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Edwards RR, Tan CO, Dairi I, Whittington AJ, Thomas JD, Campbell CM, Ross E, Taylor HA, Weisskopf M, Baggish AL, Zafonte R, Grashow R. Race differences in pain and pain-related risk factors among former professional American-style football players. Pain 2023; 164:2370-2379. [PMID: 37314441 PMCID: PMC10502895 DOI: 10.1097/j.pain.0000000000002948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/17/2023] [Accepted: 04/03/2023] [Indexed: 06/15/2023]
Abstract
ABSTRACT The burden of pain is unequal across demographic groups, with broad and persisting race differences in pain-related outcomes in the United States. Members of racial and ethnic minorities frequently report more pervasive and severe pain compared with those in the majority, with at least some disparity attributable to differences in socioeconomic status. Whether race disparities in pain-related health outcomes exist among former professional football players is unknown. We examined the association of race with pain outcomes among 3995 former professional American-style football players who self-identified as either Black or White. Black players reported more intense pain and higher levels of pain interference relative to White players, even after controlling for age, football history, comorbidities, and psychosocial factors. Race moderated associations between several biopsychosocial factors and pain; higher body mass index was associated with more pain among White but not among Black players. Fatigue and psychosocial factors were more strongly related to pain among Black players relative to White players. Collectively, the substantial social and economic advantages of working as a professional athlete did not seem to erase race-related disparities in pain. We highlight an increased burden of pain among elite Black professional football players and identify race-specific patterns of association between pain and biopsychosocial pain risk factors. These findings illuminate potential future targets of interventions that may serve to reduce persistent disparities in the experience and impact of pain.
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Affiliation(s)
- Robert R. Edwards
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
| | - Can Ozan Tan
- RAM Group, Department of Electrical Engineering, Mathematics, and Computer Science, University of Twente, the Netherlands
| | - Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
| | - Alicia J. Whittington
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
| | - Julius Dewayne Thomas
- Department of Clinical Psychology, Nova Southeastern University, Fort Lauderdale, FL, United States
| | - Claudia M. Campbell
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Edgar Ross
- Department of Anesthesiology, Perioperative & Pain Medicine, Harvard Medical School, Brigham & Women's Hospital, Boston, MA, United States
| | - Herman A. Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
| | - Marc Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Aaron L. Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Cardiology, Lausanne University Hospital (CHUV) and Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA, United States
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
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Dairi I, Brown C, DiGregorio H, Wasfy M, Baggish A, Pitler L, Copen WA, Doyle M, Wu O, Zafonte R, Tenforde AS. A Case Report of Reversible Cognitive Decline in a Former Professional American-Style Football Player: Findings from the Football Players Health Study In-Person Assessments. Curr Sports Med Rep 2023; 22:154-157. [PMID: 37141607 DOI: 10.1249/jsr.0000000000001061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Cheyenne Brown
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Heather DiGregorio
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | | | | | - Linda Pitler
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - William A Copen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Michael Doyle
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, MA
| | - Ona Wu
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA
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Grashow R, Shaffer-Pancyzk TV, Dairi I, Lee H, Marengi D, Baker J, Weisskopf MG, Speizer FE, Whittington AJ, Taylor HA, Keating D, Tenforde A, Guseh JS, Wasfy MM, Zafonte R, Baggish A. Healthspan and chronic disease burden among young adult and middle-aged male former American-style professional football players. Br J Sports Med 2022; 57:bjsports-2022-106021. [PMID: 36588423 PMCID: PMC9887383 DOI: 10.1136/bjsports-2022-106021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the relationships between age, healthspan and chronic illness among former professional American-style football (ASF) players. METHODS We compared age-specific race-standardised and body mass index-standardised prevalence ratios of arthritis, dementia/Alzheimer's disease, hypertension and diabetes among early adult and middle-aged (range 25-59 years) male former professional ASF players (n=2864) with a comparator cohort from the National Health and Nutrition Examination Survey and National Health Interview Survey, two representative samples of the US general population. Age was stratified into 25-29, 30-39, 40-49 and 50-59 years. RESULTS Arthritis and dementia/Alzheimer's disease were more prevalent among ASF players across all study age ranges (all p<0.001). In contrast, hypertension and diabetes were more prevalent among ASF players in the youngest age stratum only (p<0.001 and p<0.01, respectively). ASF players were less likely to demonstrate intact healthspan (ie, absence of chronic disease) than the general population across all age ranges. CONCLUSION These data suggest the emergence of a maladaptive early ageing phenotype among former professional ASF players characterised by premature burden of chronic disease and reduced healthspan. Additional study is needed to investigate these findings and their impact on morbidity and mortality in former ASF players and other athlete groups.
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Affiliation(s)
- Rachel Grashow
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Hang Lee
- Massachusetts General Hospital Biostatistics Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Dean Marengi
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Jillian Baker
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Frank E Speizer
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Alicia J Whittington
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
| | - Herman A Taylor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, USA
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Dylan Keating
- Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Adam Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - James Sawalla Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Cardiology, Lausanne University Hospital (CHUV) and Institute for Sport Science, University of Lausanne (ISSUL), Lausanne, Switzerland
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Cortez B, Valdivia C, Keating D, Marengi D, Bates T, Brown C, Dairi I, Doyle M, Keske R, Connor A, Grashow R, Tenforde A, Wasfy MM, Weisskopf MG, Speizer F, Zafonte R, Baggish A. Multi-modality human phenotyping to examine subjective and objective health afflictions in former professional American-style football players: The In-Person Assessment (IPA) protocol. PLoS One 2022; 17:e0265737. [PMID: 35358242 PMCID: PMC8970522 DOI: 10.1371/journal.pone.0265737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Participation in American-style football (ASF), one of the most popular sports worldwide, has been associated with adverse health outcomes. However, prior clinical studies of former ASF players have been limited by reliance on subjective self-reported data, inadequate sample size, or focus on a single disease process in isolation.
Objective
To determine the burden of objective multi-system pathology and its relationship with subjective health complaints among former professional ASF players.
Methods
The In-Person Assessment is a case-control, multi-day, deep human phenotyping protocol designed to characterize and quantify pathology among former professional ASF players. Participants, recruited from an on-going large-scale longitudinal cohort study, will include 120 men who report either no health conditions, a single health condition, or multiple health conditions across the key domains of cardiometabolic disease, disordered sleep, chronic pain, and cognitive impairment. Data will be collected from validated questionnaires, structured interviews, physical examinations, multi-modality imaging, and functional assessments over a 3-day study period. A pilot study was conducted to assess feasibility and to obtain participant feedback which was used to shape the final protocol.
Results
This study provides a comprehensive assessment of objective multi-system pathology and its relationship with subjective health complaints among former professional ASF players.
Conclusion
The study will determine whether subjective health complaints among former professional ASF players are explained by objective explanatory pathology and will provide novel opportunities to examine the interrelatedness of co-morbidities. It is anticipated that this protocol will be applicable to other clinical and occupational populations.
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Affiliation(s)
- Bryan Cortez
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Chelsea Valdivia
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Dylan Keating
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Dean Marengi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Trevor Bates
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Cheyenne Brown
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Inana Dairi
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Michael Doyle
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Robyn Keske
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ann Connor
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurology, Berenson Allen Center and Division for Cognitive Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Rachel Grashow
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Adam Tenforde
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, United States of America
| | - Meagan M. Wasfy
- Department of Internal Medicine, Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Marc G. Weisskopf
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Frank Speizer
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Ross Zafonte
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, United States of America
| | - Aaron Baggish
- Football Players Health Study at Harvard University, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Internal Medicine, Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
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