Sports epidemiology is relatively new. Sports injuries were typically categorized as accidents by general physicians and epidemiologists 20 years ago. However, a need for more evidence on risk factors, prevention, and treatment methods in athletes motivated clinicians and researchers to use epidemiology methods when studying athletes. The key study that was missing from sports medicine research was the longitudinal cohort study. This is when a researcher measures the characteristics of a large sample of people and then waits to see how many are diagnosed with different diseases (Figure 1-1). Some epidemiology studies follow thousands of participants for 15 or more years to collect this type of data. Prior to 2000, there were few such studies in American sports. Because athletic careers are relatively short, longitudinal studies in sports epidemiology may only last for 1 to 2 years. However, similar to public health epidemiology, sports injury researchers examine patterns between the characteristics of the athlete and his or her sport and the likelihood that he or she will sustain a specific injury. For example, Badgeley et al6 examined 10,000 high school football injuries by position, mechanism of injury, athlete’s activity when injured, and whether the injury occurred during a game or practice, all of which helps identify who is more likely to get hurt and under what conditions. Sports epidemiologists also test the effect of changes to risk factors on the incidence of injury. After high school girl’s lacrosse required players to wear an eye shield, Lincoln et al7 saw that facial injuries decreased but the number of concussions increased. As mentioned previously, public health and medicine have successfully used epidemiology to make evidence-based decisions and have provided a path for sports injury specialists to reduce Figure 1-2. US life expectancy 2006 to 2011.9 (Reprinted with permission from Hoyert DL, Xu J. Deaths: preliminary data for 2011. http://www. cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf. Published October 10, 2012. Accessed October 15, 2015.) injuries. There are 3 key steps. First, describe the scope of the problem and identify common factors through careful documentation. Next, examine the effect of reducing a single disease factor. Last, find the best approach to reduce that factor, realizing that a solution may require multiple tries.
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To better understand the type of information that epidemiology provides, the next section reviews the authors’ current knowledge of the leading causes of death. In Chapter 2, this knowledge is connected to the role of physical activity in reducing disease incidence and decreasing the number of people with risk factors.
Prevalence and Leading Causes of Death in the United States
Life expectancy among Americans continues to rise. Children born in 2011 will live on average 78.7 years.8 This is improved from 76.86 years in 2001.9 Since the Centers for Disease Control and Prevention (CDC) began tracking life expectancy in 1902, there has been a steady increase in years until death (Figure 1-2). This is not surprising given the advancements in sanitation and medicine since the Industrial Revolution. What may be surprising is the fact that the United States lags behind other nations in life expectancy. Data collected by the United Nations found that the United States ranked 51st overall.10 Other large industrial nations similar to the United States have greater life expectancies. Japan’s average was 83.91 years, followed by Australia at 81.9 and Canada at 81.48.10
Life expectancy also differs by race and gender. For example, Black males have considerable lower life expectancies than White males. Black females tend to live longer than all males but are significantly lower than White females.11 Several behavioral, social, and environmental factors are related to these disparities, such as access to health care, education, access to healthy food, neighborhood safety, and employment opportunities.12
Although life expectancy continues to increase, there has been relatively little change to the leading causes of death for Americans in the past 60 years.7 The top 10 leading causes of death are shown in Table 1-1. Five of the top 10 have a common risk factor. Heart disease, some cancers, cerebrovascular disease, Alzheimer’s disease, and type 2 diabetes mellitus (T2DM) occur less frequently among people who are physically active.13,14 Incorporating physical activity into the treatment of these diseases improves the outcomes in 6 of the top 10, including heart disease,
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