W

hen NFL players went on strike in 1987, NFL teams scrambled to fill their rosters with replacement players, individuals who had some experience with college or professional football but who weren’t on NFL rosters that year. The games they played during the three-week strike were exceedingly unpopular with fans, and the replacement players became a footnote in sports history.

So it’s ironic that these players may actually play a vital role by helping us understand how playing in the NFL affects long-term health.

There is considerable interest in this topic. The main concern is that injuries to the brain may shorten the lives of NFL players. Lifestyle choices, such as substance use (either during or after a player’s career), and the loss of purpose that can come after early retirement, are other factors that may also raise the risk of early death.

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But understanding the life spans of NFL players is difficult, in large part because they represent some of the best, most highly trained professional athletes in the world.

Previous studies have compared NFL players to men of similar age and race drawn from the general population, regular guys like the three of us. Such studies have found that NFL players have a much lower risk of dying prematurely. But that’s really comparing apples and couch potatoes — the two groups are nothing alike. To make an NFL roster, players have to be in incredible shape. They also tend to make more money than most men and have access to the very best health care while they are playing, which can improve health.

This is where the replacement players come in. Unlike members of the general population, replacement players often had prior experience playing football and maybe even similar training, but their professional experience was typically limited to just the strike games. In other words, replacement players are much more like NFL players than the rest of us, but without the prolonged exposure to the hazards of professional football. This makes them an ideal comparison group for NFL players.

We compared the life expectancies of replacement players from the 1987 strike to the life expectancies of professional NFL players who began their careers between 1982 and 1992. As we reported in this week’s Journal of the American Medical Association, NFL players were 38 percent more likely to die in any given year after retirement compared to replacement players, though that difference wasn’t statistically significant.

The results are only suggestive because the overall death rate in both groups was low. By the end of our study in December 2016, the players were on average just 52 years old and only a small proportion (4.2 percent of replacement players and 4.9 percent of NFL players) had died.

Even though we can’t say for certain that the risk of premature death was higher among NFL players, our estimates do let us rule out the possibility that NFL players have substantively lower death rates than replacement players, which is what studies comparing NFL players to men in the general population have found.

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We also looked at causes of death. Heart disease was the most common cause of death among both NFL and replacement players. But there was a higher proportion of deaths from traffic accidents, unintentional harm (typically accidental overdoses from prescriptions drugs or drugs of abuse), and neurological diseases like ALS among the NFL players. Other research has also shown higher risk of death from neurological disease among NFL players.

Going forward, studies that look beyond life expectancy and instead compare measures of physical and mental health among career NFL players and replacement players over time will help increase statistical precision and provide a more detailed understanding of how the health of professional football players evolves with age.

With more research, these replacement players — far from being forgotten — might be able to play an even greater role in history by helping us better understand how playing in the NFL affects long-term health and identify ways to improve the health of football players in the future. That would be a win for every team.

Atheendar Venkataramani, M.D., is an assistant professor in the Department of Medical Ethics and Health Policy at the Perelman School of Medicine at the University of Pennsylvania. Maheer Gandhavadi, M.D., a cardiologist in Everett, Wash., is affiliated with Providence Regional Medical Center Everett. Anupam B. Jena, M.D., is an economist, physician, and associate professor of health care policy and medicine at Harvard Medical School. He has received consulting fees from Pfizer, Hill Rom Services, Bristol-Myers Squibb, Novartis Pharmaceuticals, Vertex Pharmaceuticals, and Precision Health Economics, a company providing consulting services to the life sciences industry.

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