by Mass. General Brigham Communications, Harvard Gazette
A new study shows that players in the National Football League are four times more likely to die from neurodegenerative diseases than the general population. The study, which included nearly 20,000 NFL players, found that while players had a lower average mortality rate than the national rate, they were four times more likely to have neurodegenerative mortality. Research findings from Mass. General BrighamPublished by Boston University, and the Concussion and CTE Foundation eClinical Medicine.
“This is the clearest population-level evidence we have that NFL players are dying from neurodegenerative diseases at a real and measurably higher rate,” said the co-senior author. Daniel DaneswarAssociate Professor at Harvard Medical School and Chairman of the Department of Physical Medicine and Rehabilitation at Spaulding Rehabilitation Hospital. “This study shows that, when looking at athletes who played in an NFL game, including nearly 20,000 players across each official cause of death, the results are the same: NFL players are three to four times more likely to die of dementia and Parkinson’s disease than non-NFL players.”
Neurodegenerative diseases, such as dementia, ALS or Parkinson’s, affect millions of people worldwide. Generally, age is the biggest risk factor for developing neurodegenerative diseases, but studies have shown that people with exposure to repeated head impacts — such as pro football players — also have a higher incidence of the disease. In the largest retrospective cohort study to date, researchers looked at the health records of 19,824 NFL players who competed between 1960 and 2019 to determine exactly how much.
They found that players had lower all-cause mortality but almost four times more neurodegenerative mortality, including all-cause dementia (3.8 times higher) and Parkinson’s (3.88 times higher). When accounting for other known risk factors, neurodegenerative mortality was still three times higher for athletes than for the general population.
“A fourfold increase in dementia rates from a presumed environmental cause is enormous — and brain bank research indicates that CTE is the primary explanation.”
Jesse Maze
The increase was even more significant for young NFL players. Those who died before age 60 had a 12-fold increase in neurodegenerative mortality compared to the general population. Players with long careers (five seasons or more) had nearly double the risk of neurodegenerative death compared to those with short careers (one to four seasons), reinforcing the dose-response relationship between years of play and risk of brain disease identified in chronic traumatic encephalopathy (CTE) studies.
“A fourfold increase in the rate of dementia from a presumed environmental cause is enormous — and the brain bank study suggests that CTE is the primary explanation,” said study co-senior author Jesse Maze, associate director of the Boston University Alzheimer’s Disease Research Center and co-director of clinical research at the BU CTE Center. Heavy lead exposure was found to lead to a two- to three-fold higher rate of dementia and a 1.5-fold higher rate of cardiovascular death.”
The study showed that NFL players had a significantly lower overall mortality than the general population despite dramatically elevated rates of neurodegenerative disease. NFL players were less likely to die from cancer, cardiovascular disease, and suicide—a population that is generally healthy yet dies from brain disease at high rates.
The study also introduces a new concept called the Athletic Resilience Survivor (STARS) effect to explain why former NFL players tend to live longer overall. The STARS effect suggests that the same genetic, environmental, medical, and behavioral characteristics that enable individuals to become professional athletes—such as exceptional physical and cognitive performance, resilience, self-discipline, and low rates of smoking and serious early illness and injury—also contribute to longer overall survival. Higher educational attainment and better access to medical care may further reduce the impact of other health conditions later in life. These benefits make the higher rates of neurodegenerative disease more striking because NFL players would otherwise be expected to have lower rates of brain disease than the general population because of these health benefits.
Taken together, the STARS effect suggests that the fourfold increase in neurodegenerative disease found among NFL players may actually underrepresent the true relationship between NFL and neurodegenerative disease, as NFL players would otherwise be expected to have lower rates of brain disease in the same way they have lower rates of cancer and cardiovascular disease. Indeed, mortality from neurodegenerative diseases was highest among athletes with fewer comorbidities; Linemen, who are typically heavier, have higher body-mass index and associated comorbidities including sleep apnea, had half the dementia deaths of non-linemen.
Former NFL players who are concerned about their brain health or risk of neurodegenerative disease are encouraged to seek evaluation from physicians specializing in neurodegenerative disease. Many conditions can have symptoms that resemble neurodegenerative diseases, and many of these conditions are treatable. Even when long-term risk cannot be eliminated, identifying and managing modifiable risk factors can help support overall brain health and quality of life. Players are encouraged to use available resources for guidance, specialist referrals, or assistance managing health concerns, including Trust Run by the NFL Players Association (NFLPA). NFLPA’s Professional Athlete Foundationand the Concussion & CTE Foundation Helpline.
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This story is reprinted from permission from Harvard Gazette.
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