NFL Players Have a Higher Rate of Mortality than Major League Baseball Players

National Football League (NFL) players have markedly higher rates of all-cause mortality compared to Major League Baseball (MLB) players, according to a study published in JAMA.

The long-term health of NFL players has become a hot-button topic in the US, and the league has come under increased scrutiny due to concerns surrounding former players developing chronic traumatic encephalopathy (CTE) as a result of prolonged head trauma. Despite public apprehension, previous studies have shown that NFL players have reduced mortality rates compared to the general population. However, the researchers note that these comparisons can be biased because professional athletes tend to be in better physical shape compared to “normal” individuals in the same age group – a bias known as “the healthy worker hire effect”. To ascertain more objective data regarding the health effects of playing in the NFL, the researchers sought to compare football players to athletes in MLB over the same time duration.

In this retrospective cohort study, researchers analyzed data from 3,419 NFL players and 2,708 MLB players born between 1915 and 1965 who played at least five seasons in their respective sports. They obtained vital signs and cause of death information via the National Death Index (NDI) from 1979 through 2013. Adjusted for race and decade of birth, the researchers used Cox proportional hazards regression models as a timescale to calculate hazard ratios (HRs) and 95% CIs to evaluate all-cause and specific mortality rates among both athlete cohorts. They analyzed data from January 2016 through April 2019.

Significantly Higher All-Cause Mortality

According to the results of the study, by the conclusion of follow-up, there were 517 deaths (mean age, 59.6) in the NFL cohort and 431 deaths (mean age, 66.7 years) in the MLB cohort. They found that cardiovascular and neurodegenerative conditions were the underlying or contributing causes in 498 and 39 deaths in the NFL compared to 225 and 16 deaths in the MLB. When juxtaposed with MLB players, NFL players had perceptibly elevated rates of all-cause (HR=1.26; 95% CI, 1.10 to 1.44), cardiovascular disease (HR=2.40; 95% CI, 2.03 to 2.84), and neurodegenerative disease (HR=2.99; 95% CI, 1.64 to 5.45) mortality. Moreover, when comparing hypothetical populations of 1,000 NFL and 1,000 MLB players followed up to the age of 75, according to the researchers, “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 indicates the need for cohort studies of football players with more detailed information on specific aspects of players’ football experience to isolate what specific factors are associated with increased cardiovascular and neurodegenerative risk, which could provide more insight into potentially modifiable factors that might mitigate some of the excess mortality rate we found among NFL players,” the researchers wrote.

They added that their findings also highlight “the need for complementary pathophysiological studies of former NFL athletes to delineate the biological basis for the findings we observed herein. Such efforts could lead to better general understanding of the pathophysiology of these conditions and suggest interventions that could reduce the burden of these outcomes among American-style football players.”