CTE as an Occupational Health Problem

Through simulation, I demonstrate the healthy worker survivor bias in measuring concussion risk.

Intro to CTE

• Risk when playing football
• Can come from concussions, but also from repeated subconcussive injuries
• Discovered by Dr. Bennet Omalu
• Work was dismissed and silenced by the NFL
• Still very much an issue, and currently it can only be diagnosed after death
• Boston University has an awesome academic center dedicated to CTE research

Measuring CTE Risk as an Occupational Risk

• NFL tries to downplay the impact or outright deny the existence of CTE
• The NFL doesn’t want to deal with CTE and they try to introduce initiative that help but they’re kinda lame
• In occupational health, typically for workers in factories working with potentially dangerous chemicals, you want to measure the risk associated with exposure
• In our case, the exposure is to repeated subconcussive and concussive head trauma
• When measuring risk, a typical approach would be to measure cumulative exposure and then look at outcomes
• This approach would systematically underestimate the risk associated with it

• You have a healthy worker survivor bias, where underlying resilience impacts which players even receive high exposure

• Work has been for the NBA showing that higher minute loads are riskier than a naive analysis would show, giving more credence to load management decisions </d-cite>

• FIND LITERATURE ON THE IMPACT OF SUBCONCUSSIVE IMPACTS

Modeling Subconcussive Strikes

• First going to demonstrate the phenomenon mathematically with few time points
• Then demonstrate it through simulation
• Present the very simplified model
  • No competing risks
  • Ignores play style or position
  • Difficult to measure prior exposure
  • Assume effect of a hit is the same over time (one might become more vulnerable as they take more hits)
• Some literature on accumulated exposure
  • Difficult to measure the intensity of each exposure (watching tape, accelerometers in helmet, mouthguards)
  • Brain imaging pre/post sometimes
• Try to inform a simple exposure model using literature