Impact of New Orleans Saints Football Games on Internal Medicine Admissions

DISCUSSION

The concept of social determinants of health is crucial in establishing a holistic understanding of the interrelationship among individuals, communities, and health outcomes. Factors such as socioeconomic status, social environments, and barriers to care should be taken into consideration in assessing the health profiles and psychosocial behaviors of a patient population. The city of New Orleans and its people provide an example of the complexity of clinical care delivery to underserved patient populations in a multisociocultural environment. As one of the oldest cities in America, New Orleans has a fascinating history, rich culture, and unique social activities that bring its communities together, one of which is watching Saints games.

The Dixit et al study (2019) concluded that weather conditions in New Orleans had no significant associations with medical admission rates.⁹ While the study primarily looked at environmental triggers, our retrospective study focused on the impact of a recurring sporting event on the health care system in our city. From our results, we can reasonably conclude that total admissions to internal medicine wards decrease by 19.6% on game days. This finding is consistent with our hypothesis and other studies discussed previously.^2,3,7

An additional finding from our study is that Saints football games do not exclusively affect average hospital admissions on game days, but this impact extends to the 24 hours after the game as well. Specifically, on the post-game day following a Saints victory, we found an 18.2% increase in the average number of admissions compared to the average census following a Saints loss. This observation suggests that the Saints winning their games may correlate with a delay in seeking care and predispose more patients requiring admission on the following day. Taking the local sociocultural context and health profiles of our patient populations into consideration, these phenomena can be potentially explained.

A major part of the New Orleans culture is our affinity to engage in social activities that involve community participation, such as Mardi Gras, the New Orleans Jazz & Heritage Festival, and many other festivals and events. The mental health and overall wellness of our population are certainly benefited by this nurturing system of community unity and social support. Similarly, attending the Saints games or watching the team play on TV is a bonding experience for many people and families here, which may serve as a protective factor conductive to health outcomes.

Furthermore, New Orleans is a carnival city deeply rooted in the culture of celebration, encapsulated by the unofficial city motto “laissez les bons temps rouler,” meaning “let the good times roll.” For many, this mentality involves eating rich foods, smoking, drinking, and revelry—often to excess. According to the New Orleans Community Health Improvement Report, among the 343,829 residents in Orleans Parish, 21% of adults smoke, 19% excessively drink, and 30% are obese, compared to the national benchmarks of 14%, 8%, and 25%, respectively. Also of note is that 21% of residents here have limited access to healthy foods.^10,11

In the setting of these lifestyle risk factors, the having-a-good-time mindset may be especially prevalent whenever the Saints play, manifested in large tailgate parties and big-crowd gatherings before, during, and after each game. When our beloved team wins, fans are not shy about celebrating, which often translates into lack of self-care, engaging in risky activities, and overlooking strict adherence to recommended medical treatment. We hypothesize that while watching the Saints games could be an innate protective factor, this positive influence alone might not be sufficient to maintain adequate clinical stability when patients indulge in excessive celebrations after each Saints win, likely leading to avoidable injuries and acute exacerbations of chronic diseases such as congestive heart failure, chronic kidney disease, and chronic obstructive pulmonary disease. However, further in-depth studies are warranted to provide support for this theory.

The most important limitation in our study is that we did not include the details specific to each admission or the principal diagnoses. A thorough analysis of these variables would give us more confidence in our hypothesis that the etiology of most admissions on game days and post-game days is related to acute decompensation of preexisting conditions.

Another notable study limitation is that our data were collected from only 3 hospitals located within 2 miles of the Mercedes-Benz Superdome in downtown New Orleans. The Superdome had an average of >73,000 fans in attendance in 2019, and game-related traffic could potentially play a role in deterring patients to seek care at these facilities.⁶ While traffic is a common occurrence around sporting events, heavy traffic congestion may also be a function of a temporary increase in the New Orleans population. We were not able to directly account for the contribution of visitors to the city with respect to the increased census numbers. However, we believe that including non-game days in our analysis served as an adequate control for the potential confounder.

Moreover, our design did not take into consideration the time of day for each football game. Each NFL game typically lasts 3.5 to 4 hours, and most games are played in the afternoon and early evening. Our cutoff time for admission day may not have corresponded well with when patients presented to the facilities. Our admission tally for a given day ends at 6:59 am the next day, so those who watch or attend games that take place later in the evening could possibly arrive at the ED relatively later and be counted as part of the post-game day census. To account for this trend, we chose to also examine the post-game day census.

Last, we focused on admissions to 3 hospitals proximate to the Mercedes-Benz Superdome rather than emergency room visits. While instances of excess indulgence (eg, raucous victory celebrations, drowning sorrows after a loss) were strong possibilities behind the observed change in admission rates, alternative explanations—including medication nonadherence, clinic closures on weekends, traffic patterns, and public transportation limitations—may have also contributed. However, interruptions in these services are likely because of the summative effect that a professional football game has on a locality, and as such, we believe that these factors may have been minimized by our examination of non-game days as the control.