The Cumulative Effects Of A Collegiate Career On Self-reported Health: Findings From The NCAA-DoD CARE Consortium

PURPOSE The acute effects of concussion in collegiate athletes have been widely characterized, but the intermediate effects following collegiate career end (CCE) are less understood. Thus, we evaluated differences in self-reported health (physical & psychological) measures based on lifetime concussion history and contact exposure at student-athletes’ within one year of CCE. METHODS Student-athletes (n=3,675; 51.4% female) enrolled in the Concussion Assessment, Research, and Education (CARE) Consortium completed the following measures within one year of CCE: Alcohol Use Disorders Identification Test (AUDIT), Neurological Quality of Life (Neuro-QoL), 9-item Patient Health Questionnaire (PHQ-9), 12-item Short Form Survey (SF-12; [Mental Composite Score {MCS} and Physical Composite Score {PCS}]), and Satisfaction With Life Scale (SWLS). Separate multivariable binomial logistic regressions were used to assess differential odds of outcomes crossing established clinical thresholds by sport exposure (unexposed [referent], low, high) and concussion history (0 [referent], 1-2, 3+). Models were adjusted for sex, race, and total years of sport participation, and odds ratios (OR) with 95% confidence intervals (CI) were used to assess potential associations. RESULTS Low and high contact groups, relative to non-contact student-athletes, had lower odds of reporting abnormal scores on multiple questionnaires (see table). PCS showed higher odds in low exposure student-athletes of crossing the clinical threshold. Those with 3+ concussions had higher odds of reporting an abnormal score on multiple assessments. CONCLUSIONS Sport exposure and concussion history were associated with worse outcomes across several health measures at the end of a collegiate athletic career. Additional longitudinal monitoring is warranted to evaluate these changes through early and middle adulthood. Table 1: - Odds of Reporting Abnormal Questionnaire Scores, by Contact Level and Concussion History1 Questionnaire (cutoff score) Low Exposure vs Unexposed OR (95% CI) High Exposure vs Unexposed OR (95% CI) 1-2 Concussions vs 0 OR (95% CI) 3+ Concussions vs 0 OR (95% CI) AUDIT (15) 0.61 (0.25-1.40) 1.61 (0.87-3.09) 0.80 (0.45-1.35) 1.66 (0.48-4.33) Neuro-QoL (45) 0.62 (0.48-0.79) 0.68 (0.53-0.87) 0.97 (0.78-1.21) 2.24 (1.37-3.55) PHQ-9 (10) 0.52 (0.31-0.85) 0.46 (0.27-0.77) 1.33 (0.86-2.02) 4.58 (1.73-10.81) MCS (43) 0.81 (0.64-1.03) 0.84 (0.65-1.07) 1.03 (0.84-1.26) 1.91 (1.18-3.01) PCS (50) 1.48 (1.08-2.04) 1.23 (0.89-1.70) 1.15 (0.90-1.46) 1.69 (0.93-2.88) SWLS (20) 0.57 (0.40-0.83) 0.67 (0.47-0.95) 1.10 (0.81-1.47) 1.28 (0.55-2.57) Supported by the NCAA-DoD (W81XWH-14-2-0151).