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Soccer pros may face increased risk of death from neurodegenerative disease

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Pro soccer: Good and bad news

The good news from the study by Mackay et al. is that mortality from common nonneurologic diseases is lower among former elite soccer players vs. controls; the bad news is that mortality from neurodegenerative diseases is higher and prescriptions for dementia-related medications more common, Robert A. Stern, PhD, wrote in an editorial.

The findings add to existing evidence that repetitive head impact in contact sports may increase the risk of neurodegenerative disease and dementia, but “should not engender undue fear and panic among soccer players, parents, and coaches,” as the findings cannot be generalized to recreational, amateur, or collegiate-level soccer, Dr. Stern said.

The findings should, however, lead to research and awareness of potential consequences of heading the ball in amateur soccer, he argued, noting that “perhaps ... there is already adequate evidence that repeated blows to the brain from heading in professional soccer is an occupational risk that needs to be addressed.”

Dr. Stern is with the Boston University Chronic Traumatic Encephalopathy Center, Boston University. He disclosed financial relationships (receipt of grants, personal fees, and/or other relationships outside the submitted work) with the National Institute of Neurological Disorders and Stroke, the National Institute on Aging, the Concussion Legacy Foundation, Biogen, Eli Lilly, Psychological Assessment Resources, and King Devick Technologies.



Mortality risk associated with neurodegenerative disease is higher, and mortality risk associated with other causes lower, among former Scottish professional soccer players versus matched controls, findings from a retrospective epidemiologic analysis suggest.

Soccer players Nikada/Getty Images

Former professional soccer players included in the analysis also received more dementia-related medication prescriptions than did controls, Daniel F. Mackay, PhD, of the Institute of Health and Wellbeing at the University of Glasgow (Scotland) and his colleagues reported online Oct. 21 in The New England Journal of Medicine.

Overall mortality during a median follow-up of 18 years from study entry at the age of 40 years was 15.4% among 7,676 former players, and 16.5% among 23,028 controls matched based on age, sex, and degree of social deprivation. All-cause mortality was lower among players versus controls before age 70 years, and was higher thereafter, and the mortality rates associated with ischemic heart disease and lung cancer were lower among the players (hazard ratios, 0.80 and 0.53, respectively), the investigators found.

Mortality rates from stroke or cerebrovascular disease were similar in the players and controls (HR, 0.88), they noted.

However, mortality with neurodegenerative disease listed as the primary cause was 1.7% in players versus 0.5% in controls (HR adjusted for competing risks of death, 3.45), they said. The estimated risk of death with neurodegenerative disease was highest among those with Alzheimer’s disease and lowest for those with Parkinson’s disease (HRs, 5.07 and 2.15, respectively).

Dementia-related medications also were prescribed more frequently for players vs. controls (odds ratio, 4.90).

A subgroup analysis showed no significant difference between goalkeepers and outfielders with respect to mortality with neurodegenerative disease listed as a factor (HR, 0.73), but dementia-related medications were prescribed less often to goalkeepers (OR, 0.41).

Concerns about the risk of neurodegenerative diseases among participants in contact sports have been raised, in part because of the recognition of pathologic changes of chronic traumatic encephalopathy among participants across a range of such sports, the investigators explained, noting that data regarding the risk of neurodegenerative disease among former professional soccer players are limited.

The findings of the current study, in terms of lower all-cause mortality up to the age of 70 years, are similar to those in previous studies involving elite athletes across a range of sports, and “may reflect higher levels of physical activity and lower levels of obesity and smoking in elite athletes than in the general population,” they noted.

“In contrast, mortality from neurodegenerative disease was higher among former soccer players, a finding consistent with studies involving former players in the U.S. National Football League,” they added, concluding that the findings, which “may be valuable to inform the management of risks in the sport,” require confirmation in prospective studies.

This study was supported by the Football Association and Professional Footballers’ Association, and by an NHS Research Scotland Career Researcher Fellowship. Dr. Mackay reported having no relevant financial disclosures.

SOURCE: Mackay D et al. N Engl J Med. 2019 Oct 21. doi: 10.1056/NEJMoa1908483.

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