Association of Playing College American Football With Long-term Health Outcomes and Mortality

Phelps, Alyssa; Alosco, Michael L.; Baucom, Zachary; Hartlage, Kaitlin; Palmisano, Joseph; Weuve, Jennifer; Mez, Jesse; Tripodis, Yorghos; Stern, Robert

doi:10.1001/jamanetworkopen.2022.8775

Cited by 20 publications

(27 citation statements)

References 75 publications

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“…Our systematic review retrieved 463 potentially eligible published articles of which 7 met the inclusion criteria (figure 1). 8–11,15,29,30 The characteristics of the included cohort studies are summarised in table 3. Three featured depression only as the outcome of interest, 11,15,30 3 reported on only suicide, 9,10,29 and 1 captured both endpoints.…”

Section: Resultsmentioning

confidence: 99%

“…8–11,15,29,30 The characteristics of the included cohort studies are summarised in table 3. Three featured depression only as the outcome of interest, 11,15,30 3 reported on only suicide, 9,10,29 and 1 captured both endpoints. 8 All studies exclusively comprised men and, bar two, 15,30 sampled former professional athletes.…”

Section: Resultsmentioning

confidence: 99%

“…Three featured depression only as the outcome of interest, 11,15,30 3 reported on only suicide, 9,10,29 and 1 captured both endpoints. 8 All studies exclusively comprised men and, bar two, 15,30 sampled former professional athletes. The number of events ranged from 21 30 to 38 8 for depression, and 8 10 to 19 8 for suicide.…”

Section: Resultsmentioning

confidence: 99%

“…To the best of our knowledge, there is one existing meta-analysis of suicide in former contact sports 13 but we were unable to identify the same for depression. That global participation in soccer – estimated at more than a quarter of a billion by its governing body 14 – is seemingly the highest of any sport, and programmes of American football are long-established in educational settings, 15 means that a link between a background in these activities and depression or suicide may have public health significance.…”

Section: Introductionmentioning

confidence: 99%

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Suicide and depression in former contact sports participants: population-based cohort study, systematic review, and meta-analysis

Batty

Frank

Kujala

et al. 2022

Preprint

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Background: Traumatic brain injury is associated with the future risk of depression and suicide, and this raises the possibility that former participants in sports characterised by low intensity repetitive head impact may also subsequently experience an increased burden of these mental health outcomes. Using new data from a cohort study integrated into a meta-analysis of the current evidence, we compared the occurrence of depression and suicide in former contact sports athletes against general population controls. Methods: The cohort study comprised 2004 retired male athletes who had competed internationally on an amateur basis for Finland between 1920 and 1965, and 1385 age-equivalent male general population controls. Former contact sports participants were drawn from soccer, boxing, or Olympic-style (non-professional) wrestling. During follow-up, cases of major depressive disorder and suicide were captured via linkage to mortality and hospitalisation registries. In a PROSPERO-registered (CRD42022352780) systematic review, we searched PubMed and Embase from their inception to October 31 2022 for reports of cohort studies of contact sports participation and later risk of depression and suicide that were published in English and reported standard estimates of association and variance. Study-specific estimates were aggregated using random-effect meta-analysis. The Newcastle-Ottawa Scale was used to appraise the quality of each study. Findings: In analyses of the Finnish cohort data, up to 45 years of health surveillance gave rise to 131 hospitalisations for major depressive disorder and 61 suicides. In survival analyses (hazard ratio [95% confidence interval]) adjusted for age and socioeconomic status, former boxers (depression: 1.43 [0.73, 2.78]; suicide: 1.75 [0.64, 4.38]), wrestlers (depression: 0.94 [0.44, 2.00]; suicide: 1.60 [0.64, 3.99]), and soccer players (depression: 0.62 [0.26, 1.48]); suicide: 0.50 [0.11, 2.16]) did not have statistically significantly different rates of major depressive disorder or suicide relative to general population controls. The systematic review identified 463 potentially eligible published articles, of which 7 met inclusion criteria. All studies sampled men and 3 were evaluated as being of high quality. After aggregating results from these retrieved studies with new data from the cohort study, we found that retired soccer players appeared to have a somewhat lower risk of depression (summary risk ratio: 0.71 [95% 0.54, 0.93]) relative to general population controls, while the rate of suicide was essentially the same (0.70 [0.40, 1.23]). Past participation in American football was associated with some protection against suicide (0.58 [0.43, 0.80]) but there were insufficient studies of depression for aggregation. All studies showed directionally consistent relationships and there was no indication of inter-study heterogeneity (I2=0%). Interpretation: Based on a small cluster of studies exclusively comprising men, retired soccer players had a lower rate of later depression, and former American football players had a lower risk of suicide. Whether these findings are generalisable to women requires testing. Funding: None.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Suicide and depression in former contact sports participants: population-based cohort study, systematic review, and meta-analysis

