Age at League Entry and Early All-Cause Mortality among National Football League Players

Background: A growing body of research suggests that American football players are exposed to higher cumulative head impact risk as competition level rises. Related literature finds that head impacts absorbed by youth, adolescent, and emerging adult players are associated with elevated risk of long-term health problems (e.g., neurodegenerative disease onset). Most National Football League (NFL) players enter the League as emerging adults (18–24 years old), a period of continued cognitive and overall physical development. However, no prior research has studied the effect of age-at-entry on long-term NFL player health. Hypothesis/Purpose: This study assesses whether early NFL player age-at-entry is associated with increased risk of early all-cause mortality, controlling for player position, BMI, year-of-entry, birth year, and NFL Draft round (expected ability upon League entry). Study Design: This retrospective cohort study included 9049 players who entered the NFL from 1970–2017 and subsequently played at least one game. The variables whether deceased, age-at-death, age-at-entry, and controls were collected from Pro Football Reference website, a leading data site for American football that has been used extensively in the literature. Data collection began on 13 July 2017, and follow-up ended on 1 July 2018. Statistical analysis was performed from 10 March 2020 to 3 August 2020. Data was validated by checking a large sub-sample of data points against alternative sources such as NFL.com and NFLsavant.com. Methods: Cox proportional hazards regression models were used to examine variation in death hazard by NFL player age-at-entry, conditional upon a full set of controls. Results: Conditional on controls, Cox regression results indicate that a one-year increase in age-at-entry was significantly associated with a 14% decreased hazard-of-death (H.R., 0.86; 95% CI, 0.74–0.98). Among relatively young entering players, the increased hazard appears to be concentrated in the first quartile of players by age at League entry (20.2 to 22.3 years). Players not in this quartile exhibited a decreased hazard-of-death (H.R., 0.74; 95% CI, 0.57–0.97) compared with players who entered at a relatively young (first quartile) age. Conclusion: An earlier age-at-entry is associated with an increased hazard-of-death among NFL players. Currently, the NFL regulates age-at-entry only indirectly by requiring players to be 3 years removed from high school before becoming NFL Draft-eligible. Implementing a minimum age at entry for NFL players of 22 years and 4 months at beginning of season is expected to result in reduced mortality. What is known about this subject? There are no prior studies on the effects of NFL player age-at-entry on early mortality risk. What this study adds to existing knowledge: This study determines whether entering the NFL at an age of physical and physiological development is related to early mortality risk.

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C-Reactive Protein and All-Cause Mortality in a Large Hospital-Based Cohort

Clinical Chemistry ◽

10.1373/clinchem.2007.091959 ◽

2008 ◽

Vol 54 (2) ◽

pp. 343-349 ◽

Cited By ~ 62

Author(s):

Claudia Marsik ◽

Lili Kazemi-Shirazi ◽

Thomas Schickbauer ◽

Stefan Winkler ◽

Christian Joukhadar ◽

...

Keyword(s):

Hospital Admission ◽

Acute Phase ◽

Cox Regression ◽

Disease Risk ◽

C Reactive Protein ◽

Reactive Protein ◽

Increased Risk ◽

All Cause Mortality ◽

Low Sensitivity

Abstract Background: C-reactive protein (CRP), an acute-phase protein, is a sensitive systemic marker of inflammation and acute-phase reactions. Testing CRP concentrations at hospital admission may provide information about disease risk and overall survival. Methods: All first-ever transmittals to the department of medical and chemical laboratory diagnostics for determination of low-sensitivity CRP (n = 274 515, 44.5% male, median age 51 years) between January 1991 and July 2003 were included [median follow-up time: 4.4 years (interquartile range, 2.3–7.4 years)]. The primary endpoint was all-cause mortality. Multivariate Cox regression adjusted for sex and age was applied for analysis. Results: Compared to individuals within the reference category (CRP <5 mg/L), hazard ratios (HR) for all-cause mortality increased from 1.4 (5–10 mg/L category) to 3.3 in the highest category (>80 mg/L, all P <0.001). CRP was associated with various causes of death. The relation of CRP to cancer death was stronger than to vascular death. Younger patients with increased CRP had relatively far worse outcome than older patients (maximal HR: ≤30 years: 6.7 vs >60 years: 1.7–3.7). Interestingly, both short- and long-term mortality were associated with increasing CRP concentrations (>80 mg/L: HR 22.8 vs 1.4). Conclusion: Measurement of low-sensitivity CRP at hospital admission allowed for the identification of patients at increased risk of unfavorable outcome. Our findings indicate that close attention should be paid to hospitalized patients with high CRP not only because of very substantial short-term risk, but also long-term excess risk, the basis for which needs to be determined.

