Stressful duties linked with risk of sudden cardiac death among police officers

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Stressful and physically-demanding law enforcement activities are associated with large increases in the risk of sudden cardiac death among US police officers compared with routine policing activities, finds a study published in The BMJ.

In 2011-2012, the fatality rate among US patrol officers was 15-16 per 100,000 full time workers – about 3-5 times the national average for private sector employees. Some evidence suggests that cardiovascular disease is higher among police officers than the general population, but data about the impact of specific on duty activities on cardiovascular deaths are not available.

A research team led by Stefanos Kales at Harvard Medical School assessed the association between stressful law enforcement duties and risk of sudden cardiac death compared with routine/non-emergency duties. Using nationwide data, they analysed over 4,500 US police officer deaths and proportion of time spent on specific duties from 1984 to 2010. Additional information including officer age, sex, date of death, location of police department (rural, suburban, or urban), jurisdiction size and size of police department was also recorded.

Duties were categorised as routine/non-emergency, which included attending meetings, classroom activities, desk duty and paperwork, escorting (such as funerals, dignitaries), firing range practice, patrol and roll call. Non-routine duties included disturbance (domestic disturbance calls and disturbance of peace calls), medical and rescue operations, physical training, physical restraints/physical altercations (with suspects, prisoners, other detainees, or other uncooperative members of the public), suspect pursuits, testifying in court, transporting/supervising prisoners.

A total of 441 sudden cardiac deaths were identified during the study period. While routine/non-emergency duties constituted about 75% of police work time, 77% of sudden cardiac deaths occurred during non-routine tasks.

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. Further analysis to test the strength of the results did not alter the findings.

“We found that stressful and physically demanding law enforcement activities were associated with large increases in the risk of sudden cardiac death, compared with routine/non-emergency policing activities,” write the authors. The most likely explanation for these findings is “a sudden increase in cardiovascular demand because of a combination of physical exertion and psychological stress, consistent with ‘fight or flight’ physiology,” they add.

Despite some study limitations, they say their findings have public health implications and suggest that management of risk factors for cardiovascular disease “could be used to protect police officers from the triggering effects of stressful duties and also reduce rates of long term cardiovascular disease.”

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