Doping Prevalence in Competitive Sport: Evidence Synthesis with "Best Practice" Recommendations and Reporting Guidelines from the WADA Working Group on Doping Prevalence.
Level 1 - systematic review of randomized trials
Systematic review of 105 prevalence and observational studies
PubMed 33900578 · doi:10.1007/s40279-021-01477-y
What was done
The authors conducted a PRISMA-compliant systematic review of literature published between 1975 and 2019 to synthesize doping prevalence in competitive sport. Studies were included regardless of methodology or time limit if they reported doping prevalence data. The authors also developed assessment criteria to evaluate data quality, potential bias, and reporting across self-reported survey data (SRP) and sample analysis data (SAP).
What was found
Across 105 included studies covering 102,515 athletes (72.8% men, 27.2% women) in 35 countries, doping prevalence ranged from 0% to 73%, with most values falling below 5%. Eighty-nine studies used SRP and 17 used SAP (one used both). Quality assessment categorized 20 studies as high, 60 as moderate, and 25 as low quality (SRP: 17 high, 52 moderate, 20 low; SAP: 3 high, 9 moderate, 5 low). Reporting inconsistencies prevented meta-analysis across sport, gender, region, or competition level.
Why it matters
This review demonstrates that empirical estimates of doping prevalence are based on fragmented and uneven evidence, providing a framework and reporting recommendations to improve future prevalence research and enable robust meta-analyses.
Limits
Inconsistencies in data reporting precluded quantitative meta-analyses across sport categories, gender, regions, or competition levels. Most studies (89 of 105) relied on self-report surveys subject to disclosure and social desirability bias, and participants were heavily skewed toward men (72.8%) and athletes in the United States (26 studies).
Cited by
- context World Anti-Doping Agency data indicates that up to 40% of Olympic-level athletes currently use or have used banned performance-enhancing substances.