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 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.
Document Details
- Document Type
- Pub Defense Publication
- Publication Date
- Apr 16, 2022
- Source ID
- 10.1093/aje/kwac075
Entities
People
- Ann Mckee
- Chris Nowinski
- Jennifer Weuve
- Jesse Mez
- Jessica Leclair
- Matthew P Fox
- Michael L Alosco
- Yorghos Tripodis
Organizations
- Boston University
- National Institute of General Medical Sciences
- National Institute of Neurological Disorders and Stroke
- National Institute on Aging
- National Institutes of Health
- United States Department of Defense
- United States Department of Veterans Affairs