Mortality and Its Risk Factors Among Professional Athletes

140 Pages·2018·2.296 MB·English

by  Jeffrey S. Markowitz

SPRINGER BRIEFS IN PUBLIC HEALTH
Jeff rey S. Markowitz
Mortality and
Its Risk Factors
Among Professional
Athletes
A Comparison
Between Former NBA
and NFL Players
123
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Jeffrey S. Markowitz
Mortality and Its Risk
Factors Among Professional
Athletes
A Comparison Between Former NBA
and NFL Players
Jeffrey S. Markowitz
Health Data Analytics
Princeton Junction
New Jersey, USA
ISSN 2192-3698 ISSN 2192-3701 (electronic)
SpringerBriefs in Public Health
ISBN 978-3-319-77202-8 ISBN 978-3-319-77203-5 (eBook)
https://doi.org/10.1007/978-3-319-77203-5
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Prologue
I’ve always loved playing and watching competitive sports. I think these feelings go
back to when I was a young boy growing up in the East New York section of
Brooklyn where playing any kind of ball, whether it be in a park, on a street, in an
alleyway, or even on a sidewalk, was totally intoxicating for me. It could have been
the friendships, the challenges, the competition, or just getting out of my home
where my family was living in near-impoverished conditions. It wasn’t my parents’
fault or anything like that; they were good, caring people. But as immigrants from
Cuba, they didn’t have the education or skills that were needed to provide much
more than the rent money and scanty meals for our family of five. I lived a dual
existence during these formative years. I was ecstatic while playing ball outside, but
miserable and unhappy while inside my home.
My friends and I continued to play sports outdoors during the colder months of
the year, but on those freezing New York City days, this became difficult. Staying
inside my family’s small apartment improved a bit when my parents bought a
21-inch black and white TV. I couldn’t tell you exactly when, but at some time dur-
ing the mid-1950s, I recall watching National Football League (NFL) games on
Sunday afternoons, and of course, my favorite team was the New York Giants. The
National Basketball Association (NBA) also began televising some of their games
in the mid-1950s, and the New York Knicks ascended as my favorite team. My pas-
sion for the NFL and NBA generally, and the Giants and Knicks specifically, began
back then and has continued to this day.
Of course, as a kid I played a little one-on-one and three-man basketball in the
schoolyard, as well as two-hand touch football on the street. While I never excelled
at either sport, playing them added to my respect for these games. The thing I
remember most about playing basketball was how physical and exhausting it was,
even after just a few minutes of play. Touch football, with all its blocking and occa-
sional foul play, was much more physical than it sounds. It became obvious to me
that to play these sports at higher levels required tremendous strength, speed, endur-
ance, agility, and so many other skills and attributes.
Perhaps the aspect of basketball and football that interested me most, however,
was the statistics. Honestly, math was my only good subject in grade school and I’ve
v
vi Prologue
always believed that this was because of my interest in sports. The statistics that
were published in daily newspapers during the 1950s and 1960s were rudimentary
by today’s standards. Nevertheless, I often found myself, with little success, attempt-
ing to identify relationships between game statistics and the Knicks and Giants
winning and losing. The only way for me to do this was with calculations done by
hand. As a reminder, there was no Internet or fantasy sports at that time and the
statistics I was computing could not be procured with a few clicks on a laptop.
I managed to get through grade school, junior high, and high school and in 1967
began undergraduate studies at Queens College. By then, and with the anti-Vietnam
war movement in full swing, my interests had evolved. I developed a zeal for the
social sciences, especially political science, my major, and sociology, my minor. I
became interested in social problems and the plight of the poor and other under-
privileged groups. It didn’t take long for me to develop ways of applying my primi-
tive statistical skills to these areas. I always felt strongly that the social sciences
required the application of solid statistical techniques for the work to be meaningful
and I still feel that way today.
In the late 1970s, I began graduate studies at the Columbia University School of
Public Health in New York City. I was fortunate enough to be granted a full trainee-
ship from the US Public Health Service that paid for this. I majored in Health Policy
and Management, and as a Masters and Doctor of Public Health student, also took
courses in epidemiology and biostatistics. I discovered that the social problems that
I had studied as an undergraduate student were virtually always linked to a range of
health outcomes. Upon graduating from Columbia in 1988, I held joint academic
appointments in Public Health and Psychiatry and taught graduate courses in
research methods as an Adjunct Professor.