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The association of dialysis adequacy, body mass index, and mortality among hemodialysis patients

BMC Nephrology ◽

10.1186/s12882-019-1570-0 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Woong-pyo Hong ◽

Yu-Ji Lee

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Mortality Risk ◽

Cox Regression ◽

Target Range ◽

Dialysis Adequacy ◽

Cox Regression Analysis ◽

Increased Risk ◽

All Cause Mortality ◽

High Bmi

Abstract Background Although hemodialysis (HD) adequacy, single-pool Kt/Vurea (spKt/V), is inversely correlated with body size, each is known to affect patient survival in the same direction. Therefore, we sought to examine the relationship between HD adequacy and mortality according to body mass index (BMI) in HD patients and explore a combination effect of BMI and HD adequacy on mortality risk. Methods We retrospectively reviewed patient data from the Korean Society of Nephrology registry, a nationwide database of medical records of HD patients, from January 2001 to June 2017. We included patients ≥18 years old who were receiving maintenance HD. Patients were categorized into three groups according to baseline BMI (< 20 (low), 20 to < 23 (normal), and ≥ 23 (high) kg/m2). Baseline spKt/V was divided into six categories. Results Among 18,242 patients on HD, the median follow-up duration was 5.2 (IQR, 1.9–8.9) years. Cox regression analysis showed that, compared to the reference (spKt/V 1.2–1.4), lower and higher baseline spKt/V were associated with greater and lower risks for all-cause mortality, respectively. However, among patients with high BMI (n = 5588), the association between higher spKt/V and lower all-cause mortality was attenuated in all adjusted models (Pinteraction < 0.001). Compared to patients with normal BMI and spKt/V within the target range (1.2–1.4), those with low BMI had a higher risk for all-cause mortality at all spKt/V levels. However, the gap in mortality risk became narrower for higher values of spKt/V. Compared to patients with normal BMI and spKt/V in the target range, those with high BMI and spKt/V < 1.2 were not at increased risk for mortality despite low dialysis adequacy. Conclusions The association between spKt/V and mortality in HD patients may be modified by BMI.

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High-risk lifestyle and all-cause mortality in older Australians with stroke: A data linkage study

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1119 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

W Peng ◽

Andrew Hayen ◽

J a n e Maguire ◽

J o n Adams ◽

David Sibbritt

Keyword(s):

