In 2016, 328 marathon events were organized in 30 provinces and municipalities across China, up from 22 events in 2011, drawing over 28 million participants. Before 2014, a marathon runner could register for the event a day before, but nowadays runners in some cities have to take their chances with a lottery to get a place. A growing number of cities organize marathon events mainly for economic returns and promotion of the city’s image. Along with its popularity, however, the prevalence of sudden deaths of runners, injuries, cheating and logistical problems have cast a shadow over the events. Since 2014, at least 14 runners have died after their events, with most of them under the age of 35. During an event in Guangdong in early 2016, more than 12,000 runners received treatment and five were left in a critical condition. Experts warned that many cities blindly pursue events on a scale beyond the capabilities of local organizers and a steady improvement in the level of service, awareness-making among the public and involvement of professional operation organizations is required.