title: Incidence, Cause, and Comparative Frequency of Sudden Cardiac Death in National Collegiate Athletic Association Athletes: A Decade in Review.
abstract: BACKGROUND
  The incidence and cause of sudden cardiac death (SCD) in athletes is debated with hypertrophic cardiomyopathy often reported as the most common cause.
  
  
  RESULTS
  A database of all National Collegiate Athletic Association deaths (2003-2013) was developed. Additional information and autopsy reports were obtained when possible. Cause of death was adjudicated by an expert panel. There were 4 242 519 athlete-years (AY) and 514 total student athlete deaths. Accidents were the most common cause of death (257, 50%, 1:16 508 AY) followed by medical causes (147, 29%, 1:28 861 AY). The most common medical cause of death was SCD (79, 15%, 1:53 703 AY). Males were at higher risk than females 1:37 790 AY versus 1:121 593 AY (incidence rate ratio, 3.2; 95% confidence interval, 1.9-5.5; P<0.00001), and black athletes were at higher risk than white athletes 1:21491 AY versus 1:68 354 AY (incidence rate ratio, 3.2; 95% confidence interval, 1.9-5.2; P<0.00001). The incidence of SCD in Division 1 male basketball athletes was 1:5200 AY. The most common findings at autopsy were autopsy-negative sudden unexplained death in 16 (25%), and definitive evidence for hypertrophic cardiomyopathy was seen in 5 (8%). Media reports identified more deaths in higher divisions (87%, 61%, and 44%), whereas the percentages from the internal database did not vary (87%, 83%, and 89%). Insurance claims identified only 11% of SCDs.
  
  
  CONCLUSIONS
  The rate of SCD in National Collegiate Athletic Association athletes is high, with males, black athletes, and basketball players at substantially higher risk. The most common finding at autopsy is autopsy-negative sudden unexplained death. Media reports are more likely to capture high-profile deaths, and insurance claims are not a reliable method for case identification.
authors.affiliation: From University of Washington, Seattle (K.G.H., D.S.O., J.M.P., J.C.S., M.L.Z., A.L.R., J.A.D.); University of South Carolina Greenville (I.M.A.); Mayo Clinic, Rochester, MN (J.J.M., M.J.A.); and Brown University, Providence, RI (R.E.). kharmon@uw.edu.
authors.forename: Kimberly G
authors.initials: KG
authors.lastname: Harmon
authors.affiliation: From University of Washington, Seattle (K.G.H., D.S.O., J.M.P., J.C.S., M.L.Z., A.L.R., J.A.D.); University of South Carolina Greenville (I.M.A.); Mayo Clinic, Rochester, MN (J.J.M., M.J.A.); and Brown University, Providence, RI (R.E.).
authors.forename: Irfan M
authors.initials: IM
authors.lastname: Asif
authors.affiliation: From University of Washington, Seattle (K.G.H., D.S.O., J.M.P., J.C.S., M.L.Z., A.L.R., J.A.D.); University of South Carolina Greenville (I.M.A.); Mayo Clinic, Rochester, MN (J.J.M., M.J.A.); and Brown University, Providence, RI (R.E.).
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Maleszewski
authors.affiliation: From University of Washington, Seattle (K.G.H., D.S.O., J.M.P., J.C.S., M.L.Z., A.L.R., J.A.D.); University of South Carolina Greenville (I.M.A.); Mayo Clinic, Rochester, MN (J.J.M., M.J.A.); and Brown University, Providence, RI (R.E.).
authors.forename: David S
authors.initials: DS
authors.lastname: Owens
authors.affiliation: From University of Washington, Seattle (K.G.H., D.S.O., J.M.P., J.C.S., M.L.Z., A.L.R., J.A.D.); University of South Carolina Greenville (I.M.A.); Mayo Clinic, Rochester, MN (J.J.M., M.J.A.); and Brown University, Providence, RI (R.E.).
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Prutkin
authors.affiliation: From University of Washington, Seattle (K.G.H., D.S.O., J.M.P., J.C.S., M.L.Z., A.L.R., J.A.D.); University of South Carolina Greenville (I.M.A.); Mayo Clinic, Rochester, MN (J.J.M., M.J.A.); and Brown University, Providence, RI (R.E.).
authors.forename: Jack C
authors.initials: JC
authors.lastname: Salerno
authors.affiliation: From University of Washington, Seattle (K.G.H., D.S.O., J.M.P., J.C.S., M.L.Z., A.L.R., J.A.D.); University of South Carolina Greenville (I.M.A.); Mayo Clinic, Rochester, MN (J.J.M., M.J.A.); and Brown University, Providence, RI (R.E.).
authors.forename: Monica L
authors.initials: ML
authors.lastname: Zigman
authors.affiliation: From University of Washington, Seattle (K.G.H., D.S.O., J.M.P., J.C.S., M.L.Z., A.L.R., J.A.D.); University of South Carolina Greenville (I.M.A.); Mayo Clinic, Rochester, MN (J.J.M., M.J.A.); and Brown University, Providence, RI (R.E.).
authors.forename: Rachel
authors.initials: R
authors.lastname: Ellenbogen
authors.affiliation: From University of Washington, Seattle (K.G.H., D.S.O., J.M.P., J.C.S., M.L.Z., A.L.R., J.A.D.); University of South Carolina Greenville (I.M.A.); Mayo Clinic, Rochester, MN (J.J.M., M.J.A.); and Brown University, Providence, RI (R.E.).
authors.forename: Ashwin L
authors.initials: AL
authors.lastname: Rao
authors.affiliation: From University of Washington, Seattle (K.G.H., D.S.O., J.M.P., J.C.S., M.L.Z., A.L.R., J.A.D.); University of South Carolina Greenville (I.M.A.); Mayo Clinic, Rochester, MN (J.J.M., M.J.A.); and Brown University, Providence, RI (R.E.).
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ackerman
authors.affiliation: From University of Washington, Seattle (K.G.H., D.S.O., J.M.P., J.C.S., M.L.Z., A.L.R., J.A.D.); University of South Carolina Greenville (I.M.A.); Mayo Clinic, Rochester, MN (J.J.M., M.J.A.); and Brown University, Providence, RI (R.E.).
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Drezner
mesh_terms: D056352:Athletes; D001265:Athletic Injuries / Q000150:complications / Q000453:epidemiology*; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012307:Risk Factors; D013177:Sports / Q000639:trends; D013334:Students
keywords: athletes; death; epidemiology; pathology; sudden