Public Health ◽

High Risk ◽

Cox Regression ◽

Healthy Lifestyle ◽

Lifestyle Factors ◽

Stroke Survivors ◽

Vigorous Exercise ◽

Increased Risk ◽

All Cause Mortality

Abstract Background Stroke prevention via lifestyle modification is a public health priority in developed countries. Few studies have examined the association of high-risk lifestyle factors with long-term mortality of stroke survivors. Therefore, this study aims to explore the effect of key lifestyle factors on all-cause mortality after stroke. Methods Sample is derived from the 45 and Up Study, the largest ongoing study in the Southern Hemisphere focusing on the health of people aged 45 years and older living in NSW, Australia. The lifestyle data in the 45 and Up Study between 2006 to 2015 were linked with data from the NSW Registry of Births, Deaths and Marriages, NSW Cause of Death Unit Record File, and NSW Admitted Patient Data Collection by the Centre for Health Record Linkage. We defined a high-risk lifestyle as no vigorous exercise, smokers, or > 10 alcoholic drinks/week. Multivariate Cox regression model is used to examine the effect of high-risk lifestyle on survival using 10-year all-cause mortality as the main outcome, adjusted for key confounders. Results We analysed information on 8410 adults with a stroke event occurring prior to the baseline 45 and Up Study, and 31% of them died in 10 years. 6219 participants were identified as having a high-risk lifestyle at baseline. Being a current smoker and without vigorous exercise were associated with 41% (95% CI: 16%, 73%) and 52% (95% CI: 30%, 78%) increase in the likelihood of death in 10 years, respectively. However, high-risk alcohol drinking was not significantly associated with survival. Of note, having cardiovascular-related comorbidities showed greater risks of mortality (HR range, 3.6-7.2). Conclusions High-risk lifestyle factors were associated with an increased risk of long-term all-cause mortality, suggesting that enhancing public health initiatives to promote 'healthy' lifestyle behaviours can be of great benefit to stroke survivors. Key messages It is essential for stroke survivors to maintain a healthy lifestyle to delay all-cause mortality. Stroke survivors with high-risk lifestyle may be associated with increased likelihood of death if they have comorbidities such as diabetes and hypertension.

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Long-Term All-Cause Mortality and Its Association with Cardiovascular Risk Factors in Thyroid Cancer Survivors: An Israeli Population-Based Study

10.21203/rs.3.rs-39122/v3 ◽

2020 ◽

Author(s):

Elena Izkhakov ◽

Lital Keinan-Boker ◽

Micha Barchana ◽

Yacov Shacham ◽

Iris Yaish ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Thyroid Cancer ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cox Regression ◽

Increased Risk ◽

All Cause Mortality

Abstract Background: The global incidence of thyroid cancer (TC) has risen considerably during the last three decades, while prognosis is generally favorable. We assessed the long-term all-cause mortality in TC survivors compared to the general population, and its association with cardiovascular risk factors. Methods: Individuals diagnosed with TC during 2001-2014 (TC group) and age- and sex-matched individuals from the same Israeli healthcare system without thyroid disease or a cancer history (non-TC group) were compared. Cox regression hazard ratios (HRs) and 95% confidence intervals (95%CIs) for all-cause mortality were calculated by exposure status. Results: During a 15-year follow-up (median 8 years), 577 TC survivors out of 5,677 (10.2%) TC patients and 1,235 individuals out of 23,962 (5.2%) non-TC patients died. The TC survivors had an increased risk of all-cause mortality (HR=1.89, 95%CI 1.71-2.10), after adjusting for cardiovascular risk factors already present at follow-up initiation. This increased risk was most pronounced in the 55- to 64-year-old age group (HR=1.49, 95%CI 1.33-1.67). The TC survivors who died by study closure had more hypertension (14.6% vs. 10.3%, P = 0.002), more dyslipidemia (11.4% vs. 7.2%, P < 0.001), and more cardiovascular disease (33.6% vs. 22.3%, P = 0.05) compared to those who died in the non-TC group. Conclusions: This large cohort study showed higher all-cause mortality with a higher prevalence of hypertension, dyslipidemia, and cardiovascular disease among TC survivors compared to matched non-TC individuals. Primary and secondary prevention of cardiovascular risk factors in TC survivors is mandatory.

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Association between Cardiovascular Risk Factors and Long-Term All-Cause Mortality in Thyroid Cancer Survivors: An Israeli Population-Based Study

10.21203/rs.3.rs-39122/v1 ◽

2020 ◽

Author(s):

Elena Izkhakov ◽

Lital Keinan-Boker ◽

Micha Barchana ◽

Yacov Shacham ◽

Iris Yaish ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Thyroid Cancer ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cox Regression ◽

