title: Mortality among marathon runners in the United States, 2000-2009.
abstract: BACKGROUND
  As participation in marathon running has increased, there has also been concern regarding its safety.
  
  
  OBJECTIVE
  To determine if the increase in marathon participation from 2000 to 2009 has affected mortality and overall performance.
  
  
  METHODS
  Descriptive epidemiology study.
  
  
  METHODS
  We used publicly available racing and news databases to analyze the number of marathon races, finishing race times, and deaths from 2000 to 2009 in marathons in the United States.
  
  
  RESULTS
  The total number of marathon finishers has increased over this decade from 299,018 in 2000 to 473,354 in 2009. The average overall marathon finishing time has remained unchanged from 2000 to 2009 (4:34:47 vs 4:35:28; P = .85). Of 3,718,336 total marathon participants over the 10-year study period, we identified 28 people (6 women and 22 men) who died during the marathon race and up to 24 hours after finishing. The overall, male, and female death rates for the 10-year period were 0.75 (95% confidence interval [CI], 0.38-1.13), 0.98 (95% CI, 0.48-1.36), and 0.41 (95% CI, 0.21-0.79) deaths per 100,000 finishers, respectively. There was no change in the death rate during this time period for overall, male, or female groups (P = .860, .533, and .238, respectively). The median age among deaths was 41.5 years (interquartile range, 25.5 years). Fifty percent (14/28) of deaths occurred in participants less than 45 years old. Myocardial infarction/atherosclerotic heart disease caused 93% (13/14) of deaths in those 45 years and older. A variety of conditions caused death in younger racers, the most common being cardiac arrest not otherwise specified (21%, n = 3).
  
  
  CONCLUSIONS
  Participation in marathons has increased without any change in mortality or average overall performance from 2000 to 2009.
authors.affiliation: Julius Johns Hopkins University School of Medicine, Department of Anesthesia and Critical Care Medicine, 1909 Thames Street, 2nd Floor, Baltimore, MD 21231, USA.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Mathews
authors.forename: David L
authors.initials: DL
authors.lastname: Narotsky
authors.forename: David L
authors.initials: DL
authors.lastname: Bernholt
authors.forename: Matthew
authors.initials: M
authors.lastname: Vogt
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Julius Cuong
authors.initials: JC
authors.lastname: Pham
mesh_terms: D000328:Adult; D000368:Aged; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010807:Physical Endurance; D010809:Physical Fitness; D012307:Risk Factors; D012420:Running / Q000706:statistics & numerical data*; D012737:Sex Factors; D014481:United States; D055815:Young Adult