Are African footballers more susceptible to heart attacks?

The recent death of Ivorian footballer Cheick Tiote on
 the pitch brought an outpouring of sadness in the world of football. This left us asking if there is any evidence to
 suggest that African players are more likely to die on 
the pitch than other players, writes Jordan Dunbar.

In the past few years there have been a number of
 players who have died while playing football.

Perhaps the most high profile incidents involved two 
African players; Cameroonian Marc Vivien Foe, who
 died during a game, and Congolese Fabrice Muamba, 
who had a cardiac arrest on the pitch but survived.

There is no official register of people who have died
 playing football. So instead we have used a list from Wikipedia as, though not ideal, it is the most complete we could find.

And we are looking at people who died playing the game, 
that is either in training or during a match.

Robert Mastrodomenico from Global Sports Statistics
 has done some calculations to give us a rough estimate.

Restricting himself to the last 10 years he found 
that 64 footballers had died during that period, but said it 
was not easy to figure out what all their nationalities were.

This means this list certainly has its limitations, aand
yet, he persevered to crunch the numbers and we think
 it still shows something interesting.

The analysis suggests that 26 of the 64 players who have
 died in the last 10 years are from African countries. 
That is nearly 40%.

Fifa, football's world governing body, estimates that
 there are about 265 million people playing in recognised teams around the world. Around 17% of those are playing
 in Africa.

That is not an ideal measure as many African players 
are in leagues in other continents. But it is a useful benchmark.

Therefore, while Africans make up 17% of the world's footballers they account for nearly 40% of the known deaths.

Overall, the biggest cause of death of footballers on
 the pitch was sudden cardiac death and this was 
particularly true for African players, as 25 of the 26 died from this cause.

Could African players really be more susceptible
 to sudden cardiac death?

Professor of cardiology Sanjay Sharma told the ERICGOSSIP sports that evidence from the US shows that sudden cardiac death amongst black basketball players is around three times more common than for white players.

But, he added, that is not the only place he has seen that pattern.

"There is data from the National Collegiate Athletic Association in the US that shows that the overall risk of sudden cardiac death during sport is around one in 48,000.

"But when someone actually examines this more
 closely that risk is considerably higher in black athletes;
 one in 18,000 in black males."

Professor Sharma said that in the UK the Football 
Association has done research on young players. The
 death rate for white footballers in that sample is one in 
25,000 but it is one in 4,000 for black players.

In other words, a black player is about six times more
 likely to die than a white player, though the chances 
are still very small.


African footballers who died on the pitch

Former Gabon international Moise Brou Apanga died in
training for Libreville 105 this April, aged 35

Cameroon international Patrick Ekeng died while 
playing for Dinamo Bucharest in Romania in May 2016, 
aged 26

Zambia's Chaswe Nsofwa died during a club match
 in Israel in 2007, aged 28

Nigeria's Samuel Okwaraji died playing a World Cup
 qualifier against Angola in 1989, aged 25



"The precise reasons aren't clear," said Prof Sharma.
 But he thinks that the evidence he looked at suggests 
black sports players are more likely to suffer from cardiac arrest because the wall of the left side of the heart seems to thicken more than players of other ethnicities.

"Which may be a situation that causes abnormal
 electrical disturbances that can cause a sudden death."

Professor Sharma said this can be made worse by higher blood pressure during exercise.

Most of Prof Sharma's research has looked at black
 players in the US and UK. But it turns out the picture is 
more complicated.

"There is going to be some genetic variation amongst 
the black population. Our information in the UK and from
 the US is based predominately among black athletes who have originated in West Africa."

Prof Sharma added that while we do not have much
 data on East Africa, what we do have seems to indicate players from there do not suffer as badly as their West 
African counterparts.

Heart screening is rarer in poorer African countries so problems in players do not always get picked up.

"Overall the risk of sudden death is one in 48,000 to
 one in 50,000."

The answer to the question "are more African football
 players dying?" is "perhaps".

The lack of good data, the national and ethnic differences,
 as well as not enough monitoring means it is too difficult to give a definitive answer.

But the medical research seems to suggest that
 there are good reasons to think that this is a serious issue.