Batty

Frank

Kujala

et al. 2022

Preprint

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“…40 Specific mechanisms of risk in boxing and American football are less clear. That global participation in soccer – estimated at more than a quarter of a million by its governing body 41 – is seemingly the highest of any sport, and programmes of wrestling and American football are long-established in many colleges, 42 means that, if indeed causal, a link between a background in these activities and dementia may have public health significance.…”

Section: Discussionmentioning

confidence: 99%

Dementia and Alzheimer’s disease in former contact sports participants: population-based cohort study, systematic review, and meta-analysis

Batty

Sarna

Valencia‐Hernández

et al. 2022

Preprint

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BackgroundNeuropathology consistent with chronic traumatic encephalopathy has been reported at autopsy in retired collision sports athletes, but whether these individuals also experience greater rates of dementia over their lifetime is uncertain.MethodsCohort study of 2005 male retired athletes who had competed internationally for Finland between 1920 and 1965, and 1386 male controls. At follow-up, data were captured via questionnaire administration and linkage to mortality, hospitalisation, and medication registries.ResultsA mean of 31 years of event surveillance (range 1-46) of a sample of 3391 men gave rise to 488 cases of neurodegenerative disease. In multiple-adjusted analyses, relative to the general population, boxing was associated with a quadrupling (4.10; 2.55, 6.61), and soccer (2.07; 1.23, 3.46) and wrestling (2.11; 1.28, 3.48) a doubling of the risk of Alzheimer’s disease. Boxers with extended careers had twice the risk of Alzheimer’s disease (2.07; 0.95, 4.51) relative to those who competed for shorter periods. For all collision sports, disease risk was most pronounced for those who competed after the second World War. Computation of competing risks and a series of sensitivity analyses did not appreciably alter these results.ConclusionsIn the present study, men with an elite-level background in soccer, wrestling, and boxing subsequently experienced poorer brain health than general population and non-collision sports controls.

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Traumatic Brain Injury and Subsequent Risk of Brain Cancer in US Veterans of the Iraq and Afghanistan Wars

Stewart,

Howard,

Poltavskiy

et al. 2024

JAMA Netw Open

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ImportanceWhile brain cancer is rare, it has a very poor prognosis and few established risk factors. To date, epidemiologic work examining the potential association of traumatic brain injury (TBI) with the subsequent risk of brain cancer is conflicting. Further data may be useful.ObjectiveTo examine whether a history of TBI exposure is associated with the subsequent development of brain cancer.Design, Setting, and ParticipantsA retrospective cohort study was conducted from October 1, 2004, to September 20, 2019, and data analysis was performed between January 1 and June 26, 2023. The median follow-up for the cohort was 7.2 (IQR, 4.1-10.1) years. Veterans Affairs (VA) and Department of Defense (DoD) administrative data on 1 919 740 veterans from the Long-Term Impact of Military-Relevant Brain Injury Consortium–Chronic Effects of Neurotrauma Consortium were included.ExposureThe main exposure of interest was TBI severity (categorized as mild, moderate or severe [moderate/severe], and penetrating).Main Outcomes and MeasuresThe outcome of interest was the development of brain cancer based on International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes in either the DoD/VA medical records or from the National Death Index.ResultsAfter 611 107 exclusions (predominately for no encounter during the study period), a cohort including 1 919 740 veterans was included, most of whom were male (80.25%) and non-Hispanic White (63.11%). Median age at index date was 31 (IQR, 25-42) years. The cohort included 449 880 individuals with TBI (mild, 385 848; moderate/severe, 46 859; and penetrating, 17 173). Brain cancer occurred in 318 individuals without TBI (0.02%), 80 with mild TBI (0.02%), 17 with moderate/severe TBI (0.04%), and 10 or fewer with penetrating TBI (≤0.06%). After adjustment, moderate/severe TBI (adjusted hazard ratio [AHR], 1.90; 95% CI, 1.16-3.12) and penetrating TBI (AHR, 3.33; 95% CI, 1.71-6.49), but not mild TBI (AHR, 1.14; 95% CI, 0.88-1.47), were associated with the subsequent development of brain cancer.Conclusions and RelevanceIn this cohort study of veterans of the Iraq and Afghanistan wars, moderate/severe TBI and penetrating TBI, but not mild TBI, were associated with the subsequent development of brain cancer.

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Association of Playing College American Football With Long-term Health Outcomes and Mortality

Cited by 20 publications

References 75 publications

Suicide and depression in former contact sports participants: population-based cohort study, systematic review, and meta-analysis

Suicide and depression in former contact sports participants: population-based cohort study, systematic review, and meta-analysis

Dementia and Alzheimer’s disease in former contact sports participants: population-based cohort study, systematic review, and meta-analysis

Traumatic Brain Injury and Subsequent Risk of Brain Cancer in US Veterans of the Iraq and Afghanistan Wars

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