Mortality Among Professional American-Style Football Players and Professional American Baseball Players

Vy T Nguyen,Ross D Zafonte,Jarvis T Chen,Marc G Weisskopf,Sabrina Paganoni,Lee M Nadler,Herman A Taylor,Ann Connor,Alvaro Pascual-Leone,Kalé Z Kponee-Shovein,Frank E Speizer,Theodore K Courtney,Aaron L Baggish

doi:10.1001/jamanetworkopen.2019.4223

Abstract

Studies of American-style football players have suggested lower overall mortality rates compared with general populations, but with possibly increased neurodegenerative mortality. However, comparisons with general populations can introduce bias. This study compared mortality between US National Football League (NFL) and US Major League Baseball (MLB) players, a more appropriate comparison group of professional athletes. To compare all-cause and cause-specific mortality between NFL and MLB players. In this retrospective cohort study, the setting was US mortality from January 1, 1979, through December 31, 2013. The dates of analysis were January 2016 to April 2019. Participants were 3419 NFL and 2708 MLB players with at least 5 playing seasons. Participation in the NFL compared with the MLB. Vital status and causes of death from the National Death Index from 1979 through 2013 were obtained. Cox proportional hazards regression models using age as the timescale were used to calculate hazard ratios (HRs) and 95% CIs to examine all-cause and cause-specific mortality among NFL players compared with MLB players, adjusted for race and decade of birth. By the end of follow-up, there were 517 deaths (mean [SD] age, 59.6 [13.2] years) in the NFL cohort and 431 deaths (mean [SD] age, 66.7 [12.3] years) in the MLB cohort. Cardiovascular and neurodegenerative conditions, respectively, were noted as underlying or contributing causes in 498 and 39 deaths in the NFL and 225 and 16 deaths in the MLB. Compared with MLB players, NFL players had significantly elevated rates of all-cause (HR, 1.26; 95% CI, 1.10-1.44), cardiovascular disease (HR, 2.40; 95% CI, 2.03-2.84), and neurodegenerative disease (HR, 2.99; 95% CI, 1.64-5.45) mortality. Comparing hypothetical populations of 1000 NFL and 1000 MLB players followed up to age 75 years, there would be an excess 21 all-cause deaths among NFL players, as well as 77 and 11 more deaths with underlying or contributing causes that included cardiovascular and neurodegenerative conditions, respectively. This study found that NFL players had elevated all-cause, cardiovascular, and neurodegenerative mortality rates compared with MLB players, although the absolute number of excess neurodegenerative deaths was still small. Factors that vary across these sports (eg, body habitus and head trauma) as opposed to those common across sports (eg, physical activity) could underlie the differences.

Highlights

There has been considerable interest, both in the scientific community and among the general public, in the lifelong health of American-style football players
This study found that National Football League (NFL) players had elevated all-cause, cardiovascular, and neurodegenerative mortality rates compared with Major League Baseball (MLB) players, the absolute number of excess neurodegenerative deaths was still small
The results of this study found that NFL players had a significantly elevated rate of all-cause mortality compared with MLB players, driven by elevated rates of cardiovascular and neurodegenerative mortality

Summary

Introduction

There has been considerable interest, both in the scientific community and among the general public, in the lifelong health of American-style football players. To become a professional athlete in any sport, one is typically healthier and fitter than people of a similar age in the general population, a bias known as the healthy worker hire effect.[8,9] The bias is typically borne out with a reduced risk of overall mortality compared with the general population. Such comparisons have limited ability to distinguish true health risks or benefits attributable to playing a particular sport from preexisting differences inherent in the people who play sports at an elite level. Comparison with other football players may have had limited power to detect differences in outcomes, and the study did not have the sample size to examine specific causes of death

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