When compared with short-term replacement players, career participation in the National Football League (NFL) did not increase a player’s long-term mortality risk, according to a study published in JAMA.

Researchers from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia conducted a retrospective cohort study of 3812 retired NFL players who made their debut between 1982 and 1992. Nearly 3000 (n=2933) regular NFL players and 879 “replacement players,” who were hired to play for a 3-game period in 1987, were included in the study.

Atheendar S. Venkataramani, MD, PhD, from the Department of Medical Ethics and Health Policy at the University of Pennsylvania, and colleagues sought to assess all-cause mortality of study participants by December 31, 2016.

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Median NFL tenure of regular players was 5 seasons (interquartile range [IQR], 2-8 seasons); median tenure of replacement players was 1 season (IQR, 1-1 season). Median follow-up for the groups was 30 and 31 years, respectively (IQR, 27-33 and 30-33 years, respectively). In total, 181 deaths were recorded over the course of 95,441 person-years, with 144 deaths among regular players and 37 deaths among replacement players. Overall mortality risk for both groups was 4.9% and 4.2% for both groups, respectively, with an absolute risk difference of 0.7% (95% CI, -0.9% to 2.2%; P =.39). After adjustments for birth year, body mass index, height, and position played, absolute risk difference was 1.0% (95% CI, -0.7% to 2.7%; P =.25).

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The most common cause of death in both groups was cardiometabolic disease (35.4% and 51.4%, in regular and replacement players, respectively). Additional causes of death among replacement players were transportation injuries, unintentional injuries (accidental poisonings from substances, medications, or biological substances), and neoplasms; among replacement players, additional causes of death were self-harm and interpersonal violence and neoplasms. Seven deaths resulting from neurological causes were attributed to amyotrophic lateral sclerosis.

Study limitations include residual differences between the 2 groups of players that could not be addressed by researchers, estimates based on a small number of deaths, and possible misreported data, drawn from a public online database. In addition, results may be specific to NFL players who made their debut during the 10-year study period.

“Career participation in the NFL, compared with limited NFL exposure obtained primarily as an NFL replacement player…was not associated with a statistically significant difference in long-term all-cause mortality,” the researchers concluded. “[A]nalysis of long periods of follow-up may be informative.”


Venkataramani AS, Gandhavadi M, Jena AB. Association between playing American football in the National Football League and long-term mortality [published online February 1, 2018]. JAMA. doi:10.1001/jama.2018.0140