Cited by 484Amyotrophic Lateral Sclerosis ResearchSports injuries and preventionCardiovascular Effects of Exercise

The DOI matches its Crossref record; 24 of the 24 references it cites were found in a registry or an index; none of the 24 sources its claims cite is checked for support yet.

Severely increased risk of amyotrophic lateral sclerosis among Italian professional football players

Chio, A.·2005·Brain

Abstract

The cause of amyotrophic lateral sclerosis (ALS) is still unknown. A possible relationship between ALS and sport participation has been supposed, but never definitely demonstrated. We studied a cohort of 7325 male professional football players engaged by a football team from the Italian First or Second Division in the period 1970-2001. ALS cases were identified using different concurrent sources. Standardized morbidity ratios (SMRs) were calculated. During the 137,078 person-years of follow-up, five ALS cases were identified (mean age of onset, 43.4 years). Three cases had a bulbar onset, significantly more than expected (P = 0.003). Since the number of expected cases was 0.77, the overall SMR was 6.5 [95% confidence interval (CI), 2.1-15.1]. The SMR was significantly increased for an ALS onset before 49 years, but not for older subjects. A significant increase of the SMR was found in the periods 1980-1989 and 1990-2001, whereas no ALS case was found in the 1970-1979 period. A dose-response relationship between the duration of professional football activity and the risk of ALS was found (>5 years, 15.2, 95% CI, 3.1-44.4; < or =5 years, 3.5, 95% CI, 0.4-12.7). Our findings seem to indicate that playing professional football is a strong risk factor for ALS.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In a cohort of 7325 Italian male professional football players followed for 137,078 person-years, five ALS cases occurred versus 0.77 expected, yielding an overall SMR of 6.5 (95% CI 2.1–15.1). The authors conclude that professional football playing is a strong risk factor for ALS, though the causal exposure remains unknown.

Key findings

  • Overall ALS SMR was 6.5 (95% CI 2.1–15.1) based on 5 observed cases and 0.77 expected during 1970–2001.
  • Risk was significantly increased for ALS onset before age 49 (SMR 7.5, 95% CI 2.0–19.2) but not for ages 50–69 (SMR 4.2, 95% CI 0.1–23.4).
  • A dose-response relationship was found by duration of professional football activity: >5 years SMR 15.2 (95% CI 3.1–44.4); <5 years SMR 3.5 (95% CI 0.4–12.7).
  • Three of five cases had bulbar onset, significantly more than expected (P = 0.003); mean age of onset was 43.4 years (SD 9.1).

Methods

  • Retrospective incidence cohort of all male professional football players engaged by Italian First or Second Division teams from September 1, 1970 to June 30, 2002, who played at least one official match; foreign-born players were excluded, leaving 7325 players.
  • ALS cases were identified from death certificates, major Italian ALS centre archives, the Italian ALS Association, media/websites, and self-reports; only definite or probable ALS by El Escorial revised criteria were included.
  • Standardized morbidity ratios were calculated using age- and gender-specific incidence rates averaged from the Piemonte and Valle d’Aosta Register for ALS and the Puglia ALS register, with 95% CIs assuming a Poisson distribution; a two-tailed chi-square test compared observed and expected site of onset.

Limitations

  • The authors state that underestimation of cases in the first decade cannot be ruled out, possibly explaining the absence of ALS cases in 1970–1979; they also note foreign-born players were excluded because complete follow-up was not possible, and the causal exposure remains unknown.
  • The authors consider and correct for a possible “false cluster” using implicit multiple comparisons, and state that all other requirements for evaluating an identified cluster were met with a conservative design.
  • Evident from the text: the analysis rests on only five ALS cases, producing wide confidence intervals; case finding combined active ascertainment with passive “spider” methodology, which could be influenced by media publicity and self-reporting; and no individual-level data identified specific toxic, drug, trauma, or environmental exposures.

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Integrity signals

Registry

Crossref · 10.1093/brain/awh373

Cites

24 of 24 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 24 cited sources checked · 0 supported · 0 flagged

Show all 23 claims

  • It may state two separate claims as one. 11
  • Probably not a substantial claim. 12
21 of 21
  • The paper relies on this without support.

    The total number of possible comparisons among professional sports in Italy does not exceed 30.

    “Considering the professional sports in Italy, the total number of possible comparisons does not exceed 30; therefore, even after the proposed correction, the lower limit of SMR confidence interval would largely exceed 1.”
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Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Death-certificate date ranges disagree

    Minor

    Death certificates are said to cover 1970-2000, but the stated ICD-9 portion of those records extends through 2001.

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Metadata

Authors
Chio, A.
Venue
Brain
Published
2005-01-05
Volume
128
Issue
3
Pages
472-476
ISSN
  • 0006-8950 (ISSN-L)
  • 1460-2156
OpenAlex
W2099565072
Cited by
484
References
24
Citations by year
2026: 5 · 2025: 14 · 2024: 15 · 2023: 20 · 2022: 24 · 2021: 20 · 2020: 24 · 2019: 28 · 2018: 23 · 2017: 34 · 2016: 35 · 2015: 36 · 2014: 20 · 2013: 25 · 2012: 26
FWCI
11.96
Type
journal article
Language
en
Open access
closed
Locations
  • Brain (publishedVersion)
  • PubMed (publishedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
Topics
  • Health Sciences › Medicine › Clinical Neurology › Amyotrophic Lateral Sclerosis Research
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
Keywords
amyotrophic lateral sclerosis, professional football players, sports participation, ALS risk factors, bulbar onset, standardized morbidity ratio, dose-response relationship
MeSH terms
Adolescent, Adult, Aged, Amyotrophic Lateral Sclerosis, Humans, Italy, Male, Middle Aged, Occupational Diseases, Retrospective Studies, Risk Factors, Soccer, Time Factors, Incidence, Age of Onset

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