Do career NFL players have a higher risk of death?

Bottom Line: Career players in the National Football League (NFL) had slightly higher rates of death that were not statistically different from those of replacement players who made only a few appearances during a short league strike in the 1980s.

Why The Research Is Interesting: Playing football may be potentially harmful for several reasons, including repeated head trauma that may result in chronic traumatic encephalopathy (CTE), a degenerative brain disease. Previous studies examining the rate of death in retired NFL players have been limited by comparisons with the general population because a better comparison group would be individuals with similar athletic attributes and lifestyles.

Who and When: 3,812 retired players who started in the NFL from 1982 to 1992, including 2,933 regular NFL players and 897 replacement players hired temporarily to play during a three-game strike in 1987

What (Study Measures): Participation in the NFL as a career or replacement player (exposures); death from any cause by December 31, 2016 (outcome)

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Atheendar S. Venkataramani, M.D., Ph.D., Perelman School of Medicine, University of Pennsylvania, Philadelphia and coauthors

Results: A slightly higher, but not statistically significant, difference in long-term risk of death was associated with a playing career in the NFL compared with a short stint as a replacement player during a league strike. Seven career players died of amyotrophic lateral sclerosis (ALS) compared to no replacement players.

Study Limitations: Estimates were based on a small number of deaths so the analysis may not detect meaningful associations; additional analyses with longer-term follow-up may be helpful.

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Related material: The following related elements also are available on the For The Media website:

• A summary video is available for download or to embed on your website. Download the video as a high-quality MP4 file by right-clicking on this link and then clicking the down-pointing arrow in the control bar at the bottom of the video. In addition, you may copy and paste the html code below to embed the video on your website.
• The editorial, "Long-Term Mortality in NFL Professional Football Players: No Significant Increase But Questions Remain," by Steven T. DeKosky, M.D., of the University of Florida College of Medicine, Gainesville, and coauthors
• The Patient Page, "Sport-Related Concussion"
• Previously published articles by JAMA that also may be of interest: Clinicopathological Evaluation of Chronic Traumatic Encephalopathy in Players of American Football and Advances and Gaps in Understanding Chronic Traumatic Encephalopathy

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jama.2018.0140)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.