Older people who experience a heart attack or cardiac arrest near a major in-progress marathon are more likely to die within the next 30 days than people who have a similar medical emergency in the same area on a non-marathon day or in a neighborhood just outside the marathon’s route, according to a study published Thursday in the New England Journal of Medicine (NEJM).
The study also found that the increase in deaths is most likely due to delays in getting people to the hospital — delays caused by widespread, marathon-related street closures.
“We have traditionally focused medical preparedness and emergency care availability to address the needs of race runners, but our study suggests that effects of a marathon may spread well beyond the course of the event and affect those who live or happen to be nearby,” said Dr. Anupam Jena, the study’s senior author and an associate professor of health care policy at Harvard Medical School, in a released statement.
For the study, Jena and his colleagues analyzed a decade (2002-2012) of hospitalization and ambulance data for Medicare recipients who experienced an acute cardiac emergency — either a heart attack or cardiac arrest — on the day of a major marathon or during the five weeks before or after the marathon.
The data was collected from 11 cities — Minneapolis, as well as Boston, Chicago, Honolulu, Houston, Los Angeles, New York City, Orlando, Philadelphia, Seattle and Washington, D.C.
During the period of the study, 1,145 Medicare patients in those 11 cities were hospitalized for a cardiac event on marathon days, and another 11,074 had been hospitalized on identical days of the week in the five weeks before and after the marathon. The average age of these Medicare patients was 77, and the majority had more than one chronic medical condition.
The researchers then compared the health outcomes of each of those groups of people — specifically, how many died within a month of their cardiac event. They found that the 30-day death rate for people whose heart-related emergency took place on the day of the marathon was 13 percent higher.
Among the people whose heart attack or cardiac arrest occurred in the vicinity of an ongoing marathon, 28.2 percent died within a month of hospitalization. That compared with 24.9 percent of the people admitted to a hospital in the weeks before or after the marathon and with 24.8 percent of those who were admitted to a hospital on the day of the race, but from a zip code just outside the race’s route.
The differences in the 30-day death rates held even after adjusting for the patients’ age, gender, race, household income and preexisting chronic medical.
“Our findings imply that, for every 100 patients who have a heart attack or cardiac arrest, an additional three people would die within one month if the cardiac event happened on the day of a marathon,” write Jena and co-author Andrew Olenski, a research analyst at Harvard Medical School, in an article on the study for the Harvard Business Review.
The researchers then looked to see what might be driving these results. One possibility was that the road closures and large crowds were causing patients to be taken to lower-quality hospitals outside the marathon city. But the researchers found no evidence of this.
“The hospitals that treated patients on marathon days were similar in quality to the hospitals that treated patients on non-marathon days,” write Jena and Olenski. “Similarly, Medicare patients tended to receive the same treatments when hospitalized on marathon and non-marathon days, including percutaneous coronary intervention (or stenting of the heart).”
The researchers then considered delays in care. This time they did find some important differences.
“Our results showed that during the mornings of marathons, ambulances took 4.5 minutes longer, on average, to get to the hospital, relative to the surrounding non-marathon days,” Jena and Olenski explain. “While this may seem small in absolute terms, it reflects a nearly 30% increase in travel time (the average travel time in our data was about 12 minutes). We found no corresponding increase during the evenings of the marathon date (by which point we assume most roads have re-opened), nor in neighboring areas unaffected by the marathon.”
The researchers also point out that their analysis of travel times only looked at ambulance data. Almost 1 in 4 of the patients in the study arrived at the hospital by other means — a factor that most likely resulted in even longer delays.
For patients experiencing a cardiac emergency, “mere minutes can be the difference between life and death,” the researchers write.
Limitations and implications
This study does not definitely prove that marathon-related road congestion was the cause of the higher death rates among people hospitalized during those events. But it does suggest that marathon planners — and everybody living in the vicinity of a marathon event — need to take greater precautions.
First, it is essential that organizers of marathons and other large public events “consider and plan for the unintended side effects these events create,” write Jena and Olenski. “Municipalities and organizations already devote tremendous resources to the safety of participants, but should account for the costs imposed on bystanders as well. Additional measures to take up might include instructing emergency medical personnel to prepare alternative protocols on the dates of major events — rather than simply increasing the number of ambulances available — to help reduce the health costs imposed on others.”
Second, residents living near a marathon or other public event should be aware that even with the delays, an ambulance is your best bet for getting to a hospital quickly on the day of a major public event.
Don’t attempt to drive yourself to the hospital, Jena and Olenski advise. Pick up the phone and call 911.
FMI: You’ll find an abstract of the study on the NEJM website, but the full study is behind a paywall.