Association Between History of Multiple Concussions and Health Outcomes Among Former College Football Players: 15-Year Follow-up From the NCAA Concussion Study (1999-2001)

Zachary Y Kerr, Leah C Thomas, Janet E Simon, Michael McCrea, Kevin M Guskiewicz
American Journal of Sports Medicine 2018, 46 (7): 1733-1741

BACKGROUND: Previous research has examined associations between concussion history and adverse health outcomes among former professional football players. Less is known about the potential effects of concussion among former college football players without additional exposure at the professional level.

PURPOSE: To examine the association between concussion and adverse health outcomes in a cohort of former college football players without exposure to professional football, 15 years after their playing careers ended.

STUDY DESIGN: Cross-sectional study; Level of evidence, 3.

METHODS: A sample of 204 former collegiate football players (23.4% of eligible athletes with available contact information)-all of whom played at least 1 season of football from 1999 to 2001 in the National Collegiate Athletic Association (NCAA) and had no professional football exposure-completed a general health survey that assessed lifetime concussion history and included the following: the Veterans RAND 36 Item Health Survey, containing a physical composite score (PCS) and mental composite score (MCS); the depression module of the Patient Health Questionnaire; and the 4-item CAGE alcohol dependence questionnaire (for "cutting down, annoyance by criticism, guilty feeling, and eye-openers"). Multivariable binomial regression models estimated adjusted prevalence ratios (PRs) with 95% CIs while controlling for demographics and playing history covariates through forward selection model building.

RESULTS: Most participants reported a concussion history (84.3%). Overall, 22.1% and 39.2% of participants reported a PCS and an MCS <50, respectively (indicating worse health than the US national average); 19.1% reported Patient Health Questionnaire scores ≥10 (indicating moderate/severe depression); and 24.8% reported CAGE scores ≥2 (indicating alcohol dependence). The prevalence of having an MCS <50 was higher among those reporting ≥3 versus 0 concussions (PR, 2.5; 95% CI, 1.3-4.9). Controlling for body mass index (BMI), the prevalence of moderate/severe depression was higher among those reporting ≥3 versus 0 concussions (PR, 4.2; 95% CI, 1.0-16.3). Controlling for BMI, the prevalence of having a PCS <50 was higher among those reporting ≥3 versus 1 or 2 concussions (PR, 2.6; 95% CI, 1.3-5.0) but not 0 concussions (PR, 1.5; 95% CI, 0.6-3.6). No associations were found for alcohol dependence.

CONCLUSION: Associations between a history of multiple concussions and adverse health outcomes were found among former collegiate football players without professional football exposure but were limited to those reporting ≥3 prior concussions. Because only 23.4% of eligible athletes responded to the survey, the possibility of ascertainment bias exists, and our findings should thus be interpreted with some caution. Continued examination within nonprofessional football populations is needed, but findings highlight the need for prevention efforts to reduce concussion incidence.

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