What is the incidence of sudden death in long distance runners?

To get a good answer, you’d want to identify a sample of large long-distance races and a particular time period – you could work out the numbers of participants and number of deaths. For example, take the set of World Marathon Majors (excluding Boston in the year of the bombing), or the set of Rock and Roll races, or the ten biggest marathons in Europe, over a period of ten years.

In Ireland, in the last ten years of Dublin marathon there has been one death, in 2013, out of about 100,000 participants.

In the same period there was also a death in a half marathon that is part of the same series, and in 2006, outside the ten year span, there was another death in the marathon.

So, ballpark, 1 in 100,000.

I think all of those deaths were heart attacks, not hyponatremia (although that is a problem in some races). I remember when a woman died during London marathon a few years ago, there was some concern about the energy drinks/stimulants she was taking during the race, because they may have contributed to the stress on her heart.

When I was doing the Everest Marathon in 2010 I was chatting with Irish Gerry who had done a fair few in the 3:00 range. I’m not sure which marathon he was talking about – I guess in Ireland from some of the context but he saw someone die during the race.

Whether he knew the lad from his running club or heard the details later via the press I’m not sure. The guy was pretty young, in his early 20’s and was a fairly good runner – which I guess you need to be to be doing 3 hours or so. (My best is about 4 but I do live in the tropics)

So he’s a few feet ahead of Gerry and he dies. I can’t remember TH exact phrase Gerry used. It was either

It was like God just switched off the lights

Or

It was like God cut the strings

You get the idea

From one moment to the next the guy was running fast and well. The next he was dead. There was no slowing down or anything that indicated he was in difficulty or that something was going wrong. He just went from moment to moment.

Apparently the guy had some sort of latent heart defect and that’s what caused the death. I have no idea if that’s a sufficient explanation of what happened or indeed if Gerry was there. In 15 years of endurance racing it’s the only case I’ve heard.

In triathlon by contrast there are fairly regular deaths. These are typically middle aged men who have heart attacks about 1/3 of the way round the swim course. No one as far as I’m aware has had a similar problem on the bike or run course – even of Ironman races.

More generally in marathons causes of death tend to be Hyponatremia – Wikipedia (there were a few on the Great North Run some years back) or heat stroke. I looked after a guy who was having convulsions as a result of heat stroke a few years back whilst we waited for the ambulances to arrive. No pleasant but it certainly wasn’t sudden. He survived.

Probably not much higher than the incidence of sudden death in sleeping people. Or drivers. Or TV watchers. Or fried chicken eaters.

I’ve never heard of even a single runner dying during a race who didn’t already long before have ample reason to suspect they were at extreme and immediate health risk.