Neurology · 2 h ago
Bias-adjusted CTE prevalence estimated at 74.5% among deceased NFL players
A population-based cross-sectional study used brain-bank and death-record data for 2,362 deceased former NFL players to adjust for selection bias in brain donation. The estimated prevalence of CTE neuropathology was 74.5%, lower than the 93.5% observed among donors; a conservative analysis estimated 63.7%.
- Study included 2,362 deceased former NFL players.
- CTE prevalence estimate after adjustment was 74.5%.
- Conservative lower-bound estimate was 63.7%.
- Clinical impact of CTE remains uncertain.
Researchers combined Understanding Neurologic Injury and Traumatic Encephalopathy brain-bank data with National Death Index records for former NFL players who died from 2008 through 2023. The cross-sectional study included 2,362 players: 396 brain donors and 1,966 nondonors. To account for donation selection bias, the investigators estimated the relative likelihood of donation associated with cognitive symptoms and applied that ratio to donor-based prevalence estimates.
Among 387 donors with reported neuropathology results, 362 (93.5%) had CTE. The estimated median selection ratio was 4.97 (95% CI, 4.72-5.26). After adjustment, estimated CTE prevalence at death was 74.5% (95% CI, 69.6%-78.3%); a conservative lower-bound analysis yielded 63.7% (95% CI, 57.2%-68.9%). Adjusted prevalence of all-cause dementia history during life was 27.2% (95% CI, 22.6%-31.6%).
The estimates suggest that selection bias inflates donor-based prevalence but may not account for the high estimated burden in this population. The study is observational and relies on modeled adjustment for donation bias; its findings do not establish how often CTE causes clinical symptoms. The authors say further research is needed to clarify the disease’s clinical impact.
In practice
This study estimates CTE neuropathology prevalence among deceased former NFL players, not the likelihood of CTE in living players or the cause of symptoms in an individual. Adjustment for donation-related selection bias reduced the estimate from 93.5% among donors to 74.5% in the target population, with a conservative estimate of 63.7%. These observational, model-based estimates do not establish the clinical impact of CTE or support a change in diagnosis or management; further research is needed.
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JAMA Network Open: Bias-Adjusted Prevalence of Chronic Traumatic Encephalopathy Among Deceased National Football League Players ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.