Mortality patterns in Croatian Olympic athletes: subanalyses by sport type

Abstract Background General and sport-specific effects of competitive sport on overall and cardiovascular (CV) health remain debated. Beyond inconsistent research results, substantial geographic disparities persist: North America and Northern, Central, and Western Europe are well represented in the literature, whereas regions such as the former Yugoslavia and Southeastern Europe remain underrepresented. A large meta-analysis, however, reported lower overall mortality in endurance elite athletes compared with the general population, whereas power athletes did not show this benefit. Purpose To assess overall and CV mortality among Croatian Olympians and to determine whether mortality outcomes differ between endurance and power athletes. Previous reports have addressed general mortality patterns in this population; however, sport-specific mortality differences remain unexplored. Methods Participants were Croatian male athletes who competed in the Olympic Games between 1948 and 2016. We compared their overall and CV mortality with that of the age-, sex-, and period-adjusted general Croatian population using standardized mortality ratios (SMR) with 95% confidence intervals (CI). Overall mortality analysis included 652 athletes (504 endurance, 105 power, 32 intermediate, and 11 low-intensity athletes), while cause-specific analysis included 642 athletes (498 endurance, 101 power, 32 intermediate, and 11 low-intensity athletes). Causes of death were obtained from official national registries or, when unavailable, through interviews conducted according to World Health Organization (WHO) verbal autopsy principles. General population mortality data were sourced from the Croatian Bureau of Statistics and WHO databases. Mortality differences between endurance and power athletes were assessed using log-rank tests and Kaplan–Meier curves. Results Athletes’ overall and CV mortality were significantly lower compared with the general population (observed total deaths 142, expected 255.37, SMR 0.56, CI 0.47–0.66, p 0.001; observed CV deaths 52, expected 102.93, SMR 0.51, CI 0.38–0.66, p 0.001). Both endurance and power athletes showed lower overall and CV mortality compared with the general population (endurance: total deaths 117, expected 203.53, SMR 0.57, CI 0.47–0.66, p 0.001; CV deaths 45, expected 82.57, SMR 0.55, CI 0.40–0.73, p 0.001; power: total deaths 19, expected 38.34, SMR 0.50, CI 0.30–0.77, p 0.001; CV deaths 5, expected 14.84, SMR 0.34, CI 0.11–0.78, p 0.001). Direct comparison of endurance and power athletes using Kaplan–Meier curves (Figures 1 and 2) showed no differences in overall or CV mortality (log-rank tests: overall χ² = 0.01, p = 0.91; CV χ² = 0.71, p = 0.40). Conclusion Both endurance and power Croatian Olympians exhibit lower overall and CV mortality compared with the Croatian general population. No significant overall or CV mortality differences were observed between power and endurance athletes.Figure 1For image description, please refer to the figure legend and surrounding text. Figure 2For image description, please refer to the figure legend and surrounding text.