Proportionate mortality of Italian soccer players: Is amyotrophic lateral sclerosis an occupational disease?
Abstract
Objectives The objective of the study is to investigate the mortality experience of Italian soccer players and to discuss the findings in the light of possible long term effects of doping. Methods Standardized proportionate mortality ratio (SPMR) and standardized proportionate cancer mortality ratio (SPCMR) were computed for 350 deceased subjects deriving from a list of about 24,000 active Italian soccer players from 1960 to 1996 in the three top leagues (A, B and C). Results When considering SPMRs, there is a substantial adherence of observed to expected mortality, with the only exception of mortality for diseases of the nervous system (13 obs. vs. 6 exp.) mainly explained by an excess of amyotrophic lateral sclerosis (8 obs. vs 0.69 exp.). As far as SPCMRs are concerned, some digestive cancers (namely: colon cancer, liver cancer and pancreas cancer) show a doubled risk. Conclusions A high risk for amyotrophic lateral sclerosis is observed among Italian soccer players. Epidemiological data on association between sport and Amyotrophic Lateral Sclerosis (ALS) are contrasting. On the basis of the overall available evidence we suggest a possible connection between dietary supplements or drugs used to enhance sporting performance and ALS pathogenesis. Further epidemiological studies are needed to confirm these specific mortality risks among soccer players.
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Others considered an impact of drugs or dietary supplements on ALS as more likely.
“An impact of drugs or dietary supplements was considered as more likely by others (Armon, 2007; Belli & Vanacore, 2005).”
From Prevalence of potential sports‐associated risk factors in Swiss amyotrophic lateral sclerosis patients (2017) · cites this paper as Belli & Vanacore, 2005
Increased risk of ALS has been reported in Italian football players, American football players, and sport-related physical exercise in general.
“While an increased risk has been reported in Italian football players (Belli & Vanacore, 2005; Chio et al., 2005), American football players (Lehman et al., 2012), and sport‐related physical exercise in general (Beghi et al., 2010), no such link has been found in population‐based case–control studies in Europe (Pupillo et al., 2014) and the US (Longstreth et al., 1998).”
From Prevalence of potential sports‐associated risk factors in Swiss amyotrophic lateral sclerosis patients (2017) · cites this paper as Belli & Vanacore, 2005
Cites
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TDP-43 proteinopathy and motor neuron disease in chronic traumatic encephalopathy
McKee, A. C., Gavett, B. E., Stern, R. A., Nowinski, C. J., Cantu, R. C., Kowall, N. W., Perl, D. P., Hedley-Whyte, E. T., Price, B., Sullivan, C., et al. (2010) · Journal of Neuropathology & Experimental Neurology · doi:10.1097/nen.0b013e3181ee7d85 · Cited by 659 · see citing works
Head Injury and Amyotrophic Lateral Sclerosis
Chen, H., Richard, M., Sandler, D. P., Umbach, D. M., & Kamel, F. (2007) · American Journal of Epidemiology · doi:10.1093/aje/kwm153 · Cited by 279 · see citing works
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“Soccer Belli and Vanacore [55] (2005) 350 Similar observed and expected MR, although a ten-fold increase of ALS MR (SPMR = 1158, CI 672–1998) was present (active 1960–1996) =”
BackgroundResultInfluentialAssociation of ALS with head injury, cigarette smoking and APOE genotypes
Schmidt, S., Kwee, L. C., Allen, K. D., & Oddone, E. Z. (2010) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2010.01.011 · Cited by 117 · see citing works
Trauma and amyotrophic lateral sclerosis: a case–control study from a population‐based registry
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Self-citationHead Injury and Amyotrophic Lateral Sclerosis: A Meta-Analysis
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“In the past, reported clusters of ALS in professional football (soccer) players in Italy (Belli & Vanacore, 2005; Chio, Benzi, Dossena, Mutani, & Mora, 2005) and American football players in the US (Lehman, Hein, Baron, & Gersic, 2012) have received intense media coverage and have fuelled the…”
BackgroundInfluentialGamez, J., & Carmona, F. (2021) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2021.117586 · Cited by 10 · see citing works
Martinez-Nunez, A. E., Guo, J., Dorsey, E. R., Ruffing, K. W., Wymer, J., & Okun, M. S. (2026) · BMJ Neurology Open · doi:10.1136/bmjno-2026-001574 · Cited by 1 · see citing works
- Authors
- Belli, S., & Vanacore, N.
- Affiliations
- Istituto Superiore di Sanità (IT)
- Corresponding author
- Belli, Stefano
- Venue
- European Journal of Epidemiology
- Published
- 2005-01
- Volume
- 20
- Issue
- 3
- Pages
- 237-242
- ISSN
- 0393-2990 (ISSN-L)
- 1573-7284
- OpenAlex
- W2136076175
- Cited by
- 140
- References
- 1
- Citations by year
- 2026: 1 · 2025: 4 · 2023: 5 · 2022: 7 · 2021: 9 · 2020: 7 · 2019: 8 · 2018: 4 · 2017: 7 · 2016: 7 · 2015: 11 · 2014: 11 · 2013: 6 · 2012: 8
- FWCI
- 24.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- European Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Sociology and Political Science › Doping in Sports
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Health Sciences › Medicine › Neurology › Amyotrophic Lateral Sclerosis Research
- Keywords
- amyotrophic lateral sclerosis, soccer players, proportionate mortality ratio, cancer mortality, occupational diseases, doping, sports-related mortality, neurological disorders, gastrointestinal cancer, dietary supplements, performance-enhancing drugs
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Amyotrophic Lateral Sclerosis, Cause of Death, Doping in Sports, Female, Humans, Italy, Male, Middle Aged, Occupational Diseases, Soccer, Risk Assessment, Dietary Supplements
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