%), and other (7%). Of 145 cardiovascular deaths with reported ages, 62% were in persons 65 years of age and older. Nineteen (73%) of 26 persons who died from infectious diseases had chronic medical conditions. There was significant seasonal variation (lowest in July-September) in cardiovascular mortality in cruise ship passengers.
  
  
  CONCLUSIONS
  Cardiovascular conditions were the major cause of death for both sexes. Travelers should seek pre-travel medical consultation, including guidance on preventing cardiovascular events, infections, and injuries. Persons with chronic medical conditions and the elderly should promptly seek medical care if they become ill during travel.
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, USA. clawson2@cdc.gov
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Lawson
authors.forename: Clare A
authors.initials: CA
authors.lastname: Dykewicz
authors.forename: Noelle Angelique M
authors.initials: NA
authors.lastname: Molinari
authors.forename: Harvey
authors.initials: H
authors.lastname: Lipman
authors.forename: Francisco
authors.initials: F
authors.lastname: Alvarado-Ramy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D002487:Centers for Disease Control and Prevention, U.S. / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000145:classification / Q000401:mortality; D003141:Communicable Diseases / Q000145:classification / Q000401:mortality; D015897:Comorbidity; D005006:Ethnicity; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D008297:Male; D009026:Mortality; D012307:Risk Factors; D012621:Seasons; D016019:Survival Analysis; D014195:Travel / Q000145:classification / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology