Abstract
BACKGROUND: Despite advancements in preparticipation physical examinations and cardiovascular evaluations, sport-related mortality persists. This study assesses athlete mortality over 25 years, stratifying data by sport, state, cause of death, socioeconomic factors, and age. HYPOTHESIS: Most athlete mortality would be due to sudden cardiac death (SCD) and occurred in contact sports in low-resource communities. STUDY DESIGN: Descriptive epidemiology study. LEVEL OF EVIDENCE: Level 3. METHODS: A retrospective search of athlete deaths occurring during games or practice from 1999 to 2024 was conducted using an online search engine (https://www.google.com/). Inclusion criteria required deaths to be related directly to athletic activity. Unrelated cases were excluded. The socioeconomic status of athletes was determined through the area deprivation index (ADI). Poisson regression was used to compare mortality rates with respect to sport type and region. RESULTS: A total of 593 athlete deaths were recorded, with a mean age of 16.2 years (range, 5-43). Most deaths occurred in male athletes (92%), at the high school level (70%), and during football participation (65%). Cardiovascular events were the leading cause of death (51%), followed by neurological causes (18%), and exertional heat stroke (11%). Mortality was highest during practice (69%) and was significantly more frequent in rural areas (P < 0.001). States with the highest mortality rates had an average national ADI of 67.8, indicating moderate socioeconomic deprivation, while states with the lowest mortality rates had an average ADI of 43.8. Exertional heat stroke accounted for 87.5% of deaths in football and was most prevalent in the South Atlantic region (P < 0.001). CONCLUSION: Football had the highest rate of all-cause athlete mortality, driven by cardiovascular events, traumatic brain injuries, and exertional heat stroke. Mortality was disproportionately higher in rural areas during practice. CLINICAL RELEVANCE: Higher mortality rates correlated positively with greater socioeconomic deprivation, as indicated by ADI values.