Journal Article

Career duration and later-life health conditions among former professional American-style football players

DiGregorio, Heather, Lee, Hang, Rotem, Ran S, Zafonte, Ross D, Weisskopf, Marc G, Iverson, Grant L, Grashow, Rachel, Eagle, Shawn R, Tan, Can Ozan, Baggish, Aaron L, Whittington, Alicia J, Marengi, Dean, Thomas, Julius Dewayne, Terry, Douglas P

2024

Overview

ObjectivesCareer duration is often used as a metric of neurotrauma exposure in studies of elite athletes. However, as a proxy metric, career length may not accurately represent causal factors, and associations with health outcomes may be susceptible to selection effects. To date, relationships between professional American-style football (ASF) career length and postcareer health remain incompletely characterised.MethodsWe conducted a survey-based cross-sectional cohort study of former professional ASF players. Flexible regression methods measured associations between self-reported career duration and four self-reported health conditions: pain, arthritis, mood and cognitive symptoms. We also measured associations between career duration and four self-reported ASF exposures: prior concussion signs and symptoms (CSS), performance enhancing drugs, intracareer surgeries and average snaps per game. Models were adjusted for age and race.ResultsAmong 4189 former players (52±14 years of age, 39% black, 34% lineman position), the average career length was 6.7±3.9 professional seasons (range=1–20+). We observed inverted U-shaped relationships between career duration and outcomes (all p<0.001), indicating that adverse health effects were more common among men with intermediate career durations than those with shorter or longer careers. Similar findings were observed for play-related exposures (eg, CSS and snaps).ConclusionsRelationships between ASF career duration and subsequent health status are non-linear. Attenuation of the associations among longer career players may reflect selection effects and suggest career length may serve as a poor proxy for true causal factors. Findings highlight the need for cautious use of career duration as a proxy exposure metric in studies of former athletes.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Adult / Aged / Anxiety / Arthritis / Arthritis - epidemiology / Athletes / Athletes - psychology / Athletes - statistics & numerical data / Body mass index / Brain Concussion - epidemiology / Brain Concussion - etiology / Careers / Chronic pain / Cohort Studies / Concussion / Cross-Sectional Studies / Epidemiology / Exposure / Football / Football - injuries / Football - statistics & numerical data / Health risks / Health Status / Humans / Male / Mental depression / Mental health / Middle Aged / Occupational Health / Original Research / Osteoarthritis / Pain - epidemiology / Pain - etiology / Participation / Players / Professional football / Questionnaires / Regression analysis / Signs and symptoms / Surgery / Time Factors / Trauma / United States - epidemiology / Workplace / Wounds and Injuries