Indian Journal of Medical Research (Jan 2023)

Factors associated with unexplained sudden deaths among adults aged 18-45 years in India – A multicentric matched case–control study

  • Manickam Ponnaiah,
  • Tarun Bhatnagar,
  • Rizwan Suliankachi Abdulkader,
  • Rajalakshmi Elumalai,
  • Janani Surya,
  • Kathiresan Jeyashree,
  • Muthusamy Santhosh Kumar,
  • Ranjithkumar Govindaraju,
  • Jeromie Wesley Vivian Thangaraj,
  • Hari Krishan Aggarwal,
  • Suresh Balan,
  • Tridip Dutta Baruah,
  • Ayan Basu,
  • Yogita Bavaskar,
  • Ajeet Singh Bhadoria,
  • Ashish Bhalla,
  • Pankaj Bhardwaj,
  • Rachana Bhat,
  • Jaya Chakravarty,
  • Gina Maryann Chandy,
  • Bal Kishan Gupta,
  • Rakesh Kakkar,
  • Ali Hasan Faiz Karnam,
  • Sushila Kataria,
  • Janakkumar Khambholja,
  • Dewesh Kumar,
  • Nithin Kumar,
  • Monaliza Lyngdoh,
  • M Selva Meena,
  • Kedar Mehta,
  • M P Sheethal,
  • Subhasis Mukherjee,
  • Anuj Mundra,
  • Arun Murugan,
  • Seetharaman Narayanan,
  • Balamurugan Nathan,
  • Jutika Ojah,
  • Pushpa Patil,
  • Sunita Pawar,
  • A Charles Pon Ruban,
  • R Vadivelu,
  • Rishabh Kumar Rana,
  • S Nagendra Boopathy,
  • S Priya,
  • Saroj Kumar Sahoo,
  • Arti Shah,
  • Mohammad Shameem,
  • Karthikeyan Shanmugam,
  • Sachin K Shivnitwar,
  • Abhishek Singhai,
  • Saurabh Srivastava,
  • Sudheera Sulgante,
  • Arunansu Talukdar,
  • Alka Verma,
  • Rajaat Vohra,
  • Rabbanie Tariq Wani,
  • Bhargavi Bathula,
  • Gayathri Kumari,
  • Divya Saravana Kumar,
  • Aishwariya Narasimhan,
  • N C Krupa,
  • Thirumaran Senguttuvan,
  • Parvathi Surendran,
  • Dharsikaa Tamilmani,
  • Alka Turuk,
  • Gunjan Kumar,
  • Aparna Murkherjee,
  • Rakesh Aggarwal,
  • Manoj Vasant Murhekar

DOI
https://doi.org/10.4103/ijmr.ijmr_2105_23
Journal volume & issue
Vol. 158, no. 4
pp. 351 – 362

Abstract

Read online

Background & objectives: In view of anecdotal reports of sudden unexplained deaths in India's apparently healthy young adults, linking to coronavirus disease 2019 (COVID-19) infection or vaccination, we determined the factors associated with such deaths in individuals aged 18-45 years through a multicentric matched case–control study. Methods: This study was conducted through participation of 47 tertiary care hospitals across India. Cases were apparently healthy individuals aged 18-45 years without any known co-morbidity, who suddenly (<24 h of hospitalization or seen apparently healthy 24 h before death) died of unexplained causes during 1st October 2021-31st March 2023. Four controls were included per case matched for age, gender and neighborhood. We interviewed/perused records to collect data on COVID-19 vaccination/infection and post-COVID-19 conditions, family history of sudden death, smoking, recreational drug use, alcohol frequency and binge drinking and vigorous-intensity physical activity two days before death/interviews. We developed regression models considering COVID-19 vaccination ≤42 days before outcome, any vaccine received anytime and vaccine doses to compute an adjusted matched odds ratio (aOR) with 95 per cent confidence interval (CI). Results: Seven hundred twenty nine cases and 2916 controls were included in the analysis. Receipt of at least one dose of COVID-19 vaccine lowered the odds [aOR (95% CI)] for unexplained sudden death [0.58 (0.37, 0.92)], whereas past COVID-19 hospitalization [3.8 (1.36, 10.61)], family history of sudden death [2.53 (1.52, 4.21)], binge drinking 48 h before death/interview [5.29 (2.57, 10.89)], use of recreational drug/substance [2.92 (1.1, 7.71)] and performing vigorous-intensity physical activity 48 h before death/interview [3.7 (1.36, 10.05)] were positively associated. Two doses lowered the odds of unexplained sudden death [0.51 (0.28, 0.91)], whereas single dose did not. Interpretation & conclusions: COVID-19 vaccination did not increase the risk of unexplained sudden death among young adults in India. Past COVID-19 hospitalization, family history of sudden death and certain lifestyle behaviors increased the likelihood of unexplained sudden death.

Keywords