In 1989, I returned to my childhood roots as a biostatistician for a major pharma-
ceutical company in New Jersey. I analyzed clinical trial data, mainly in the cardio-
vascular area, and submitted statistical documentation to support new drug
applications.
Following my career in the drug industry, I began a consulting business, mainly
with pharmaceutical company clients. Most of my projects focused on outcomes
and epidemiological research. The conflating of social science, public health plus
advanced biostatistical skills served me well for about the next 15 years. By then, in
2010, I was ready to retire.
My plans for retirement included playing tennis, guitar, chess, going to the gym,
as well as some travel. The very next year, however, heart valve leakage that my
cardiologist had been following for years had deteriorated. The hope was to repair
the valve with “minimally invasive” surgery. However, these plans went awry when
the surgeon discovered the full extent of the pathology, and after 11 hours, I emerged
from surgery with two major incisions, a pig’s mitral valve, and a whole lot of recu-
perating in front of me.
Obviously, I was happy to be alive, although my original plans for retirement had
to be modified. I had continued to closely follow the NBA and NFL and became
interested in studying the epidemiology of concussions in professional football. It
took 2 years to collect data that would enable me to determine the incidence and risk
Prologue vii
factors of concussions among NFL players during a 3-year period, 2010 through
2012, and then another year to write, with my older daughter’s help, my first book
titled “Pigskin Crossroads: The Epidemiology of Concussions in the National
Football League, 2010–2012” (Markowitz and Markowitz 2013). Three years later,
my second book, “Lost Seasons: Arrests, Suspensions, Career Chaos and Mortality
in the National Football League” was published (Markowitz 2016).
In one chapter of Lost Seasons, I delved into mortality within former NFL play-
ers. This preliminary analysis served as the impetus for the current book. I knew that
it would make things much more interesting if I could compare mortality rates
between former NFL players with another group of professional athletes, and it
didn’t take long for me to decide to add NBA players to my study. It took me about
2 years to collect and organize data on every NBA player who played in the league
anytime between 1960 and 1986. This was the same period that I had already col-
lected mortality and other data on NFL players. The final data collection step was
updating the NFL mortality data that I had used in my second book.
My approach to identifying risk factors for mortality among former NBA and
NFL players focuses on social, demographic, and play-related variables. Because of
my background in the social sciences, I’m especially interested in understanding the
role of variables related to socioeconomic status (SES), a blend of education,
income, occupation, and residence.
I begin the book with an introductory chapter that covers two areas. First, there
is a brief description of historical public health and epidemiological efforts that
have contributed to our understanding of factors associated with the risk of mortal-
ity. As this brief review will demonstrate, risk factors for mortality are often social
in origin. Also, early-life circumstance can be quite important with respect to mor-
tality later in life. The other section of the Introduction explains the objectives of the
empirical research detailed in this book as well as the general analytic approach that
will be taken.
After this, there is a chapter that describes the methods used in this study. I detail
the data sources that will be used and provide a summary of how the data will be
analyzed. Chapter 3 is the first chapter with actual empirical data and provides back-
ground information for many of the key study variables; things like vital status, year
of birth, and age at death. The next four chapters focus on each of the potential risk
factor variables analyzed in this book: race, body mass index (BMI), birthplace
region, and number of career years played. The rationale for studying each of these
variables will be explained in the respective chapters. Following individual exami-
nation of each of these four variables, I determine which of these are independent
predictors of mortality using multivariate analyses. Chapter 9 describes the role of
player position which is the only other variable that will be studied as a potential
risk factor for mortality in this book. (It’s impossible to include player position in
the multivariate analysis conducted in Chap. 8 because there’s no overlap whatso-
ever between the leagues with respect to position.)
The empirical data chapters described above are internal analyses that focus on
identifying within- and between-league risk and protective factors for mortality.
