Sudden death accounts for 10% of deaths in the United States. Prior research has focused on sudden death in older victims, leaving much unknown about risk factors for younger, working age adults. Compared to older adults, younger adults may be more vulnerable to genetic factors. Understanding age related differences in sudden death risk factors may guide future prevention efforts, as the factors contributing to sudden death in younger patients may warrant different types of prevention than those affecting older adults.
From 2013-2015, out-of-hospital deaths among adults aged 18-64 in Wake County, NC were screened and adjudicated to identify 306 sudden death victims. A comparison group of 1,113 patients matched for age, gender, and residence was formed by randomly sampling individuals from the Carolina Data Warehouse. For sudden death victims and controls, the prevalence of sudden death risk factors, comprising comorbidities, mental illnesses, and family history variables, were assessed in three age groups (18-41, 42-54, and 55-64 years old). Hypothesis testing was conducted for each variable across all pairwise combinations of age groups using an unpaired, two-sample proportion Z-test with $p<0.05$ as statistically significant.
None of the variables analyzed were more prevalent in younger sudden death victims compared to older victims. However, family history variables were largely missing (>80%) compared to comorbidities and mental illnesses (<10%), with younger adults being disproportionately affected.
Underreporting of family history in medical records leaves younger adults as a poorly understood subset of sudden death victims who are currently unable to be appropriately screened for lifesaving preventive measures.
Better family history documentation may identify younger adults at higher risk of sudden death, allowing more comprehensive population level screening and implementation of prevention measures appropriate for addressing genetic factors instead of the environmental factors more common in older adults.