Limitations of athlete-exposures as a construct for comparisons of injury rates by gender/sex: A narrative review
Publication information:
Danielsen, Ann Caroline, Annika Gompers, Sheree Bekker, and Sarah S. Richardson. “Limitations of Athlete-Exposures As a Construct for Comparisons of Injury Rates by Gender Sex: A Narrative Review”. British Journal of Sports Medicine doi:10.1136/ bjsports-2024-108812 (2024).
Abstract
High rates of anterior cruciate ligament (ACL) injuries in girls’ and women's sports have garnered significant attention from researchers, sport organizations, and the media. Gender/sex disparities in ACL injury rates are often estimated using the construct of athlete-exposures (AEs), a widely used measure of exposure time in sports science and epidemiology that is defined as one athlete participating in one practice or competition. In this narrative review, we explain the limitations of AEs as a measure of exposure time and develop a series of conceptual critiques regarding the use of AEs for the purposes of comparing injury rates by gender/sex. We show that the differing training-to-match ratio and average team size between women and men - rooted in persistent gendered inequities in sports participation and professionalization - may jeopardize the validity of using AEs for cross-gender comparisons and skew gender/sex disparities in ACL injury rates. To avoid bias, we invite researchers interested in gender/sex disparities in injury rates to collect finer-grained data including individual-level AEs and separate training and competition AEs, as well as to appropriately control for team size and training-to-match ratio at the data analysis stage. Any quantitative comparisons of injury rates should also thoroughly contextualize the limitations of AEs, including their inability to capture the potential qualitative differences between women’s and men’s training and sporting environment that may influence injury rates. Ann Caroline Danielsen and Annika Gompers are co-lead authors of this article.