23 Apr Long-Term Health Outcomes Associated with College Football
MedicalResearch.com Interview with:
Robert A. Stern, Ph.D.
Professor of Neurology, Neurosurgery, and Anatomy & Neurobiology
Director of Clinical Research, BU CTE Center
Senior Investigator, BU Alzheimer’s Disease Research Center
Boston University School of Medicine
MedicalResearch.com: What is the background for this study?
Response: The link between playing American football at the professional level and later-life brain disorders like chronic traumatic encephalopathy – or CTE — and ALS has received increasing attention over the past 15 years. Previous research has shown that former NFL players are more likely to die from CTE and amyotrophic lateral sclerosis (ALS) and more likely to report cognitive impairment, behavioral changes, and dementia during life. Despite previous research focusing on the later-life effects of playing American football at the professional level, the long-term effects of college football participation remain largely unknown.
We had two goals for this new investigation. The first was to conduct a survey of the current overall health status, including cognitive and other neurological disorders, of older former college American football players compared with men in the general population. The second goal was to examine the mortality rate and causes of death in a cohort of older former college football players. The target population for this study was all 447 former Notre Dame football players who were listed as seniors on the varsity rosters during the 1964-1980 seasons. This was the era of legendary coaches Ara Parseghian and Dan Devine. I should add that this study was fully independent of the University of Notre Dame.
MedicalResearch.com: What are the main findings?
Response: Results of this new study found that, similar to previous reports of former professional football players, there are both positive and negative long-term health outcomes associated with playing American football at the college level. The health survey study found that, compared to a representative sample of same age men in the general population, the former Notre Dame football players were five times more likely to report cognitive impairment diagnoses during life and two and a half times more likely to report recurrent headaches. They were also 65 percent more likely to have cardiovascular disorders, and 80 percent more likely to report having high cholesterol during life. In contrast, the former college players were 48 percent less likely to have diabetes.
In the mortality study, we found both good news and bad news. The good news is that overall mortality among the former college football players was significantly lower than the general US population of same age men. Similarly, mortality from circulatory, respiratory, and digestive system conditions, and from lung cancer. The bad news is that, consistent with reports of former NFL players, mortality due to degenerative brain disease, specifically Parkinson’s disease and ALS, was higher in the former college players compared to the general population, but that difference did not reach statistical significance. Unexpectedly, we found that mortality from brain and other nervous system cancers was almost four times higher in the former college players compared to the general population. This was statistically significant.
MedicalResearch.com: What should readers take away from your report?
Response: Similar to previous findings of former professional football players, the results of this study suggest that there are both positive and negative long-term health outcomes associated with playing American football at the college level. Additional research must be conducted to provide stakeholders, such as players, parents, coaches, athletic directors, league officials, and healthcare providers, with objective data and guidance to maximize those factors that improve health outcomes and eliminate or reduce those factors that may increase the risk for later-life brain disorders.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: The next step for us it to examine specific risk and resiliency factors for later life brain disorders in former football players. So, all former Notre Dame football players who are currently age 40 or older will now be asked to participate in the new Head Impact & Trauma Surveillance Study – or HITSS — which is funded by a grant from the National Institutes of Health. HITSS is a fully online annual assessment examining the risks of developing later-life brain health issues from repetitive head impacts in American football and soccer. We are recruiting 4,800 former football AND soccer players (including both men and women), age 40 or older, including 2,400 former football players, who played at any level, i.e., youth, high school, college, or professional. We will be conducting a substudy focusing specifically on the former Notre Dame football players.
MedicalResearch.com: Is there anything else you would like to add?
Response: Based on previous research, there is a dose-dependent relationship between the amount of exposure to repetitive impacts from football and later life risk for cognitive and behavioral impairments, as well as for CTE. I would think that an important way to reduce risk for later life brain disorders associated with American football is to reduce the overall exposure to repetitive head impacts, including those impacts resulting in symptomatic concussions as well as the much, much more common “subconcussive” trauma, that is the injuries to the brain that do not immediately result in the symptoms of concussion. This does not mean just building a bigger helmet. It means removing the head from the game and from practice as much as possible, including eliminating tackle football for children.
Disclosures: I receive research funding from several grants from the National Institutes of Health. In addition, I receive consulting fees from Biogen and Lundbeck, and I receive royalties for published neuropsychological tests from Psychological Assessment Resources, Inc. I am a Board Member for King-Devick Technologies, for which I receive stock options. I am was also a member of the court-appointed Medical Scientific Committee for the NCAA Student-Athlete Concussion Injury Litigation.
Phelps A, Alosco ML, Baucom Z, et al. Association of Playing College American Football With Long-term Health Outcomes and Mortality. JAMA Netw Open. 2022;5(4):e228775. doi:10.1001/jamanetworkopen.2022.8775
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