Objective To assess the association between risk of sudden cardiac
death and stressful law enforcement duties compared with routine/non-emergency
Design Case distribution study (case series with survey information
on referent exposures).
Setting United States law enforcement.
Participants Summaries of deaths of over 4500 US police officers
provided by the National Law Enforcement Officers Memorial Fund and the Officer
Down Memorial Page from 1984 to 2010.
Main outcome measures Observed and expected sudden cardiac death
counts and relative risks for sudden cardiac death events during specific
strenuous duties versus routine/non-emergency activities. Independent estimates
of the proportion of time that police officers spend across various law
enforcement duties obtained from surveys of police chiefs and front line
officers. Impact of varying exposure assessments, covariates, and missing cases
in sensitivity and stability analyses.
Results 441 sudden cardiac deaths were observed during the study
period. Sudden cardiac death was associated with restraints/altercations (25%,
n=108), physical training (20%, n=88), pursuits of suspects (12%, n=53),
medical/rescue operations (8%, n=34), routine duties (23%, n=101), and other
activities (11%, n=57). Compared with routine/non-emergency activities, the risk
of sudden cardiac death was 34-69 times higher during restraints/altercations,
32-51 times higher during pursuits, 20-23 times higher during physical training,
and 6-9 times higher during medical/rescue operations. Results were robust to
all sensitivity and stability analyses.
Conclusions Stressful law enforcement duties are associated with a
risk of sudden cardiac death that is markedly higher than the risk during
routine/non-emergency duties. Restraints/altercations and pursuits are
associated with the greatest risk. Our findings have public health implications
and suggest that primary and secondary cardiovascular prevention efforts are
needed among law enforcement officers.