Football Players Health Study Publications

Through our research, we’ve observed that Black and white players don’t always share the same post-career health experience. Our researchers investigated why these health disparities may be occurring. Using data from more than 20,000 players, we examined demographic trends in position and race from 1960 to 2020.

To analyze patterns in player position and career duration, we relied on a unique data set documenting race, position, and career length for all NFL players who played during that time period. While changes in the racial makeup in the NFL over the past several decades have been widely known and discussed, this is the first-time evidence is being presented via our analysis.

The burden of pain is unequal across demographic groups, with broad and persisting race differences in pain-related outcomes in the United States. Members of racial and ethnic minorities frequently report more pervasive and severe pain compared with those in the majority, with at least some disparity attributable to differences in socioeconomic status. Whether race disparities in pain-related health outcomes exist among former professional football players is unknown. We examined the association of race with pain outcomes among 3995 former professional American-style football players who self-identified as either Black or White. Black players reported more intense pain and higher levels of pain interference relative to White players, even after controlling for age, football history, comorbidities, and psychosocial factors. Race moderated associations between several biopsychosocial factors and pain; higher body mass index was associated with more pain among White but not among Black players. Fatigue and psychosocial factors were more strongly related to pain among Black players relative to White players. Collectively, the substantial social and economic advantages of working as a professional athlete did not seem to erase race-related disparities in pain. We highlight an increased burden of pain among elite Black professional football players and identify race-specific patterns of association between pain and biopsychosocial pain risk factors. These findings illuminate potential future targets of interventions that may serve to reduce persistent disparities in the experience and impact of pain.

Chronic traumatic encephalopathy (CTE) is a brain condition thought to be linked to repeated injuries to the head. In this study, researchers attempted to replicate findings from a landmark study (Stern et al. NEJM, 2019) that used PET, showing increased tau in the brains of former professional football players when compared to controls. Our results call into question the results of that study and whether a specific PET tracer can be used to diagnose or study CTE in living players.

As part of our In-person Assessment Study, a 54-year-old former NFL player was tested after he was previously diagnosed with frontotemporal dementia prior to his participation in the study. A brain MRI examination revealed that he suffers from Normal Pressure Hydrocephalus (NPH). This case highlights the challenges in diagnosing cognitive decline for physicians, and an opportunity to explore treatable causes of cognitive impairment in former athletes.

Sustaining concussions has been linked to health issues later in life, yet evidence for associations between contact sports exposure and long-term cognitive performance is mixed. This cross-sectional study of former professional American-style football players tested the association of several measures of football exposure with later life cognitive performance, while also comparing the cognitive performance of former players to nonplayers.

The study found that future investigations of the long-term outcomes of contact sports exposure should include measures of sports-related concussion symptoms, which were more sensitive to objective cognitive performance than other football exposure measures, including self-reported diagnosed concussions.

High blood pressure or hypertension is a common condition in American men as well as in former NFL players. While we know there are several risk factors for hypertension, including smoking, weight gain, diabetes, aging, and identifying as Black, the link between concussion during NFL play and later-life hypertension is unknown.

• Among 4,168 former NFL players, those reporting high numbers of concussion symptoms during playing years were almost twice as likely to report high blood pressure post-career.
• The risk of high blood pressure gradually increased with more concussion symptoms, even after taking into account smoking, older age, diabetes, race, and elevated BMI.

Previous research has shown that former professional football players live as long or longer than men in the general population. However, former players have reported that they feel older than their actual age. Despite their long lifespans, are football players experiencing early aging and living with illness and disability for more years than non-football players? Our researchers and health practitioners examined the occurrence of four chronic diseases in 2,864 former players under the age of 60, including arthritis, dementia/Alzheimer’s Disease, hypertension, and diabetes.

• As expected, our research confirmed that hypertension, diabetes, arthritis, and dementia all increased with age in both football and general populations.
• However, the proportion of players who experienced these conditions was different from non-players. For both arthritis and Alzheimer’s disease/dementia, we found an increase in self-reported diagnoses across all ages.
• For hypertension and diabetes, a higher proportion of former players reported these conditions only in the youngest age group (25–29).
  Our findings showed that players, on average, had 10 fewer years of healthspan, meaning they were without hypertension, arthritis, Alzheimer’s/dementia, and/or diabetes (as shown in the graphic below). This means that former players reported “loss of health” (reporting at least one of the four conditions of interest) appropriately ten years earlier than non-football American men.
• Among football players, linemen were more likely to report at least one of the conditions studied compared to non-linemen under the age of 50.

Please read our results return for more information and action items for former players.

Anterior cruciate ligament (ACL) revision surgery is challenging for both patients and surgeons. Understanding the risk factors for failure after bridge-enhanced ACL restoration (BEAR) may help with patient selection for ACL restoration versus ACL reconstruction. The purpose of this paper was to identify the preoperative risk factors for ACL revision surgery within the first two years after BEAR. They found that gounger age and higher MTS were predictors of ipsilateral ACL revision surgery after the BEAR procedure. Younger patients with higher tibial slopes should be aware of the increased risk for revision surgery when deciding to undergo ACL restoration.

Insomnia is highly prevalent among persons with chronic pain. Although cognitive behavioral therapy for insomnia is recommended as first-line treatment for insomnia, it is underutilized. We tested the feasibility of a potentially scalable alternative – Brief Behavioral Therapy for Insomnia (BBTI) for former National Football League (NFL) players, a group with a high prevalence of chronic pain. We assessed changes in sleep, pain, and psychological health, and found that an adapted telephone-delivered BBTI is acceptable and feasible among retired players with a range of insomnia symptoms. It shows promise for improving sleep and pain. These data support the need for future trials assessing BBTI’s effect on both sleep and pain outcomes.

In this cohort study including 4351 patients, each with mild or moderate to severe traumatic brain injury (TBI), and 4351 frequency-matched unexposed patients without TBI, the rates of cardiovascular and endocrine comorbidities after TBI were significantly higher in patients with mild or moderate to severe TBI compared with patients without TBI. The risk of post-TBI comorbidities was higher in all age groups compared with age-matched unexposed patients, particularly in patients younger than 40 years, and post-TBI comorbidities were associated with higher mortality over a 10-year follow-up period.

These findings suggest that patients with TBI in all age groups may benefit from a proactive targeted screening program for chronic multisystem diseases, particularly cardiometabolic diseases, after injury.