Individual and Cumulative Health Afflictions Are Associated with Greater Impairment in Physical and Mental Function in Former Professional American Style Football Players.

INTRODUCTION Former American style football players (ASF players) have recognized health concerns associated with prior sport participation. It remains unknown whether categorizations of current health conditions, referred in this report as afflictions (conceptually framed as neurocognitive, cardiovascular, cardiometabolic, sleep apnea, and chronic pain) are associated with physical and mental function. OBJECTIVE The purpose of this study was to evaluate the association of afflictions to physical and mental function. We hypothesized that former National Football League players with any affliction would have worse function compared to unafflicted participants. We anticipated multiple afflictions would result in cumulative loss of function. DESIGN Cross-sectional retrospective design SETTING: Academic Medical Multisite Hospital System PARTICIPANTS: 3913 of 15611 Former ASF players who played professionally from 1960 to 2019 completed a survey containing measures of health and function (response rate 25%). OUTCOME Each participant completed the Patient Reported Outcome Measurement Information System (PROMIS) Global Health Scale and Physical Function questionnaires. Responses were used to generate two physical function and one mental function subscale scores. Raw scores were converted to T-scores categorized as impaired (T-score <40) or unimpaired (T-score ≥40). Primary analyses measured the association of affliction to function (impaired or unimpaired). RESULTS After adjusting for confounders (age, race, position, number of seasons, age of first exposure to football, alcohol use, smoking history, and current BMI) each affliction was associated with reduced physical function on the Global physical function subscale (risk ratio [RR]=1.23-2.45, all P<0.005), physical function scale (RR=1.24-2.75, all P<0.01) and mental function (RR=1.34 to 2.87, all P<0.0001) except for cardiovascular affliction was not associated with mental function (RR=1.15, P=0.15). The lowest functional measures were observed in those afflicted by chronic pain. Cumulative afflictions were associated with worse function. CONCLUSIONS Afflictions are associated with cumulative reduction of function. Research evaluating how afflictions interact may help elucidate mechanisms for illness and develop interventions to optimize function. This article is protected by copyright. All rights reserved.