Ironman Triathlon-Related Fatalities From 2017-2022: A Case Series

In the sport of triathlon the isolated and combined effects of swimming, biking, and running present extreme physiological stress and occasionally, these stressors overwhelm the human body resulting in death. Research suggests the average incidence-rate of triathlon-related deaths is 1.5 per 100,000 participants. Though the overall incidence rate of triathlon-related fatalities has been reported, few have identified trends among incidence rate and other factors including age, sex, portion of race, region, occupation, and cause of death. PURPOSE: To identify demographic and race day specific trends among Ironman® 70.3 triathlon-related fatalities from 2017 to 2022. METHODS: Data specific to triathlon-related fatalities between January 1st, 2017, and December 31st, 2022, were collected via NexusUni and other published news articles. Demographics such as age, sex, occupation, cause of death, and race day specifics including region of race, portion of race, and ambient temperature were extracted and descriptive statistics were analyzed. Total participation among triathlons were recorded from Ironman 70.3 Triathlons from 2017-2022 to calculate incidence rates per 100,000 participants. RESULTS: From 2017 to 2022, 16 Ironman 70.3 triathlon-related deaths (mean ± SD; age 48 ± 8) were recorded. The overall incidence rate was 17.0 per 100,000 finishers. Of fatalities, 68.75% were male and 87.5% occurred during the swim portion of the race. The largest causes of death were heart attack (25%) and drowning (25%). The mean ambient air temperature of the races with fatalities was 21.69 ± 3.93 °C. The mean ambient water temperature of the races with fatalities was 21.06 ± 4.09 °C. The region with the highest fatality rate per number of races was North America (0.30 per race). Finally, the athlete occupation with the highest percentage of athlete fatalities was engineer (18.75%). CONCLUSIONS: Triathlon-related deaths were most often experienced by males, during the swim portion of the race, and within North America. The swimming portion of the triathlon continues to represent the deadliest section and future safety measures should be focused on how to improve these outcomes.