The Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA.
Occup Environ Med. 2024 Oct 23;81(10):498-506. doi: 10.1136/oemed-2024-109571.
Career 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.
We 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.
Among 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).
Relationships 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.
职业年限常被用作研究精英运动员神经创伤暴露的指标。然而，作为一种替代指标，职业年限可能无法准确代表因果因素，且与健康结果的关联可能易受选择效应影响。迄今为止，美式职业橄榄球（ASF）职业年限与退役后健康之间的关系仍未被充分描述。
我们对前职业 ASF 运动员进行了一项基于调查的横断面队列研究。灵活回归方法测量了自我报告的职业年限与四种自我报告的健康状况之间的关联：疼痛、关节炎、情绪和认知症状。我们还测量了职业年限与四种自我报告的 ASF 暴露之间的关联：既往脑震荡征象和症状（CSS）、性能增强药物、职业生涯内手术和每场比赛的平均快照数。模型调整了年龄和种族。
在 4189 名前运动员中（52±14 岁，39%为黑人，34%为线卫），平均职业年限为 6.7±3.9 个职业赛季（范围为 1-20+）。我们观察到职业年限与结果之间存在倒 U 型关系（均 p<0.001），表明与较短或较长职业生涯的运动员相比，中等职业年限的男性运动员出现不良健康影响更为常见。与比赛相关的暴露（例如，CSS 和快照）也观察到了类似的发现。
ASF 职业年限与随后的健康状况之间的关系是非线性的。较长职业生涯运动员的关联减弱可能反映了选择效应，并表明职业年限可能不能很好地代表真正的因果因素。研究结果强调了在研究前运动员时谨慎使用职业年限作为替代暴露指标的必要性。
