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- Title
Association of Limited In-Person Attendance in US National Football League and National Collegiate Athletic Association Games With County-Level COVID-19 Cases.
- Authors
Toumi, Asmae; Zhao, Haoruo; Chhatwal, Jagpreet; Linas, Benjamin P.; Ayer, Turgay
- Abstract
Key Points: Question: Are football games with limited in-person attendance associated with increased county-level COVID-19 cases? Findings: This cross-sectional study of US counties that hosted National Football League and National Collegiate Athletic Association football games used a matching and difference-in-differences design to estimate the association of games with limited in-person attendance with county-level COVID-19 spread. There was no association between higher county-level COVID-19 cases and hosting football games with limited in-person attendance. Meaning: This study suggests that football games held with limited in-person attendance were not associated with increased COVID-19 cases in the counties they were held. This cross-sectional study examines the association of limited in-person attendance at US National Football League (NFL) and National Collegiate Athletic Association (NCAA) football games with changes in county-level COVID-19 case numbers. Importance: In 2020 and early 2021, the National Football League (NFL) and National Collegiate Athletic Association (NCAA) opted to host football games in stadiums across the country. The in-person attendance of games varied with time and from county to county. There is currently no evidence on whether limited in-person attendance of games is associated with COVID-19 case numbers on a county-level. Objective: To assess whether NFL and NCAA football games with limited in-person attendance were associated with increased COVID-19 cases in the counties they were held compared with a matched set of counties. Design, Setting, and Participants: In this time-series cross-sectional study, every county hosting NFL or NCAA games with in-person attendance (treated group) in 2020 and 2021 was matched with a county that that did not host a game on the corresponding day but had an identical game history for up to 14 days prior (control group). A standard matching method was used to further refine this matched set so that the treated and matched control counties had similar population size, nonpharmaceutical interventions in place, and COVID-19 trends. The association of hosting games with in-person attendance with COVID-19 cases was assessed using a difference-in-difference estimator. Data were analyzed from August 29 to December 28, 2020. Exposures: Hosting NFL or NCAA games. Main Outcomes and Measures: The main outcome was estimation of new COVID-19 cases per 100 000 residents at the county level reported up to 14 days after a game among counties with NFL and NCAA games with in-person attendance. Results: A total of 528 games with in-person attendance (101 NFL games [19.1%]; 427 NCAA games [80.9%]) were included. The matching algorithm returned 361 matching sets of counties. The median (interquartile range [IQR]) number of attendance for NFL games was 9949 (6000 to 13 797) people. The median number of attendance for NCAA games was not available, and attendance was recorded as a binary variable. The median (IQR) daily new COVID-19 cases in treatment group counties hosting games was 26.14 (10.77-50.25) cases per 100 000 residents on game day. The median (IQR) daily new COVID-19 cases in control group counties where no games were played was 24.11 (9.64-48.55) cases per 100 000 residents on game day. The treatment effect size ranged from −5.17 to 4.72, with a mean (SD) of 1.21 (2.67) cases per 100 000 residents, within the 14-day period in all counties hosting the games, and the daily treatment effect trend remained relatively steady during this period. Conclusions and Relevance: This cross-sectional study did not find a consistent increase in the daily COVID-19 cases per 100 000 residents in counties where NFL and NCAA games were held with limited in-person attendance. These findings suggest that NFL and NCAA football games hosted with limited in-person attendance were not associated with substantial risk for increased local COVID-19 cases.
- Subjects
UNITED States; RISK factors of epidemics; HEALTH policy; COVID-19; CONFIDENCE intervals; ATHLETIC associations; CROSS-sectional method; POPULATION geography; REGRESSION analysis; RISK assessment; TIME series analysis; DESCRIPTIVE statistics; RESEARCH funding; FOOTBALL; SPORTS events; DATA analysis software; SOCIAL distancing
- Publication
JAMA Network Open, 2021, Vol 4, Issue 8, pe2119621
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2021.19621