Objective:

To investigate neurodegenerative mortality rates among former NFL players compared to the general US population.

Approach:

• Study Design: Population-based retrospective cohort study of NFL players who debuted from 1960 to 2019, including 19,824 players and over 518,000 person-years of follow-up.
• Data Sources: Matched National Death Index records from 1979 to 2023 with Sports Reference, LLC data.
• Mortality Comparison: Compared mortality rates of NFL players with age-, sex-, race-, and calendar year-standardized US population.
• Sensitivity Analyses: Performed to assess the impact of competing causes of death on neurodegenerative mortality findings.

Key Findings:

• Former NFL players had nearly four times the neurodegenerative mortality of the general population.
• Overall mortality among NFL players was 30% lower than expected.
• Neurodegenerative mortality remained approximately threefold higher after accounting for competing mortality risks.
• Players in speed positions had higher neurodegenerative mortality than nonspeed players.
• Non-White players had higher mortality from amyotrophic lateral sclerosis than White players.

Interpretation:

Limitations:

• Observational, retrospective design limits causal conclusions.
• Potential misclassification of neurodegenerative causes of death on death certificates.
• Chronic traumatic encephalopathy not routinely recorded as a cause of death.
• Football participation and career duration serve as proxies for repetitive head impact exposure.

Conclusion:

Sources:

• eClinicalMedicine