Neurodegenerative causes of death among retired National Football League players
Open accessAbstract
OBJECTIVE: To analyze neurodegenerative causes of death, specifically Alzheimer disease (AD), Parkinson disease, and amyotrophic lateral sclerosis (ALS), among a cohort of professional football players. METHODS: This was a cohort mortality study of 3,439 National Football League players with at least 5 pension-credited playing seasons from 1959 to 1988. Vital status was ascertained through 2007. For analysis purposes, players were placed into 2 strata based on characteristics of position played: nonspeed players (linemen) and speed players (all other positions except punter/kicker). External comparisons with the US population used standardized mortality ratios (SMRs); internal comparisons between speed and nonspeed player positions used standardized rate ratios (SRRs). RESULTS: Overall player mortality compared with that of the US population was reduced (SMR 0.53, 95% confidence interval [CI] 0.48-0.59). Neurodegenerative mortality was increased using both underlying cause of death rate files (SMR 2.83, 95% CI 1.36-5.21) and multiple cause of death (MCOD) rate files (SMR 3.26, 95% CI 1.90-5.22). Of the neurodegenerative causes, results were elevated (using MCOD rates) for both ALS (SMR 4.31, 95% CI 1.73-8.87) and AD (SMR 3.86, 95% CI 1.55-7.95). In internal analysis (using MCOD rates), higher neurodegenerative mortality was observed among players in speed positions compared with players in nonspeed positions (SRR 3.29, 95% CI 0.92-11.7). CONCLUSIONS: The neurodegenerative mortality of this cohort is 3 times higher than that of the general US population; that for 2 of the major neurodegenerative subcategories, AD and ALS, is 4 times higher. These results are consistent with recent studies that suggest an increased risk of neurodegenerative disease among football players.
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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 Lehman et al., 2012
A study looking at the cause of death in retired NFL players who played for 5 years or more found elevated rates of death due to Alzheimer's disease and amyotrophic lateral sclerosis.
“A study looking at the cause of death in retired NFL players who played for 5 years or more also found elevated rates of death due to AD and amyotrophic lateral sclerosis (ALS).”
From The neuropathology of sport (2014) · cites this paper as [109]
Recent data on American football players who played professionally for more than five seasons show the risk of dying from ALS is more than four times greater than age- and gender-matched controls.
“Recent data on American football players who played professionally for more than five seasons show the risk of dying from ALS is more than four times greater than age- and gender-matched controls [109].”
From The neuropathology of sport (2014) · cites this paper as [109]
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“27 In a subset of these NFL players, the hazard ratio for neurodegenerative death was 2.99 (95% CI 1.64 to 5.45) against a matched reference cohort of Major League Baseball players.”
Influential
- Authors
- Lehman, E. J., Hein, M. J., Baron, S. L., & Gersic, C. M.
- Affiliations
- Centers for Disease Control and Prevention (US)
- ORCID
- Baron, Sherry L.
- Venue
- Neurology
- Published
- 2012-11-06
- Volume
- 79
- Issue
- 19
- Pages
- 1970-1974
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC4098841
- OpenAlex
- W2155971051
- Cited by
- 638
- References
- 29
- Citations by year
- 2026: 21 · 2025: 31 · 2024: 26 · 2023: 38 · 2022: 49 · 2021: 49 · 2020: 88 · 2019: 50 · 2018: 38 · 2017: 47 · 2016: 47 · 2015: 56 · 2014: 48 · 2013: 40 · 2012: 5
- FWCI
- 35.55
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (CC999999)
- National Institute for Occupational Safety and Health
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- neurodegenerative diseases, causes of death, professional football players, National Football League, Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, playing position, former athletes
- MeSH terms
- Adult, Aged, Aged, 80 and over, Athletic Injuries, Cause of Death, Football, Humans, Male, Middle Aged, Reference Values, Retirement, Retrospective Studies, Cohort Studies, Neurodegenerative Diseases
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