The end game: Mortality outcomes in North American professional athletes

Jung stirbt, wen die Götter lieben?

Während moderate sportliche Bewegung die Überlebenswahrscheinlichkeit einer Risikogruppe positiv beeinflusst, sind die Befunde im Leistungssport international gemischt. Für Deutschland liegt dazu nur eine Studie zu Fußball-Nationalspielern vor. Daher wurden mit Hilfe der Daten der Mitglieder der deutschen Olympiamannschaften 1956 bis 2016 (n = 6066) Hypothesen zu Effekten im Vergleich zur Gesamtbevölkerung, zum metabolischen Stoffwechsel, zu Einzel‑, Mix- und Mannschaftssportarten, zu Doping, zum olympischen Erfolg und zum Geschlecht getestet und dabei auch die Mitgliedschaft in den Olympiamannschaften der Bundesrepublik, der DDR sowie dem wiedervereinigten Deutschland berücksichtigt. Es zeigt sich, dass die Mitglieder der deutschen Olympiamannschaften bislang eine im Vergleich mit der Gesamtbevölkerung höhere Mortalitätsrate aufweisen, es keine höheren Überlebensraten für die Mitglieder der Olympiamannschaften der alten Bundesrepublik gibt, sich keine Differenzen zwischen Sportarten finden lassen, aber steigende olympische Erfolge zu höheren Mortalitätsraten führen.

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

Importance

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.

Objective

To compare all-cause and cause-specific mortality between NFL and MLB players.

Design, Setting, and Participants

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.

Exposures

Participation in the NFL compared with the MLB.

Main Outcomes and Measures

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.

Results

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.

Conclusions and Relevance

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.

Defining Exposures in Professional Football: Professional American-Style Football Players as an Occupational Cohort

Studies of professional American football players have shown that football-related activities lead to acute injuries and may have long-term adverse health outcomes including osteoarthritis, neurocognitive impairment, and cardiovascular disease. However, the full complement of what constitutes professional football exposure has yet to be effectively articulated. Most likely, professional football exposure encompasses a multifaceted array of experiences including head impacts and joint stresses, long-term pain medication use, dietary restrictions, and strenuous training regimens. To study the health of professional American football players, characterizing the group as an occupational cohort and taking advantage of methods established within the discipline of occupational epidemiology may be beneficial. We conducted a narrative review of existing football research, occupational epidemiological methods papers, and occupational medicine studies. Here we describe the traditional occupational epidemiological approach to assessing exposure in a novel cohort and show how this framework could be implemented in studies of professional football players. In addition, we identify the specific challenges associated with studying an elite athletic occupational group, including the healthy worker effect and other types of selection and information biases, and explore these in the context of existing studies of football-related health. The application of well-established occupational epidemiological methods to professional football players may yield new insights into the effects of playing exposure and may provide opportunities for interventions to reduce harm.