Abstract
Neurodegenerative disease mortality is higher among former professional soccer players than general population controls. However, the factors contributing to increased neurodegenerative disease mortality in this population remain uncertain. To investigate the association of field position, professional career length, and playing era with risk of neurodegenerative disease among male former professional soccer players. This cohort study used population-based health record linkage in Scotland to evaluate risk among 7676 male former professional soccer players born between January 1, 1900, and January 1, 1977, and 23 028 general population control individuals matched by year of birth, sex, and area socioeconomic status providing 1 812 722 person-years of follow-up. Scottish Morbidity Record and death certification data were available from January 1, 1981, to December 31, 2016, and prescribing data were available from January 1, 2009, to December 31, 2016. Database interrogation was performed on December 10, 2018, and data were analyzed between April 2020 and May 2021. Participation in men's soccer at a professional level. Outcomes were obtained by individual-level record linkage to national electronic records of mental health and general hospital inpatient and day-case admissions as well as prescribing information and death certification. Risk of neurodegenerative disease was evaluated between former professional soccer players and matched general population control individuals. In this cohort study of 30 704 male individuals, 386 of 7676 former soccer players (5.0%) and 366 of 23 028 matched population control individuals (1.6%) were identified with a neurodegenerative disease diagnosis (hazard ratio [HR], 3.66; 95% CI, 2.88-4.65; P < .001). Compared with the risk among general population control individuals, risk of neurodegenerative disease was highest for defenders (HR, 4.98; 95% CI, 3.18-7.79; P < .001) and lowest for goalkeepers (HR, 1.83; 95% CI, 0.93-3.60; P = .08). Regarding career length, risk was highest among former soccer players with professional career lengths longer than 15 years (HR, 5.20; 95% CI, 3.17-8.51; P < .001). Regarding playing era, risk remained similar for all players born between 1910 and 1969. The differences in risk of neurodegenerative disease observed in this cohort study imply increased risk with exposure to factors more often associated with nongoalkeeper positions, with no evidence this association has changed over the era studied. While investigations to confirm specific factors contributing to increased risk of neurodegenerative disease among professional soccer players are required, strategies directed toward reducing head impact exposure may be advisable in the meantime.
Highlights
Player Field Position and Neurodegenerative Disease Over a median follow-up of 18 years (10.027.4), 386 of 7676 former professional soccer players (5.0%) and 366 of 23 028 matched population control individuals (1.6%) were identified with neurodegenerative disease diagnoses (HR, 3.66; 95% CI, 2.88-4.65; P < .001) (Table 2)
Compared with matched population control individuals, risk of neurodegenerative disease varied by field position
Era of Play and Neurodegenerative Disease Risk of neurodegenerative disease among former professional soccer players was considered in association with playing era, with soccer players divided into 2-decade subgroups by year of birth
Summary
Approvals Ethical approval was provided by the University of Glasgow College of Medical, Veterinary and Life Sciences Ethics Committee (project number 200160147), with protocol and data governance procedures reviewed and approved by National Health Service Scotland’s Public Benefit and Privacy Panel for Health and Social Care (reference 1718-0120). As all health record data were anonymized to researchers, participant consent was not required. The complete protocol for the Football’s Influence on Lifelong Health and Dementia Risk (FIELD) study is published elsewhere.[19] The analysis and reporting of this study are consistent with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.[20]. Cohort Identification and Inclusion Criteria Former professional soccer players were identified through the Record of Pre-War Scottish League Players version 221 and the Record of Post-War Scottish League Players version 622 compiled from archives of the Scottish Football Museum and individual league clubs. Study inclusion was restricted to individuals 40 years or older as of December 31, 2016.
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