Association Between Health History Flags And Medal Outcomes Among Elite Athletes Participating In International Competition

PURPOSE: To explore the association of flags (i.e., indications for medical follow-up) on a health history (HHx) and podium placement (i.e., medaling) among Team USA athletes competing in the 2023 Pan American Games (PAG). METHODS: Six hundred and four athletes (female, n = 320 [53%]; ethnic minority, n = 200 [33.1%]; medalists, n = 363 [60.1%]) competing in the PAG completed an electronic HHx prior to competition. HHx data were used to determine binary flags (yes/no) for a range of health conditions: ongoing medical concerns, family history of sickle cell trait/disease, any concussions in the last 12 months, history of eating disorder, losing weight via dehydration, diagnosis of any breathing concern/condition, the use of sleep medications regardless of frequency, allergies, carrying an EpiPen, exertional syncope or near-syncope, sudden cardiac death in a family member younger than 35, family history of a genetic heart problem, or family history of an implanted cardiac pacemaker before age 35. Binary logistic regression determined the association of these HHx flags on the probability of being a medalist at the PAG after controlling for athlete sex (male/female), minority status (white/non-white), age (years), and sport type (team/individual). RESULTS: 462 medals (220 Gold, 135 silver, 107 bronze) were awarded to 363 Team USA athletes. After controlling for sex, minority status, age, and sport type, the probability of being a medalist was lower if an athlete flagged for having sickle cell trait (OR [95%CI]; 0.42 [0.19, 0.88], p = 0.025), using dehydration as a weight loss technique (0.45 [0.21, 0.90], p = 0.025), or having a known allergy (0.64 [0.43, 0.94], p = 0.025). Athletes had a higher probability of medaling if they flagged for using sleep medications (1.90 [1.18, 3.11], p = 0.009). CONCLUSIONS: Sickle cell trait status, the use of dehydration strategies to manipulate body weight, the use of sleep medications, and presence of allergies predicted the odds of a Team USA athlete medaling at the PAG. However, mechanisms driving these associations remain speculative and may be due to environmental/external factors. The ability to predict whether an athlete will be a medalist is limited, and other variables (e.g., sports performance indicators, competition, etc.) are likely more predictive of performance outcomes. Supported by: This study was funded in part by a Research Centre Grant from the International Olympic Committee