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Uncovering the Long-Term Health Impact of Playing in the NFL

Summary: Using data from replacement players who entered into the NFL when professionals went on strike in 1987, researchers evaluate player mortality and overall health. The findings, researchers report, may help to make the game safer for current football players.

Source: Penn Medicine.

In 1987, National Football League players went on strike. As a response, NFL teams scrambled to fill their rosters with “replacement players,” individuals who had some experience with college or professional football, but who weren’t part of NFL rosters that year. Replacement games – which lasted three weeks – were deeply unpopular with fans. The replacement players themselves became a footnote in sports history.

It turns out these players may actually play a critical role in football today – by helping us understand how playing in the NFL affects long-term health.

There is considerable interest in understanding how professional football affects health. The main concern is that injuries to the brain may shorten the life of NFL players. Lifestyle choices, such as substance use (either during or after a player’s career), and listlessness and loss of purpose after early retirement are other factors that may also raise the risk of early death.

But finding an answer is difficult. The key issue is that NFL players represent some of the best, most uniquely trained professional athletes in the world, which means that any comparison of health outcomes needs to be based on a similarly athletic group of individuals who, for some reason, did not play professionally.

Previous studies have compared NFL players to men of similar age and race drawn from the general population – regular people like us. These studies find that NFL players have a much lower risk of death. While comparing NFL players to the general population might look good on the surface, the two groups are actually nothing alike. To make an NFL roster, players have to be in incredible shape. NFL players also make more money than most and have access to the very best health care while they are playing, which can improve health, too.

This is where the replacement players come in. Unlike members of the general population, replacement players often had prior experience playing football and maybe even similar training, but their professional experience was typically limited to just the strike games. Replacement players are much more like NFL players than the rest of us – but without the prolonged exposure to the game. This makes them an ideal comparison group for NFL players.

In our recent study, published in JAMA, we compared the life expectancies of professional NFL players who debuted between 1982 and 1992 to the life expectancies of replacement players from the 1987 strike.

We found that the risk of death in any given year after retirement was 38 percent higher among NFL players. These results are only suggestive, however, because the overall death rate was low. By the end of our study (December 2016), the players were on average only 52 years old and only a small proportion (4.2 percent of replacement players and 4.9 percent of NFL players) had died. These low rates of death make our estimates imprecise. Even though we can’t be truly certain that the risk of death was higher among NFL players, our estimates do allow us to rule out the possibility that NFL players have substantively lower risk of death than replacement players – which is what studies comparing NFL players to men in the general population have found.

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Comparing measures of career NFL player and replacement player health over time will help increase statistical precision. Moreover, studies that go beyond just looking at life expectancy, by comparing measures of physical and mental health among NFL players to those of replacement players, can provide a more detailed understanding of how player health evolves over time. NeuroscienceNews.com image is in the public domain.

We also looked at causes of death. Both NFL and replacement players were most likely to die from heart disease. But there was a greater proportion of deaths from traffic accidents, unintentional harm (typically accidental overdoses from prescriptions drugs or drugs of abuse), and neurological diseases – like ALS – among NFL players. The higher risk of death from neurological disease among NFL players has been found in other research, as well.

Comparing measures of career NFL player and replacement player health over time will help increase statistical precision. Moreover, studies that go beyond just looking at life expectancy, by comparing measures of physical and mental health among NFL players to those of replacement players, can provide a more detailed understanding of how player health evolves over time.

With more research, these replacement players – far from being forgotten – might be able to play an even greater role in history by helping us to better understand how playing in the NFL affects long-term health, and identify ways to improve football player health in the future. That would be a win for every team.

About this neuroscience research article

Source: Katie Delach – Penn Medicine
Publisher: Organized by NeuroscienceNews.com.
Image Source: NeuroscienceNews.com image is in the public domain.
Original Research: Open access research in JAMA.
doi:10.1001/jama.2018.0140

Cite This NeuroscienceNews.com Article
Penn Medicine “Uncovering the Long-Term Health Impact of Playing in the NFL.” NeuroscienceNews. NeuroscienceNews, 5 February 2018.
<http://neurosciencenews.com/nfl-football-health-outcomes-8425/>.
Penn Medicine (2018, February 5). Uncovering the Long-Term Health Impact of Playing in the NFL. NeuroscienceNews. Retrieved February 5, 2018 from http://neurosciencenews.com/nfl-football-health-outcomes-8425/
Penn Medicine “Uncovering the Long-Term Health Impact of Playing in the NFL.” http://neurosciencenews.com/nfl-football-health-outcomes-8425/ (accessed February 5, 2018).

Abstract

Association Between Playing American Football in the National Football League and Long-term Mortality

Importance Studies of the longevity of professional American football players have demonstrated lower mortality relative to the general population but they may have been susceptible to selection bias.

Objective To examine the association between career participation in professional American football and mortality risk in retirement.

Design, Setting, and Participants Retrospective cohort study involving 3812 retired US National Football League (NFL) players who debuted in the NFL between 1982 and 1992, including regular NFL players (n = 2933) and NFL “replacement players” (n = 879) who were temporarily hired to play during a 3-game league-wide player strike in 1987. Follow-up ended on December 31, 2016.

Exposures
NFL participation as a career player or as a replacement player.

Main Outcomes and Measures The primary outcome was all-cause mortality by December 31, 2016. Cox proportional hazards models were estimated to compare the observed number of years from age 22 years until death (or censoring), adjusted for birth year, body mass index, height, and position played. Information on player death and cause of death was ascertained from a search of the National Death Index and web-based sources.

Results Of the 3812 men included in this study (mean [SD] age at first NFL activity, 23.4 [1.5] years), there were 2933 career NFL players (median NFL tenure, 5 seasons [interquartile range {IQR}, 2-8]; median follow-up, 30 years [IQR, 27-33]) and 879 replacement players (median NFL tenure, 1 season [IQR, 1-1]; median follow-up, 31 years [IQR, 30-33]). At the end of follow-up, 144 NFL players (4.9%) and 37 replacement players (4.2%) were deceased (adjusted absolute risk difference, 1.0% [95% CI, −0.7% to 2.7%]; P = .25). The adjusted mortality hazard ratio for NFL players relative to replacements was 1.38 (95% CI, 0.95 to 1.99; P = .09). Among career NFL players, the most common causes of death were cardiometabolic disease (n = 51; 35.4%), transportation injuries (n = 20; 13.9%), unintentional injuries (n = 15; 10.4%), and neoplasms (n = 15; 10.4%). Among NFL replacement players, the leading causes of death were cardiometabolic diseases (n = 19; 51.4%), self-harm and interpersonal violence (n = 5; 13.5%), and neoplasms (n = 4; 10.8%).

Conclusions and Relevance Among NFL football players who began their careers between 1982 and 1992, career participation in the NFL, compared with limited NFL exposure obtained primarily as an NFL replacement player during a league-wide strike, was not associated with a statistically significant difference in long-term all-cause mortality. Given the small number of events, analysis of longer periods of follow-up may be informative.

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