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Comment & Response
April 2017

Correct Data and Meta-analytic Approaches Show the Reduced Risk of Concussion for Athletes Playing at Higher Altitudes—Reply

Author Affiliations
  • 1Department of Respiratory Therapy, Georgia State University, Atlanta
  • 2Department of Physical Therapy, High Point University, High Point, North Carolina
JAMA Neurol. 2017;74(4):485-486. doi:10.1001/jamaneurol.2016.6068

In Reply We appreciate the 2 letters concerning our recent meta-analysis.1 These letters were essentially from the same research group, and include individuals holding a licensed patent on technology aiming to replicate the supposedly protective effects of “high” altitude.

This group’s first concern addresses the 2 seasons of the National Football League data published in their earlier work.2 Since our meta-analysis,1 we used the same data set they used to replicate their analysis and added data from 2 additional National Football League seasons.3 Our analysis confirmed the author’s previously reported findings that altitude reduced concussion risk in the 2012 and 2013 seasons but showed that this effect was not repeatable for the 2014 and 2015 seasons.3 We updated our meta-analysis after ensuring all numbers were correct and used the expanded data set (4 National Football League seasons),3 along with the high school football4 and National Collegiate Athletic Association Division I football5 data sets that we originally included. As expected, there still was no difference in the incidence of concussions between altitude categories (Table).

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