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Comparative Study
. 2019 May 3;2(5):e194223.
doi: 10.1001/jamanetworkopen.2019.4223.

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

Vy T Nguyen  1 , Ross D Zafonte  2 , Jarvis T Chen  3 , Kalé Z Kponee-Shovein  1   4 , Sabrina Paganoni  2 , Alvaro Pascual-Leone  5 , Frank E Speizer  1   6 , Aaron L Baggish  7 , Herman A Taylor Jr  4   8 , Lee M Nadler  9 , Theodore K Courtney  1   10 , Ann Connor  5 , Marc G Weisskopf  1   4
Affiliations
Comparative Study

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

Vy T Nguyen et al. JAMA Netw Open. .

Abstract

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.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Zafonte reported receiving royalties from Oakstone for an educational CD (Physical Medicine and Rehabilitation: A Comprehensive Review) and from Demos for being coeditor of the textbook Brain Injury Medicine; reported serving on scientific advisory boards for Myomo, Oxeia Biopharmaceuticals, elminda, and BioDirection; and reported evaluating patients in the Massachusetts General Hospital Brain and Body Program, which is funded by the National Football League (NFL) Players Association. Dr Paganoni reported receiving grants from the American Academy of Neurology, The Salah Foundation, The ALS Association, ALS Finding a Cure, Amylyx, Target ALS, Spastic Paraplegia Foundation, and MGH ALS Therapy Fund. Dr Pascual-Leone reported receiving grants from the NFL Players Association, The Sidney R. Baer, Jr Foundation, and Harvard Catalyst (National Institutes of Health); reported receiving personal fees from the Annals of Neurology; and reported serving on advisory boards for Neuroelectrics, StarLab, Constant Therapy, Neosync, Neuronix, and Cognito. Dr Baggish reported receiving funding from the National Institutes of Health/National Heart, Lung, and Blood Institute, NFL Players Association, American Heart Association, American Society of Echocardiography, and Department of Defense; reported serving as an associate editor for Medicine & Science in Sports & Exercise; reported being on the editorial board for Circulation; and reported receiving compensation for his role as team cardiologist from US Soccer, USRowing, New England Patriots, Boston Bruins, New England Revolution, and Harvard University. Dr Taylor reported receiving grants from the NFL Players Association. Mr Courtney reported receiving grants from the NFL Players Association. Ms Connor reported receiving support from the Football Players Health Study at Harvard University, which is funded by the NFL Players Association. Dr Weisskopf reported being a member of the faculty team for the Football Players Health Study at Harvard University, which is funded by the NFL Players Association. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Flowchart of Matching Major League Baseball (MLB) Players With the National Death Index (NDI)
Information on death date and death state was available for 444 MLB players from the Lahman Baseball Database, and NDI linkage identified 432 (97.3%) of these deaths. Of the 432 identified deaths, 340 deaths (78.7%) were exact matches, and 14 deaths (3.2%) were found after allowing nonmatch on death day and death month. We manually checked and confirmed the remaining 78 deaths (18.1%) in the Lahman Baseball Database that had minor differences in name or birth date with NDI records. The remaining 2264 of the 2708 players in the Lahman Baseball Database without death dates were considered alive.
Figure 2.
Figure 2.. Kaplan-Meier Curves for Underlying Causes of Death by League
Survival by age is shown for each league; P values are from log-rank tests. MLB indicates Major League Baseball; NFL, National Football League.
Figure 3.
Figure 3.. Kaplan-Meier Curves for Underlying or Contributing Causes of Death by League
Survival by age is shown for each league; P values are from log-rank tests. MLB indicates Major League Baseball; NFL, National Football League.
See this image and copyright information in PMC

Comment in

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