BALTIMORE, MD - JANUARY 15: NFL Commissioner Roger Goodell speaks to fans during a Q&A prior to the AFC Divisional playoff game between the Houston Texans and the Baltimore Ravens at M&T Bank Stadium on January 15, 2012 in Baltimore, Maryland. (Photo by Patrick McDermott/Getty Images)
A study of player mortality rates and the impact of cardiovascular disease among retired NFL players prompted positive steps toward improving the long-term health of players. Will an upcoming study of neurological diseases do the same?
The first of May is always a sleepy time in the NFL as the football world recovers from two months of free agency and the draft. Even a brewing storm of litigation from more than 1,500 players centered on the long-term health impacts of concussions rarely made it above the fold.
But everything changed May 2 when authorities in Oceanside, Calif., revealed that 12-time Pro Bowl linebacker Junior Seau killed himself with a gunshot to the chest. Seau's death is putting the health and safety of former players in the national conversation for the second time in the last 22 years.
The follow-up to a government study about retired player mortality rates made ripples earlier this week. A pending study, currently in the review phase, examining neurological causes of death is sure to make even more waves upon its release.
Concerns about the longevity of former NFL players last elbowed its way into public awareness more than two decades ago. The NFL Players Association approached the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control, in 1990 with a request to study mortality rates among former football players.
NIOSH conducted a records-based study of 3,439 retired players with at least five seasons of service between 1959 and 1988. The results, released in 1994, revealed that retired NFL players actually lived longer than the general population of American men of a similar age and racial mix. (See the fact sheet from the 1994 study here.)
"There was a common belief at the time, and I think the statistic still circulates, that the average life expectancy of a football player was in their 50s," said Dr. Sherry Baron, an occupational physician at NIOSH who authored the 1994 study, who SB Nation spoke to on Wednesday.
In January on this year, Baron and NIOSH published a follow-up to the 1994 study that appeared in the American Journal of Cardiology. In the original study, researchers anticipated 189 deaths based on estimates from the general population. Only 103 of the players were deceased as of 1991. The follow-up study anticipated 625 deaths among players, but found 334 deaths.
"I think it was reassuring to people," Baron said in a phone interview. "There was a huge concern amongst players that they were going to retire from the game and die shortly thereafter. It was a relief to find that not to be the case."
NFL players get cardiovascular disease and cancer at much lower rates than the general population. Because this was a records-based study, additional information into the reasons for that was not available. Two things that likely aid former football players in reduced mortality rates include a lower rate of smoking than the general population as well as the fact that athletes, you know, exercise.
"Elite athletes like football players are highly physically fit, and there's a certain selection factor as to who gets into the sport to begin with," Baron said.
"There's one thing in occupation health we call the healthy worker effect. Just by virtue of people being in the workplace, and in this case it's a highly selective workplace, it means that those people who become sick are selected out."
Overall mortality rates aside, the NIOSH study did find increased risk of death from heart disease among two groups of players. African Americans had 69 percent higher risk of death from heart disease compared with Caucasian players. Players with a body mass index of 30, considered obese, or more during their playing days had twice the risk of death from heart disease as other players. Both are trends also seen among the general population.
"Some of the thoughts about why African Americans have a higher mortality rate have to do with socioeconomic status as opposed to race," Baron said of the findings related to players. "It's interesting info that when you look at players who would be somewhat more similar in terms of socioeconomic status, at least while they're playing, we still found the same. So that's additional information that will be important for following up."
The study also found higher mortality rates among offensive and defensive linemen. Defensive linemen had a 42 percent higher risk of death from heart disease compared with the general population.
Linemen fall into the group of players with a higher BMI, thus an increased risk. Why defensive linemen were at a higher risk than their counterparts on the other side of the ball is a subject for further study. Baron noted a higher number of African-American players among defensive linemen versus offensive linemen, but the study statistically controlled for that.
"One potential hypothesis is that for whatever reason defensive players may be less likely to take advantage of prevention and treatment," Baron said. "That's just one theory because as I said we don't have info on people and what happened after they stopped playing. "
The most notable outcome of the first study was the creation of the NFL Retired Player Cardiovascular Screening Program. Unique to the NFL, the program offers former players essential preventative care, such as screenings and consultations for fatal and non-fatal cardiovascular diseases as well as other diseases like diabetes.
Baron, explaining the impetus for the program, said, "There was a concern by many individuals inside and outside the NFL about monitoring cardiovascular disease, and given that players are getting larger rather than smaller over time, there was concern about continuing to monitor and do preventative care."
Information collected through the NFL screening program provides complementary information to researchers, whose work has been limited to fatal diseases.
Asked whether the screening program has had a positive impact on retired players, Baron noted it was not something they could study specifically. In time, as they gather more data, it may be possible. Baron did point out one positive trend.
"The difference between defensive players and others seems to be diminishing over time," she said. "Whether it's attributed to the screening program or the general medical care available in the community, the difference in risk seems to be decreasing."
NIOSH does plan to continue this study with the players in this cohort as they age. Those findings represent an important next step in the discussion of player health and safety.
Reports resulting from the player mortality study focused on cardiovascular disease and cancer. The study also included mortality rate data for other causes of death versus the general population.
Nine players in the study died by "intentional self-harm" versus an expected number of 21.8. The more than 3,400 retired players studied were 59 percent less likely to die by suicide than men in the general population. That offers a notable data point in the back and forth resulting from Seau's death.
Musculoskeletal and connective tissue diseases did take a heavier toll on former players versus the general population. Though concussions are in the spotlight now, bone and joint problems are frequently mentioned in the discussion of players' health beyond retirement.
Another finding in the study segues into the hotly anticipated study of neurodegenerative diseases. Diseases of the nervous system and sense organs exacted a higher toll on former players than the general population. Researchers expected to find 9.7 deaths from nervous system diseases in the population of players; they found 12 players dead from those causes.
The next study from NIOSH examines the neurodegenerative causes of death, such as Parkinson's, Alzheimer's and ALS. The study is complete; however, Baron was unable to discuss details because it is still in the review process. It should be released soon.
Asked what prompted the forthcoming study, Baron replied, "When we do a mortality study we can look at all causes of mortality.
"There's been a lot of concern about neurodegenerative disease, and that's how come we're looking at that."
It must be noted that, like the previous study, this one will also be records-based.
"We're looking at causes of death, so we have info on positions people played and how long they played. That's the only info we have," Baron said. "Things like association between head trauma and measuring head trauma wasn't data that was part of this study."
Nevertheless, the findings will arrive at a time when attention is laser-focused on anything related to the neurological health of former football players. The results of that study are likely to add further fuel to a contentious debate threatening the place of professional football and its widespread popularity. Perhaps the results of the next government study combined with the loss of a beloved superstar can spur some progress along with the debate.