A Systematic Review of Etiological Risk Factors Associated With Early Mortality Among National Football League Players.

ABSTRACT

BACKGROUND: Multiple risks predispose professional football players to adverse health outcomes and, in extreme cases, early death; however, our understanding of etiological risk factors related to early mortality is limited. PURPOSE: To identify etiological risk factors associated with all-cause and cause-specific mortality among National Football League (NFL) players. STUDY DESIGN: Systematic review; Level of evidence, 3. METHODS: Articles examining all-cause and cause-specific mortality risk factors among previous NFL players were identified by systematically searching PubMed, PsycINFO, Web of Science, and Google Scholar from 1990 to 2017. Study eligibility and quality were evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS: A total of 801 nonduplicated studies were identified through our search strategy. Of these, 9 studies examining 11 different risk factors were included in the systematic review. Overall, the risk of all-cause and cause-specific mortality was lower among NFL players than among the general male population in the United States. Nonwhite athletes, those in power positions, and those with a high playing-time body mass index (≥30 kg/m2) were associated with elevated all-cause and cardiovascular mortality risks. CONCLUSION: Methodological issues associated with the examined all-cause and cause-specific mortality risk factors preclude a definitive conclusion of etiological protective or risk effects. Comparison groups less prone to selection bias ("healthy worker effect") and a life-course approach to the evaluation of suspected risk factors are warranted to identify etiological factors associated with early mortality among NFL players.