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

Research output: Contribution to journalReview article

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.

Original languageEnglish (US)
Pages (from-to)2325967118813312
JournalOrthopaedic Journal of Sports Medicine
Volume6
Issue number12
DOIs
StatePublished - Dec 2018
Externally publishedYes

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Football
Mortality
Healthy Worker Effect
Selection Bias
PubMed
Athletes
Observational Studies
Epidemiology
Body Mass Index
Guidelines
Health
Population

Cite this

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title = "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.",
author = "Owora, {Arthur H} and Kmush, {Brittany L} and Bhavneet Walia and Shane Sanders",
year = "2018",
month = "12",
doi = "10.1177/2325967118813312",
language = "English (US)",
volume = "6",
pages = "2325967118813312",
journal = "Orthopaedic Journal of Sports Medicine",
issn = "2325-9671",
publisher = "SAGE Publications Inc.",
number = "12",

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T1 - A Systematic Review of Etiological Risk Factors Associated With Early Mortality Among National Football League Players

AU - Owora, Arthur H

AU - Kmush, Brittany L

AU - Walia, Bhavneet

AU - Sanders, Shane

PY - 2018/12

Y1 - 2018/12

N2 - 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.

AB - 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.

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