Background Millions of community-dwelling individuals run marathons each year. There are infrequent deaths, which are often reported widely, and may create unnecessary alarm about the potential risks. Equally, sensible planning for such eventualities is important when staging an event.
Objective The aim of the review was to determine the risk of death from running a marathon and the likely location of such deaths in order to inform the public of the likely risks and improve planning for such events.
Design Narrative review.
Data sources Primary: PubMed. Secondary: contact was made with the organisers and medical teams of specific marathons and online data sought where necessary.
Eligibility criteria for selecting studies Studies had to report the number of participants and deaths during, or within 24 hours of completing the marathon. Results relevant to half marathons or ultramarathons or other endurance events, such as triathlons, were not included. Deaths due to terrorist activity were not included.
Results The risk of death estimated by these studies was approximately 0.67 per 100 000 finishers, that is, 1 death per 149 968 participants. From those studies that reported deaths by sex, the rate of male deaths was 0.98/100 000 (1 per 102 503) vs 0.41/100 000 (1 per 243 879) in females. Deaths tended to occur in the last quarter of the race.
Summary/conclusion The risk of death from participating in a marathon is small. Men are more at risk than women. Deaths tend to occur later in the race.
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Contributors MJD and IG conceived the review. MJD undertook the literature review and obtained the data and wrote the initial draft of the manuscript. IG critically reviewed the manuscript and approved the final version. Both authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests MJD reports personal fees from Biotronik, personal fees from Daiichi Sankyo, outside the submitted work.
Patient consent for publication Not required.
Ethical approval As a literature review of existing publicly available data, no consent or ethical approval was required or sought
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement We have included all data within the manuscript and supplements. There are no additional data to share.
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