title: Law enforcement duties and sudden cardiac death among police officers in United States: case distribution study.
abstract: OBJECTIVE
  To assess the association between risk of sudden cardiac death and stressful law enforcement duties compared with routine/non-emergency duties.
  
  
  METHODS
  Case distribution study (case series with survey information on referent exposures).
  
  
  METHODS
  United States law enforcement.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Environmental and Occupational Medicine and Epidemiology, Harvard School of Public Health, Boston, MA, USA Department of Internal Medicine, St Elizabeth's Medical Center, Tufts Medical School, Brighton, MA, USA.
authors.forename: Vasileia
authors.initials: V
authors.lastname: Varvarigou
authors.affiliation: Environmental and Occupational Medicine and Epidemiology, Harvard School of Public Health, Boston, MA, USA Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA Department of Medical and Surgical Sciences, DIMEC, University of Bologna, Bologna, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Farioli
authors.affiliation: Environmental and Occupational Medicine and Epidemiology, Harvard School of Public Health, Boston, MA, USA Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Korre
authors.affiliation: Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.
authors.forename: Sho
authors.initials: S
authors.lastname: Sato
authors.affiliation: Center for Evidence-based Medicine, School of Public Health, Brown University, Providence, RI, USA Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, RI, USA.
authors.forename: Issa J
authors.initials: IJ
authors.lastname: Dahabreh
authors.affiliation: Environmental and Occupational Medicine and Epidemiology, Harvard School of Public Health, Boston, MA, USA Occupational Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA skales@hsph.harvard.edu.
authors.forename: Stefanos N
authors.initials: SN
authors.lastname: Kales
mesh_terms: D000328:Adult; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D005260:Female; D006801:Humans; D035846:Law Enforcement; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology*; D016495:Police / Q000706:statistics & numerical data*; D018570:Risk Assessment; D013315:Stress, Psychological; D014481:United States / Q000453:epidemiology