Racial Disparities in Sudden Cardiac Arrest Among Athletes: A Call for Comprehensive Research

A major review published in The Lancet and led by Emory sports cardiologist Dr. Jonathan Kim has brought to light significant racial disparities in the prevalence of sudden cardiac arrest (SCA) and sudden cardiac death (SCD) among athletes. According to the findings, Black athletes are approximately five times more likely to experience these life-threatening events compared to their White counterparts. This comprehensive analysis, based on 30 years of national and international data, underscores the critical need for a broader investigation into the role of social determinants of health in young athletes.

Historically, SCA and SCD have ranked among the leading causes of mortality in high-intensity sports. Despite some evidence of a decline in SCD rates overall, the disproportionate impact on Black athletes highlights an alarming trend that demands attention. The review, conducted in collaboration with researchers from institutions such as Lausanne University Hospital and Massachusetts General Hospital, also examined disparities in athlete electrocardiography (ECG) screenings. These screenings, widely implemented as part of pre-participation evaluations (PPE), often yield false positives in Black athletes, which may exacerbate the challenges they face.

ECG Screening and Disparities in Follow-Up Care

The analysis revealed that Black athletes are more likely to receive false-positive results from ECG screenings, a finding with significant implications. Athletes who are wrongly identified as having a serious heart condition may face unnecessary stress and, in many cases, struggle to access follow-up care. This issue is particularly acute for those with limited resources or inadequate access to healthcare facilities, leaving them vulnerable to incorrect diagnoses or a lack of clarity regarding their health status.

“Effective management of sudden cardiac arrest in athletes begins with a thorough pre-participation evaluation, including follow-up testing for ECG abnormalities,” emphasized Dr. Kim. However, the disparities in access to comprehensive follow-up care make this goal difficult to achieve for many Black athletes.

The Role of Social Determinants of Health

The disparities in SCA and SCD rates are further complicated by social determinants of health. Factors such as economic stability, proximity to healthcare facilities, access to health information, and experiences with discrimination have been identified as contributors to health inequities. Despite their evident influence on health outcomes, these factors remain under-researched in the context of young athletes.

Dr. Kim highlighted the importance of incorporating these social determinants into future research, noting that they could provide a more holistic understanding of the risks faced by athletes. “We must consider the environmental stressors young individuals face, including where they grow up, alongside their physical health,” Kim stated.

Addressing Racial Disparities Through Improved PPE

The review stressed that careful planning and adequate resources are essential for effective PPE. Proper management should include a detailed medical history and physical examination, along with appropriate follow-up when abnormalities are detected in ECG screenings. By addressing both medical and social determinants of health, healthcare professionals can better identify and mitigate risks.

Dr. Kim also pointed out the significant progress made in recent years in addressing these disparities. “Just five to ten years ago, social determinants of health and their impact on young athletes were not widely discussed,” he observed. Today, however, these questions are at the forefront of research efforts, signaling a shift toward more equitable healthcare practices in sports medicine.

The findings from this comprehensive review serve as a wake-up call for the sports and healthcare communities to address racial disparities in SCA and SCD among athletes. By integrating social determinants of health into research and healthcare practices, the impact of these disparities can be reduced. This forward-thinking approach holds promise for ensuring that all athletes, regardless of their racial or socioeconomic background, receive the care and support they need.

Reference:

1. Sudhakar Selvaraj, Laura M. Koehly, et al. "Functional Connectivity Between Brain Regions Mediating Social Reward Processing." The Lancet.. Accessed November 29, 2024. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02086-5/abstract.

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