Longer NFL careers tied to higher ALS and neurodegenerative death rates

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Repeated blows to the head during professional American football may come with a lasting cost to brain health, including higher death rates from amyotrophic lateral sclerosis (ALS) and other neurodegenerative diseases.

That’s according to a U.S. study involving more than 19,000 National Football League (NFL) players. Compared with men of similar age, race and calendar year in the general U.S. population, the players had more than 4.5 times the expected ALS mortality rate and nearly four times the expected mortality rate from neurodegenerative diseases overall.

Neurodegenerative mortality remained about three times the expected rate even after a sensitivity analysis accounted for players’ lower mortality from other causes. The finding strengthens evidence linking presumed repetitive head-impact exposure during NFL careers to deaths from neurodegenerative diseases.

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“Together, these findings strengthen the evidence for [repetitive head impact] exposure-related neurodegenerative mortality in NFL players that cannot be explained by differential survivorship,” the researchers wrote, emphasizing “the need for exposure mitigation strategies.”

The study, “Neurodegenerative mortality among National Football League Players,” was published in eClinicalMedicine.

A growing number of studies suggest that traumatic head injuries may be linked to several neurological conditions, including ALS.

Football players can experience repetitive head impacts throughout their careers. Although many of these hits do not result in a diagnosed concussion, researchers are studying whether their cumulative effects may damage the brain over time.

Previous studies have linked repeated head impacts sustained during football to ALS and other neurodegenerative diseases. However, limitations such as small study populations and uncertainty about the timing of head injuries relative to disease onset have left questions about the relationship.

To provide a clearer picture, researchers analyzed mortality data from 19,824 players who appeared in at least one NFL regular-season or postseason game and made their league debut between 1960 and 2019. The players were followed for an average of 26.2 years.

During that time, 1,994 deaths were recorded, including 178, or 8.9%, from neurodegenerative diseases. These included 33 deaths from ALS, 39 from Parkinson’s disease, and 106 from dementia.

Compared with players who died from other causes, those who died from neurodegenerative diseases were significantly older at death, and a significantly higher proportion were white. They also had significantly longer NFL careers, played in and started significantly more games, and appeared in significantly more Pro Bowls.

Death rates compared with U.S. population

The researchers then compared the players’ death rates with those expected among men of similar age and race during the same calendar years in the U.S. population. Overall, NFL players had a significantly lower all-cause mortality rate — 30% below the expected rate — than men in the general population. Deaths from cancer, cardiovascular disease, injury, and suicide were also significantly less frequent among the players.

Despite their lower overall mortality, NFL players had nearly four times the expected mortality rate from neurodegenerative diseases overall. The difference was greatest for ALS, with mortality more than 4.5 times the expected rate. Mortality from Parkinson’s disease and dementia was also nearly four times the expected rate among the players.

Further analyses showed that players with five or more NFL seasons had an 86% higher neurodegenerative mortality rate than those with one to four seasons. The researchers said this finding supports an association between longer NFL careers, used as a measure of greater presumed exposure to repeated head impacts, and higher neurodegenerative mortality.

Players in speed positions had a 67% higher neurodegenerative mortality rate than those in nonspeed positions, including about twice the dementia mortality rate. Among players younger than 60, ALS mortality was more than 15 times the expected rate in the general population.

Because NFL players had lower mortality from other causes than the general population, researchers examined whether this survival advantage could account for the higher neurodegenerative mortality rate. Even after accounting for these competing risks, neurodegenerative mortality among NFL players remained about three times the expected rate.

“These results strongly support the increased risk of [repetitive head impact] exposure-related neurodegenerative mortality among NFL players that cannot be explained by differential survivorship,” the researchers wrote, adding that the findings reinforce “the need for policies limiting [repetitive head impact] exposure and supporting evaluation of healthspan-focused interventions.”