Applying the Bradford Hill Criteria for Causation to Repetitive Head Impacts and Chronic Traumatic Encephalopathy

Details

• Personal Author:
  Buckland ME ; Bureau SC ; Cantu RC ; Curtis MA ; Daneshvar DH ; Faull RLM ; Finkel AM ; Grinberg LT ; Hill-Yardin EL ; Murray HC ; Nowinski CJ ; Pearce AJ ; Suter CM ; White AJ
• Description:
  Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease associated with a history of repetitive head impacts (RHI). CTE was described in boxers as early as the 1920s and by the 1950s it was widely accepted that hits to the head caused some boxers to become "punch drunk." However, the recent discovery of CTE in American and Australian-rules football, soccer, rugby, ice hockey, and other sports has resulted in renewed debate on whether the relationship between RHI and CTE is causal. Identifying the strength of the evidential relationship between CTE and RHI has implications for public health and medico-legal issues. From a public health perspective, environmentally caused diseases can be mitigated or prevented. Medico-legally, millions of children are exposed to RHI through sports participation; this demographic is too young to legally consent to any potential long-term risks associated with this exposure. To better understand the strength of evidence underlying the possible causal relationship between RHI and CTE, we examined the medical literature through the Bradford Hill criteria for causation. The Bradford Hill criteria, first proposed in 1965 by Sir Austin Bradford Hill, provide a framework to determine if one can justifiably move from an observed association to a verdict of causation. The Bradford Hill criteria include nine viewpoints by which to evaluate human epidemiologic evidence to determine if causation can be deduced: strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experiment, and analogy. We explored the question of causation by evaluating studies on CTE as it relates to RHI exposure. Through this lens, we found convincing evidence of a causal relationship between RHI and CTE, as well as an absence of evidence-based alternative explanations. By organizing the CTE literature through this framework, we hope to advance the global conversation on CTE mitigation efforts. [Description provided by NIOSH]
• Subjects:
  Epidemiology Occupational Health Safety
• Keywords:
  Author Keywords: Chronic Traumatic Encephalopathy Bradford Hill Causation CTE Head Injuries Neurological Diseases Neurological Reactions Public Health Punch Drunk Repetitive Head Impact Sports Injuries TBI Traumatic Brain Injury

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• ISSN:
  1664-2295
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  California ; Massachusetts ; Michigan ; OSHA Region 1 ; OSHA Region 5 ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  13
• NIOSHTIC Number:
  nn:20070733
• Citation:
  Front Neurol 2022 Jul; 13:938163
• Contact Point Address:
  Christopher J. Nowinski, Concussion Legacy Foundation, Boston, MA, United States
• Email:
  nowinski@concussionfoundation.org
• Federal Fiscal Year:
  2022
• Performing Organization:
  University of Michigan, Ann Arbor
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  Frontiers in Neurology
• End Date:
  20280630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:fc981830f3bec8cd9a4aac056fefef13361c17dd26c0afd70e24991f9479e9d191e95db076c9a4e1e081a5998fff525e5ce952831a2daccc4c1c000b71d9fc28
• Download URL:
  https://stacks.cdc.gov/view/cdc/208903/cdc_208903_DS1.pdf
• File Type:
  [PDF - 457.90 KB ]