Relationship Between Level of American Football Playing and Diagnosis of Chronic Traumatic Encephalopathy in a Selection Bias Analysis

Abstract Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts such as those from American football. Our understanding of this association is based on research in autopsied brains, since CTE can only be diagnosed postmortem. Such st...

Full description

Saved in:
Bibliographic Details
Published in:American journal of epidemiology 2022-07, Vol.191 (8), p.1429-1443
Main Authors: LeClair, Jessica, Weuve, Jennifer, Fox, Matthew P, Mez, Jesse, Alosco, Michael L, Nowinski, Chris, McKee, Ann, Tripodis, Yorghos
Format: Article
Language:English
Subjects:
Athletes
Autopsies
Bias
Brain
Brain Concussion
Chronic traumatic encephalopathy
Chronic Traumatic Encephalopathy - diagnosis
Concussion
Diagnosis
Estimates
Football
Humans
Male
Medical diagnosis
Neurodegenerative Diseases
Original Contribution
Players
Sports injuries
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with exposure to repetitive head impacts such as those from American football. Our understanding of this association is based on research in autopsied brains, since CTE can only be diagnosed postmortem. Such studies are susceptible to selection bias, which needs to be accounted for to ensure a generalizable estimate of the association between repetitive head impacts and CTE. We evaluated the relationship between level of American football playing and CTE diagnosis after adjusting for selection bias. The sample included 290 deceased male former American football players who donated their brains to the Veterans Affairs–Boston University–Concussion Legacy Foundation (VA-BU-CLF) Brain Bank between 2008 and 2019. After adjustment for selection bias, college-level and professional football players had 2.38 (95% simulation interval (SI): 1.16, 5.94) and 2.47 (95% SI: 1.46, 4.79) times the risk of being diagnosed with CTE as high-school–level players, respectively; these estimates are larger than estimates with no selection bias adjustment. Since CTE is currently diagnosed only postmortem, we additionally provide plausible scenarios for CTE risk ratios for each level of play during the former players’ lifetime. This study provides further evidence to support a dose-response relationship between American football playing and CTE.
ISSN:0002-9262
1476-6256
DOI:10.1093/aje/kwac075