Increased Risk ◽

All Cause Mortality

Abstract Background: The global incidence of thyroid cancer (TC) has risen considerably during the last three decades, while prognosis is generally favorable. We assessed the association between long-term all-cause mortality and cardiovascular risk factors in TC survivors compared to the general population. Methods: Individuals diagnosed with TC during 2001-2014 (TC group) and age- and sex-matched individuals from the same Israeli healthcare system without thyroid disease or a cancer history (non-TC group) were compared. Cox regression hazard ratios (HRs) and 95% confidence intervals (95%CIs) for all-cause mortality were calculated by exposure status. Results: During a 15-year follow-up (median 8 years), 577 TC survivors out of 5,677 (10.2%) TC patients and 1,235 individuals out of 23,962 (5.2%) non-TC patients died. The TC survivors had an increased risk of all-cause mortality (HR=1.89, 95%CI 1.71-2.10), after adjusting for cardiovascular risk factors already present at follow-up initiation. This increased risk was most pronounced in the 55- to 64-year-old age group (HR=1.49, 95%CI 1.33-1.67). The TC survivors who died by study closure had more hypertension (14.6% vs. 10.3%, P = 0.002), more dyslipidemia (11.4% vs. 7.2%, P < 0.001), and more cardiovascular disease (33.6% vs. 22.3%, P = 0.05) compared to those who died in the non-TC group. Conclusions: This large cohort study showed higher all-cause mortality with a higher prevalence of hypertension, dyslipidemia, and cardiovascular disease among TC survivors compared to matched non-TC individuals. Primary and secondary prevention of cardiovascular risk factors in TC survivors is mandatory.

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Clinical outcome of out-of-hospital vs. in-hospital cardiac arrest survivors presenting with ventricular tachyarrhythmias

Heart and Vessels ◽

10.1007/s00380-021-01976-y ◽

2021 ◽

Author(s):

Julian Müller ◽

Michael Behnes ◽

Tobias Schupp ◽

Linda Reiser ◽

Gabriel Taton ◽

...

Keyword(s):

Cardiac Arrest ◽

Propensity Score ◽

Propensity Score Matching ◽

Cox Regression ◽

Prognostic Impact ◽

Ventricular Tachyarrhythmias ◽

Increased Risk ◽

All Cause Mortality ◽

Hospital Cardiac Arrest

AbstractLimited data regarding the prognostic impact of ventricular tachyarrhythmias related to out-of-hospital (OHCA) compared to in-hospital cardiac arrest (IHCA) is available. A large retrospective single-center observational registry with all patients admitted due to ventricular tachyarrhythmias was used including all consecutive patients with ventricular tachycardia (VT) and fibrillation (VF) on admission from 2002 to 2016. Survivors discharged after OHCA were compared to those after IHCA using multivariable Cox regression models and propensity-score matching for evaluation of the primary endpoint of long-term all-cause mortality at 2.5 years. Secondary endpoints were all-cause mortality at 6 months and cardiac rehospitalization at 2.5 years. From 2.422 consecutive patients with ventricular tachyarrhythmias, a total of 524 patients survived cardiac arrest and were discharged from hospital (OHCA 62%; IHCA 38%). In about 50% of all cases, acute myocardial infarction was the underlying disease leading to ventricular tachyarrhythmias with consecutive aborted cardiac arrest. Survivors of IHCA were associated with increased long-term all-cause mortality compared to OHCA even after multivariable adjustment (28% vs. 16%; log rank p = 0.001; HR 1.623; 95% CI 1.002–2.629; p = 0.049) and after propensity-score matching (28% vs. 19%; log rank p = 0.045). Rates of cardiac rehospitalization rates at 2.5 years were equally distributed between OHCA and IHCA survivors. In patients presenting with ventricular tachyarrhythmias, survivors of IHCA were associated with increased risk for all-cause mortality at 2.5 years compared to OHCA survivors.

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High concentrations of plasma trimethylamine-n-oxide is associated with long-term cardiovascular mortality in patients with acute coronary syndrome

European Heart Journal ◽

10.1093/eurheartj/ehab724.1383 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

C Eyileten ◽

J Jarosz-Popek ◽

D Jakubik ◽

M Wolska ◽

A Fitas ◽

...

