Sudden Death Associated With Sickle Cell Trait Before and After Mandatory Screening

Area of Science:

• Sports Medicine
• Public Health
• Genetics

Background:

• Sickle cell trait (SCT) is linked to sudden death risk in athletes during intense exercise.
• The NCAA implemented mandatory SCT screening or waivers and educational initiatives in 2010.
• The impact of this NCAA legislation on SCT-related deaths remains undetermined.

Purpose of the Study:

• To assess the incidence of death associated with sickle cell trait (daSCT) in NCAA athletes.
• To compare daSCT rates before and after the 2010 NCAA legislation.

Main Methods:

• An observational study analyzed NCAA athlete deaths from 2000 to 2019.
• Data included 8,309,050 athlete-years (AY).
• Incidence rates of daSCT were calculated for periods before and after the NCAA legislation.

Main Results:

• In Division I football, daSCT incidence decreased by 89% post-legislation (from 1:28,145 AY to 1:250,468 AY).
• A similar 89% reduction was observed in African American DI football athletes.
• For all NCAA athletes, the incidence of daSCT decreased, but not significantly (RR, 0.288; P = 0.146).

Conclusions:

• NCAA legislation has significantly decreased daSCT incidence in Division I football.
• daSCT cases outside of football are infrequent.
• The exact contribution of screening versus education to the observed decrease requires further investigation.