Neurodegenerative disease mortality among former professional soccer players
Open accessAbstract
BACKGROUND: Neurodegenerative disorders have been reported in elite athletes who participated in contact sports. The incidence of neurodegenerative disease among former professional soccer players has not been well characterized. METHODS: We conducted a retrospective cohort study to compare mortality from neurodegenerative disease among 7676 former professional soccer players (identified from databases of Scottish players) with that among 23,028 controls from the general population who were matched to the players on the basis of sex, age, and degree of social deprivation. Causes of death were determined from death certificates. Data on medications dispensed for the treatment of dementia in the two cohorts were also compared. Prescription information was obtained from the national Prescribing Information System. RESULTS: Over a median of 18 years, 1180 former soccer players (15.4%) and 3807 controls (16.5%) died. All-cause mortality was lower among former players than among controls up to the age of 70 years and was higher thereafter. Mortality from ischemic heart disease was lower among former players than among controls (hazard ratio, 0.80; 95% confidence interval [CI], 0.66 to 0.97; P = 0.02), as was mortality from lung cancer (hazard ratio, 0.53; 95% CI, 0.40 to 0.70; P<0.001). Mortality with neurodegenerative disease listed as the primary cause was 1.7% among former soccer players and 0.5% among controls (subhazard ratio [the hazard ratio adjusted for competing risks of death from ischemic heart disease and death from any cancer], 3.45; 95% CI, 2.11 to 5.62; P<0.001). Among former players, mortality with neurodegenerative disease listed as the primary or a contributory cause on the death certificate varied according to disease subtype and was highest among those with Alzheimer's disease (hazard ratio [former players vs. controls], 5.07; 95% CI, 2.92 to 8.82; P<0.001) and lowest among those with Parkinson's disease (hazard ratio, 2.15; 95% CI, 1.17 to 3.96; P = 0.01). Dementia-related medications were prescribed more frequently to former players than to controls (odds ratio, 4.90; 95% CI, 3.81 to 6.31; P<0.001). Mortality with neurodegenerative disease listed as the primary or a contributory cause did not differ significantly between goalkeepers and outfield players (hazard ratio, 0.73; 95% CI, 0.43 to 1.24; P = 0.24), but dementia-related medications were prescribed less frequently to goalkeepers (odds ratio, 0.41; 95% CI, 0.19 to 0.89; P = 0.02). CONCLUSIONS: In this retrospective epidemiologic analysis, mortality from neurodegenerative disease was higher and mortality from other common diseases lower among former Scottish professional soccer players than among matched controls. Dementia-related medications were prescribed more frequently to former players than to controls. These observations need to be confirmed in prospective matched-cohort studies. (Funded by the Football Association and Professional Footballers' Association.).
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A study of Scottish former soccer players reported that they are more likely than controls to have Alzheimer's disease specified on their death certificates (HR 5.1, 95% CI 2.9-8.8) and to have been prescribed any dementia-related medications (OR 4.9, 95% CI 3.8-6.3) but not on medical records.
“The evidence has subsequently been strengthened by a study on Scottish former soccer players reporting that they are more likely than controls to have Alzheimer's disease specified on their death certificates (HR 5·1, 95% CI 2·9–8·8) and to have been prescribed any dementia-related medications (OR 4·9, 95% CI 3·8–6·3) but not on medical records.74”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [74]
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- Authors
- Mackay, D. F., Russell, E. R., Stewart, K., MacLean, J. A., Pell, J. P., & Stewart, W.
- Affiliations
- Queen Elizabeth University Hospital (GB)
- From the Institute of Health and Wellbeing (D.F.M., J.P.P.), the Institute of Neuroscience and Psychology (E.R.R., W.S.), and the Institute of Cardiovascular and Medical Sciences (K.S., J.A.M.), University of Glasgow, the Hampden Sports Clinic, Hampden Stadium (K.S., J.A.M.), and the Department of Neuropathology, Queen Elizabeth University Hospital (W.S.) — all in Glasgow, United Kingdom.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2019-11-07
- Volume
- 381
- Issue
- 19
- Pages
- 1801-1808
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC8747032
- OpenAlex
- W2980770587
- Cited by
- 483
- References
- 30
- Citations by year
- 2026: 43 · 2025: 73 · 2024: 58 · 2023: 90 · 2022: 67 · 2021: 66 · 2020: 79 · 2019: 5
- FWCI
- 41.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- Funders
- The Football Association and Professional Footballers Association (NA)
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Keywords
- Alzheimer's disease, Parkinson's disease, dementia, dementia medications, ischemic heart disease mortality, lung cancer mortality, contact sports, elite athletes, causes of death, competing risk of death, social deprivation, prescribing patterns, concussion
- MeSH terms
- Adult, Aged, Aged, 80 and over, Brain Injuries, Cause of Death, Female, Heart Diseases, Humans, Longevity, Lung Neoplasms, Male, Middle Aged, Retrospective Studies, Scotland, Soccer, Incidence, Logistic Models, Case-Control Studies, Nootropic Agents, Neurodegenerative Diseases, Athletes
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