Keyword(s):

Cardiovascular Disease ◽

Acute Coronary Syndrome ◽

Predictive Value ◽

Cox Regression ◽

Independent Predictor ◽

Cox Regression Analysis ◽

Coronary Syndrome ◽

Increased Risk ◽

All Cause Mortality

Abstract Background Acute coronary syndrome (ACS) remains a leading cause of mortality worldwide [1]. Patients who experienced ACS are at high risk of future cardiovascular events and death [2–4]. Identification of reliable predictive tools could potentially improve the risk stratification [5]. Numerous studies revealed that intestinal microbial organisms (microbiota) and its metabolites, as TMAO (trimethylamine-N-oxide) may play a pathogenic role in a cardiovascular disease (CVD) and ACS [6]. Elevated concentration of circulating TMAO has been associated with increased risk of CVD and major adverse cardiac events (MACE), including myocardial infarction (MI), stroke, major bleeding and all-cause mortality [7]. Purpose To investigate the association of liver metabolite TMAO with cardiovascular disease (CV)-related and all-cause mortality in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention. Methods Our prospective observational study enrolled 292 patients with ACS. Plasma concentrations of TMAO were measured during the hospitalization for ACS. Observation period lasted 7 years in the median. Adjusted Cox-regression analysis was used for prediction of mortality. Results ROC curve analysis revealed that increasing concentrations of TMAO levels assessed at the time point of ACS significantly predicted the risk of CV mortality (c-index=0.78, p<0.001). The cut-off value of >4 μmol/L, labeled as high TMAO level (23% of study population), provided the greatest sum of sensitivity (85%) and specificity (80%) for the prediction of CV mortality and was associated with a positive predictive value of 16% and a negative predictive value of 99%. A multivariate Cox regression model revealed that high TMAO level was a strong and independent predictor of CV death (HR=11.62, 95% CI: 2.26–59.67; p=0.003). High TMAO levels as compared with low TMAO levels were associated with the highest risk of CV death in a subpopulation of patients with diabetes mellitus (27.3% vs 2.6%; p=0.004). Although increasing TMAO levels were also significantly associated with all-cause mortality, their estimates for diagnostic accuracy were low. Conclusions High TMAO level is a strong and independent predictor of long-term CV mortality among patients presenting with ACS. TMAO concentration of 4 μmol/L may be a cut-off value for prognosis of ACS patients. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Kaplan-Meier curves Table 1

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P627Patterns of physical activity over 22 years and mortality: the HUNT Study, Norway

European Heart Journal ◽

10.1093/eurheartj/ehz747.0235 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Moholdt ◽

B Moe ◽

T I L Nilsen

Keyword(s):

Physical Activity ◽

Mortality Risk ◽

Cox Regression ◽

Baseline Measure ◽

Physically Active ◽

Reference Category ◽

Increased Risk ◽

All Cause Mortality ◽

Hunt Study ◽

Cvd Mortality

Abstract Background The majority of studies relating physical activity (PA) to mortality have assessed PA using one baseline measure. Important questions in a preventive perspective are whether you can compensate for prior physical inactivity by taking up PA at a later stage in life and whether being physically active earlier in life can confer benefits even if you become inactive later. We investigated how patterns of PA over 22 years associated with all-cause and cardiovascular disease (CVD) mortality. Methods We used data from the prospective population-based HUNT Study in Norway, including 10,491 men and 12,655 women aged ≥20 years who participated at HUNT in 1984–86 and 2006–08. PA was categorised into inactive, <2 h/week or ≥2 h/week, making nine categories of patterns of PA over 22 years. All-cause and CVD mortality were assessed from the national Cause of Death Registry, with follow-up until the end of 2013. We used Cox regression to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) for all-cause and CVD mortality within categories of PA patterns, compared to the reference category of individuals who reported ≥2 h/week at both examinations. Estimates were adjusted for baseline age, sex, body mass index, smoking, education level and blood pressure. Results Individuals who were inactive in both 1984–86 and in 2006–08 had increased risk of all-cause mortality (HR 1.99, 95% CI 1.48–2.67) and CVD mortality (HR 2.68, 95% 1.47–4.86) compared to those who were physically active ≥2 h/week at both examination. The HRs for all-cause and CVD mortality were 1.60 (1.22–2.15) and 1.90 (1.06–3.42), respectively, for those who reported PA of <2h/week at both examinations. Individuals who went from being physically active in 1984–86 to inactive in 2006–08, had a comparable risk of all-cause and CVD mortality as those who were inactive at both examinations. Overall, the mortality risk was still increased in those who took up PA between the two examinations, compared to the reference category. Physical activity & all-cause mortality. Discussion Individuals who remained physically inactive or who decreased their PA over 22 years had substantially increased all-cause and CVD mortality risk. Taking up PA only attenuated the risk but a high level of sustained PA was associated with the lowest risk. Acknowledgement/Funding Funded by the Norwegian Health Association

