Background

The age of first exposure (AFE) to American football participation is a growing concern for late-life function. Mixed evidence exists surrounding AFE and may be attributed to varied methods employed across studies.

Objective

To examine the associations between AFE to American football participation with measures of cognitive, behavioral, and physical function and brain-related medical diagnoses across age categories among former National Football League players.

Methods

We conducted a cross-sectional survey of 1784 former players (age: 52.3 ± 16.3 years, AFE: 11.3 ± 2.9 years, years of football: 17.5 ± 4.5 years, 86.9% ≥ one lifetime concussion). Players completed a general health questionnaire recording demographics, football playing history (including AFE), and diagnoses (anxiety, depression, any form of dementia, mild cognitive impairment). Players completed Patient-Reported Outcomes Measurement Information System (PROMIS) measures assessing domains of cognitive and physical function, anxiety, depression, sleep disturbance, pain interference, and emotional-behavioral dyscontrol. Multivariable linear and binomial regression models were used to examine the associations of AFE and age with PROMIS outcomes and diagnoses, respectively.

Results

No significant AFE by age interactions were detected for PROMIS outcomes (p ≥ 0.066) or diagnoses (p ≥ 0.147). Younger AFE associated with higher PROMIS scores of anxiety (B = − 0.22, p = 0.016), depression (B = − 0.22, p = 0.010), sleep disturbances (B = − 0.16, p = 0.007), pain interference (B = − 0.19, p = 0.014), and emotional-behavioral dyscontrol (B = − 0.22, p = 0.019). Age was associated with all PROMIS outcomes (p ≤ 0.042). AFE was not associated with the prevalence of anxiety, depression, dementia, or mild cognitive impairment (p ≥ 0.449), while age was (p ≤ 0.013).

Conclusions

AFE was significantly associated with PROMIS outcomes, albeit low-strength associations (i.e., effect sizes), but not with diagnoses. Our findings indicate AFE is a significant but minor contributing factor for health-related quality of life in this cohort. Future work should incorporate additional characterizations of cumulative head impacts and related factors when examining long-term outcomes associated with football participation.

中文翻译：

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将首次接触美式橄榄球的年龄与前国家橄榄球联盟球员的患者报告结果和医学诊断联系起来：一项 NFL-LONG 研究

背景

首次接触美式橄榄球的年龄 (AFE) 越来越受到人们对晚年生活功能的关注。围绕 AFE 存在混合证据，这可能归因于研究中采用的不同方法。

客观的

在前国家橄榄球联盟球员中，通过跨年龄组的认知、行为和身体功能测量以及大脑相关医学诊断来检查 AFE 与美式橄榄球参与之间的关联。

方法

我们对 1784 名前球员（年龄：52.3 ± 16.3 岁，AFE：11.3 ± 2.9 岁，足球年限：17.5 ± 4.5 岁，86.9% ≥ 一次脑震荡）进行了横断面调查。球员完成了一份一般健康调查问卷，记录了人口统计数据、踢足球的历史（包括 AFE）和诊断（焦虑、抑郁、任何形式的痴呆、轻度认知障碍）。玩家完成了患者报告结果测量信息系统 (PROMIS) 测量评估认知和身体功能、焦虑、抑郁、睡眠障碍、疼痛干扰和情绪行为失控等领域。多变量线性和二项式回归模型分别用于检查 AFE 和年龄与 PROMIS 结果和诊断的关联。

结果

对于 PROMIS 结果 ( p  ≥ 0.066) 或诊断 ( p  ≥ 0.147)，未检测到年龄相互作用的显着 AFE。较年轻的 AFE 与较高的 PROMIS 焦虑评分（B  = − 0.22，p  = 0.016）、抑郁（B  = − 0.22，p  = 0.010）、睡眠障碍（B  = − 0.16，p  = 0.007）、疼痛干扰（B  = − 0.19，p  = 0.014）和情绪行为失控（B  = − 0.22，p  = 0.019）。年龄与所有 PROMIS 结果相关（p ≤ 0.042)。AFE 与焦虑、抑郁、痴呆或轻度认知障碍的患病率无关 ( p  ≥ 0.449)，而年龄是 ( p  ≤ 0.013)。

结论

AFE 与 PROMIS 结果显着相关，尽管关联强度较低（即效应量），但与诊断无关。我们的研究结果表明，AFE 是该队列中与健康相关的生活质量的一个重要但次要的影响因素。在检查与足球参与相关的长期结果时，未来的工作应该包括累积头部影响和相关因素的额外特征。