Contextual patterns in publicly reported non-traumatic sudden deaths among university students in physical education and campus sports settings in China: a retrospective thematic analysis

Physical education classes, physical fitness testing, and other campus-based sports activities are important settings in which university students engage in organized and semi-organized physical activity. Although non-traumatic sudden death in these settings is rare, its consequences are severe for students, families, universities, and campus public health governance. Existing research has mainly focused on pathological mechanisms, clinical interpretation, emergency medicine, and legal responsibility, whereas less attention has been paid to how such events are publicly represented and what recurrent contextual patterns are visible in university sports settings. This study aimed to identify recurrent public-record-based contextual patterns reported in cases of non-traumatic sudden death among university students in physical education and campus sports-related settings in China, and to discuss their implications for campus sports safety governance and public health prevention.

A retrospective qualitative thematic analysis was conducted using publicly available Chinese-language case materials. Public reports, university notices, education authority notices, institutional statements, and news reports were searched for cases occurring between 1 January 2016 and 25 December 2025 in mainland China. Cases were included if they involved an enrolled university student, occurred during a physical education class, physical fitness test, campus competition, training session, extracurricular campus sport, or another clearly identifiable campus sports-related setting, and were publicly described as non-traumatic sudden death, cardiac arrest followed by death, respiratory and cardiac arrest followed by death, or acute collapse during or shortly after exercise followed by unsuccessful rescue. Multiple reports relating to the same incident were merged into case files. Source reliability and completeness were assessed according to source authority, proximity to the event, information completeness, cross-source consistency, and transparency of event description. Reflexive thematic analysis was then conducted. Five trained coders assisted with preliminary coding, while the author integrated coding outputs, developed final categories and themes, and interpreted the findings.

Twenty-one publicly reported fatal cases were included in the main analytical sample. Six recurrent public-record-based contextual themes were identified: individual health vulnerability; mismatch between task demands and physical preparedness; limited visibility of health screening and classroom monitoring; incomplete public reporting of emergency preparedness and on-site rescue capacity; evaluative contexts and possible barriers to symptom reporting; and the amplifying role of environmental conditions. These themes were interpreted as contextual signals visible in public reports rather than as clinically verified causal risk factors.

Publicly reported non-traumatic sudden deaths among university students in physical education and campus sports-related settings appear to be publicly represented within multiple interacting individual, task-related, institutional, psychosocial, environmental, and emergency-response contexts. The findings should not be interpreted as evidence of causal risk factors, incidence, population-level association, or confirmed institutional responsibility. Rather, they provide a public-record-based synthesis of recurrent contextual patterns that may inform hypothesis generation, campus safety communication, health screening, task stratification, symptom-reporting mechanisms, emergency preparedness, and future empirical research on campus sports safety governance.