Review highlights racial disparities in sudden cardiac arrest and death among athletes

A recent major review of data published by The Lancet and led by Emory sports cardiologist Jonathan Kim, MD, shows that Black athletes are approximately five times more likely to experience sudden cardiac arrest (SCA) and sudden cardiac death (SCD) compared to white athletes, despite some evidence of a decline in rates of SCD overall. SCA and SCD have historically been a leading cause of mortality among athletes, particularly those involved in high-intensity sports.

The disparities in SCA/D rates highlights the need for increased research into the social determinants of health in younger athletes, a topic that remains understudied, according to Kim.

After examining a repository of national and international data focused on SCA/D in athletes accumulated over the last 30 years, Kim and colleagues from Lausanne University Hospital, Morristown Medical, Massachusetts General Hospital, and other prominent institutions reviewed the significant racial disparities that also persist in athlete electrocardiography (ECG) screenings, which have become a standard practice for competitive athletes.

These screenings often yield more false positives in Black athletes, which means that athletes may be wrongly identified as having a serious heart condition. For those with limited access to comprehensive follow-up, testing this is especially problematic as these individuals may face unnecessary stress and may not be able to receive follow-up care to confirm whether the results are accurate.

Social determinants of health, such as economic stability, proximity to health care facilities, access to health information, and experiences with discrimination can play a significant role in disparities in health outcomes, even in young athletes. By incorporating social determinants of health into future research, Kim says we may be better poised to understand how to mitigate the impacts on young athletes in particular.

“To truly address these disparities, it’s not enough to just screen for potential problems,” Kim says. “There needs to be an understanding of how to tackle the underlying social determinants of health that puts these athletes at a greater risk.”

In The Lancet review, Kim and colleagues stress that proper management of sudden cardiac arrest in athletes starts with adequate pre-participation evaluation (PPE) which involves careful planning and sufficient resources. “We need to look for potential underlying health conditions. We also need to consider all the environmental stressors that young individuals have to deal with and also where they grow up,” says Kim. An effective PPE history and physical examination should include appropriate follow-up, especially if ECG is included and abnormalities detected.

Looking ahead, the growing focus on this topic marks a substantial shift. “Just five to 10 years ago, I doubt many were thinking about social determinants of health and impacts on young athletes,” says Kim. Asking these critical questions is a major step in the right direction. Moving forward, it’s essential to continue raising these questions but also take action to address them.