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Long-Term All-Cause Mortality and Its Association with Cardiovascular Risk Factors in Thyroid Cancer Survivors: An Israeli Population-Based Study

10.21203/rs.3.rs-39122/v2 ◽

2020 ◽

Author(s):

Elena Izkhakov ◽

Lital Keinan-Boker ◽

Micha Barchana ◽

Yacov Shacham ◽

Iris Yaish ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Thyroid Cancer ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Cox Regression ◽

Increased Risk ◽

All Cause Mortality

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Advanced Liver Fibrosis Predicts Unfavorable Long-Term Prognosis in First-Ever Ischemic Stroke or Transient Ischemic Attack

Cerebrovascular Diseases ◽

10.1159/000510436 ◽

2020 ◽

Vol 49 (5) ◽

pp. 474-480

Author(s):

Minyoul Baik ◽

Hyo Suk Nam ◽

Ji Hoe Heo ◽

Hyung Jong Park ◽

Beom Kyung Kim ◽

...

Keyword(s):

Ischemic Stroke ◽

Liver Fibrosis ◽

Transient Ischemic Attack ◽

Cox Regression ◽

Advanced Fibrosis ◽

Increased Risk ◽

All Cause Mortality ◽

Long Term Prognosis ◽

Ischemic Attack

Introduction: There are a limited number of studies investigating the relationship between the degree of liver fibrosis and the long-term prognosis, especially ischemic stroke (IS) recurrence, in first-ever IS or transient ischemic attack (TIA). Objective: We investigated whether there are differences in the long-term all-cause and cardiovascular mortalities and IS recurrence based on the degree of liver fibrosis in first-ever IS or TIA. Methods: This analysis included 2,504 patients with first-ever IS or TIA recruited from a prospective stroke cohort. Liver fibrosis was predicted using the fibrosis-4 (FIB-4) index, and advanced fibrosis was defined as an FIB-4 index of >3.25. Using Cox regression models, we compared the all-cause and cardiovascular mortalities and IS recurrence. As measures for the additive predictive value of the FIB-4 index for prediction of all-cause mortality, the integrated area under the receiver operating characteristic curve (iAUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used. Results: There were 231 (9.2%) patients with advanced fibrosis. During a median follow-up of 1.2 years, the cumulative all-cause and cardiovascular mortalities were 6.4 and 1.9%, and IS recurrence was observed in 5.3%. The advanced fibrosis was associated with an increased risk of all-cause mortality (hazard ratio [HR] = 3.98, 95% confidence interval [CI] = 2.40–6.59), cardiovascular mortality (HR = 4.48, 95% CI = 1.59–12.65), and IS recurrence (HR = 1.95, 95% CI = 1.05–3.65). Adding the FIB-4 index to the model consisting of traditional cardiovascular risk factors improved the predictive accuracy for all-cause mortality as measured using the iAUC (from 0.7594 to 0.7729) and for all-cause mortality at 1 year as measured using the NRI (38.6%) and IDI (0.037). Conclusions: The burden of liver fibrosis is associated with unfavorable long-term prognosis, including recurrent IS, in first-ever IS or TIA.

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