Chapter 10 contains an external comparison of mortality rates between former NBA
viii Prologue
and NFL players, on the one hand, versus the general population, on the other. In
epidemiology, the term “general population” often refers to all persons, although
this is sometimes narrowed down to individuals within a subgroup of the entire
population like all US males, 20 years of age and older.
At the end of each empirical chapter there are brief discussion sections. Chapter
11 will contain a more detailed discourse on the study findings and what they mean.
Conclusions and implications will be the focus of Chap. 11.
For purposes of this book, a risk factor is simply a variable that is statistically
associated with mortality and the opposite of a risk factor is a protective factor.
While the presence of a risk factor raises mortality risk, a protective factor lowers it.
Risk and protective factors are sometimes called “determinants” of disease, mortal-
ity, or any outcome of interest. In fact, some studies examine whether selected
determinants cause the outcome being examined. As will be discussed in the next
chapter, this is not the purpose of the current book.
The identification of determinants of mortality within exceptionally fit groups,
like NBA and NFL players, can provide important clues for further study and may
lead to the formulation of preventative measures. The results described in this book
can be generalized to the study cohort being investigated. Some study findings may,
however, also be germane to a much larger group of professional and nonprofes-
sional basketball and football players, as well as individuals participating in other
sports.
To address the kinds of research questions posed in this book, the application of
meaningful statistical methods is essential. With this comes a level of technical
complexity that may be challenging for some readers. To minimize this as a poten-
tial problem, some extra time will be taken to explain, at least conceptually, some of
the key statistics that I utilize in this book. There will also be “Summary of Results”
sections in each empirical chapter that briefly describe the statistical results in non-
technical terms.
In my first two books, I did not mention players’ names as part of the research
and I’m going to continue this policy in this book. It could prove interesting if sto-
ries of specific players––their lives and their deaths––were presented in this book.
This, however, must be weighed against the possibility of hurting or embarrassing
an individual and/or their family by revealing a lot of personal information in a man-
ner that’s never been done before. Given the subject matter of this book––mortal-
ity–– sensitivities about disclosing certain information about individuals could be
heightened. There may also be Health Insurance Portability and Accountability Act
(HIPPA) policies and rules (US Department of Health & Human Services 2003) that
apply to divulging private health information about individuals studied as part of a
research effort. In the spirit of these rules and policies, and in deference to the pri-
vacy and possible sensitivities of former players, their families, friends, and team-
mates, no individual player names will be disclosed in this book.
With several notable exceptions, not too much has been written about profes-
sional basketball and football players in scholarly publications. During the period
1994–2010, members of the NFL’s Mild Traumatic Brain Injury (MTBI) Committee
published more than a dozen journal articles. Unfortunately, these papers unfairly
Prologue ix
minimized the incidence and consequences of player concussions and, because of
this, the research community had no choice but to dismiss much of the information
contained in these publications (Fainaru-Wada and Fainaru 2013; Markowitz and
Markowitz 2013). In recent years, however, an influx of excellent scholarly publica-
tions has appeared related to head injuries, concussions, and chronic traumatic
encephalopathy (CTE) among football players and others affected by repetitive
blows to the head.
The truth of the matter is that a lot of what we know, or think that we know, about
NBA and NFL players comes from internet articles. Sadly, these publications often
have limited or unknown credibility. I view it as a personal responsibility to double-
check all the material cited in this book. In addition, I’ll make every effort to let
readers know exactly what my sources are.
Reader questions and comments are welcomed. Feel free to contact me at
[email protected]. Hope that you enjoy the book!
References
Fainaru-Wada, M., & Fainaru, S. (2013). League of denial: The NFL, concussions, and the battle
for truth. New York: Crown Archetype.
Markowitz, J. S. (2016). Lost seasons: Arrests, suspensions, career chaos and mortality among
National Football League (NFL) players. North Charleston: CreateSpace.
Markowitz, J., & Markowitz, A. (2013). Pigskin crossroads: The epidemiology of concussions
in the National Football League (NFL), 2010–2012 (J. S. Markowitz & A. Markowitz, eds.),
North Charleston: CreateSpace.
US Department of Health & Human Services. (2003). OCR privacy brief. Summary of the HIPPA
privacy rule. Retrieved from https://www.hhs.gov/sites/default/files/privacysummary.pdf