Medicare patients with acute myocardial infarction or cardiac arrest who are admitted to hospitals affected by marathons have longer ambulance transport times and higher 30-day mortality compared with those who are hospitalized on nonmarathon dates, according to a study in the New England Journal of Medicine.

Anupam B. Jena, MD, PhD, from Harvard Medical School in Boston, and colleagues analyzed Medicare data regarding hospitalizations for patients older than 65 years of age who had an acute myocardial infarction or cardiac arrest in 11 US cities that had hosted a major marathon between 2002 and 2012. The researchers compared 30-day mortality among beneficiaries who were hospitalized on the marathon date, those who were hospitalized on the same day of the week as the marathon day in the 5 weeks before or the 5 weeks after the marathon, and those who were hospitalized on the same day as the marathon but in neighboring ZIP code areas unaffected by the marathon.

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The investigators also analyzed data from a national registry of ambulance transports to determine whether transports that occurred before noon in marathon-affected areas had longer scene-to-hospital transport times than those that occurred on nonmarathon dates. In addition, they compared transport times on marathon dates with those on nonmarathon dates in these same areas during evenings after the roads had reopened and in areas that were unaffected by the marathon.

Dr Jena’s group found that the daily frequency of hospitalizations was similar on the marathon and nonmarathon dates (mean number of hospitalizations per city, 10.6 and 10.5, respectively); characteristics of the beneficiaries hospitalized on marathon and nonmarathon dates were also similar. However, the unadjusted 30-day mortality in areas affected by marathons on marathon dates was 28.2% (323 deaths in 1145 hospitalizations), compared with 24.9% (2757 deaths in 11,074 hospitalizations) on nonmarathon dates (relative risk difference, 13.3%).

“This pattern persisted after adjustment for covariates and in an analysis that included beneficiaries who had 5 or more chronic medical conditions (a group that is unlikely to be hospitalized because of marathon participation,” stated the researchers. “No significant differences were found with respect to where patients were hospitalized or the treatments they received in the hospital. Ambulance scene-to-hospital transport times for pickups before noon were 4.4 minutes longer on marathon dates than on nonmarathon dates (relative difference, 32.1%). No delays were found in evenings or in marathon-unaffected areas.”


  1. Jena AB, Mann NC, Wedlund LN, Olenski A. Delays in emergency care and mortality during major US marathons. N Engl J Med. 2017;376(15):1441-1450. doi:10.1056/NEJMsa1614073