NFL players, taken as a whole, actually die at lower rates than men in the general population. Multiple large studies have found their overall mortality is roughly 30 to 50 percent below what you would expect for American men of the same age and race. But that headline number is deeply misleading. It hides the fact that linemen die earlier than comparable men, that neurodegenerative disease kills former players at three to four times the expected rate, and that the physical toll of a professional football career creates cascading health problems that don’t show up in a simple mortality figure.
Why the Simple Number Looks So Good
If you look only at all-cause mortality, NFL players appear to live longer than average. A study in Neurology examining players active from 1959 to 1988 found their standardized mortality ratio was 0.53, meaning they died at roughly half the rate of men in the general U.S. population after adjusting for age and race.1PubMed Central. Neurodegenerative causes of death among retired National Football League players A more recent analysis published in The Lancet’s eClinicalMedicine found a similar pattern, with an all-cause mortality ratio of 0.70.2The Lancet. Neurodegenerative mortality in National Football League players
This doesn’t mean football is good for your health. The main explanation is something epidemiologists call the healthy worker effect. To make it into the NFL, you need to be in extraordinary physical condition. You’ve been screened, tested, and medically evaluated to a degree most people never experience. That baseline fitness advantage follows players for years after retirement. A study specifically examining this effect in professional football found that career length significantly and incrementally increased player longevity, with birth year and BMI also playing a role.3Research in Sports Medicine: An International Journal. The Healthy Worker Effect in Professional Football In other words, the comparison group (average American men) includes people who were never healthy enough to play a professional sport in the first place. That baked-in selection bias pulls the overall mortality numbers down and makes football look safer than it is.
Linemen Are the Exception
The favorable mortality picture falls apart when you break it down by position. A 2023 study in the Proceedings of the National Academy of Sciences examined two sets of data and found that linemen, both offensive and defensive, had shorter life expectancy than players at other positions and shorter life expectancy than American men of similar education, socioeconomic status, and racial background. In one analysis comparing men drafted as linemen who played at least one professional game against men drafted as linemen who never played a game, those who actually played died about two years earlier on average.4Annals of Epidemiology. The association between playing professional American football and longevity
The reasons trace to body size. Linemen are often encouraged to maintain body weight well above 300 pounds during their careers. That kind of sustained mass strains the cardiovascular system and promotes metabolic dysfunction. Research on Division I collegiate linemen has already shown that metabolic syndrome and insulin resistance are more common in linemen than in other position players, and that retired professional linemen carry metabolic syndrome at more than twice the rate of players at other positions.5PubMed Central. Metabolic Syndrome and Insulin Resistance in Division 1 Collegiate Football Players For non-linemen, the overall mortality advantage holds up. The longevity penalty is concentrated in the biggest players.
Neurodegenerative Disease Is Where the Real Danger Lies
The starkest health risk for former NFL players is neurodegeneration. While their overall death rate is low, their rate of dying from diseases like ALS, Alzheimer’s, and Parkinson’s is dramatically elevated. The eClinicalMedicine study found a neurodegenerative mortality ratio of 3.94, meaning former players were nearly four times as likely to die from these conditions as men in the general population. Broken down by specific disease, ALS was elevated by a factor of about 4.5, dementia by about 3.8, and Parkinson’s by about 3.9.2The Lancet. Neurodegenerative mortality in National Football League players
An earlier study using the same NFL cohort from the 1959-1988 era found a consistent pattern: overall mortality was halved, but neurodegenerative mortality was elevated by a factor of roughly three, with ALS and Alzheimer’s disease showing the largest increases.1PubMed Central. Neurodegenerative causes of death among retired National Football League players
A natural question is whether this excess is just a statistical artifact. If NFL players are dying less from heart disease and cancer, they live long enough to develop age-related brain diseases that would have otherwise never appeared. Researchers have examined this possibility directly through competing-risk simulations. Even after accounting for the fact that healthy longevity gives neurodegenerative disease more time to develop, the excess neurodegenerative mortality remained significant. The adjustment only reduced the ratio from about 3.94 to 3.04, still a threefold elevation.6PubMed Central. Neurodegenerative mortality among National Football League Players The researchers further found that even under the extreme (and biologically unrealistic) assumption of zero mortality from any other cause, the excess neurodegenerative risk persisted. Repeated head impacts, not statistical survivorship, are driving these numbers.
Chronic Traumatic Encephalopathy
CTE, the brain disease associated with repeated head trauma, has become the most publicly discussed health risk in football. A large retrospective study published in The BMJ examined CTE prevalence at death among NFL players and found that the total lifetime duration of football play was not associated with whether a player had CTE at all. However, longer careers were significantly associated with the most severe forms of the disease: stage IV CTE and high-severity CTE (stages III or IV) both increased with years of play.7BMJ. Prevalence of chronic traumatic encephalopathy at death in National Football League players: retrospective population based cohort study, 2008-21 This suggests that while CTE may develop regardless of career length once someone has played football at a high level, more years of exposure push the disease toward its worst manifestations.
CTE cannot currently be diagnosed in living people. It requires autopsy confirmation, which means the full scope of CTE among former players remains unclear. The cases studied tend to come from brain banks, which receive donations from players or families who suspected something was wrong, introducing a selection bias that researchers continue to grapple with.
Cardiovascular Problems After Retirement
Heart disease is the leading cause of death among all Americans, and former NFL players carry several additional risk factors that don’t fully resolve after retirement. A study in the Journal of the American College of Cardiology examining retired players found that nearly 90 percent had hypertension, though only about 38 percent had ever been told they were hypertensive. Roughly 62 percent showed structural heart abnormalities on echocardiography, and high blood pressure was a significant predictor of those abnormalities.8PubMed. Prevalence of Cardiovascular Disease and Risk Factors Among Former National Football League Players
Obstructive sleep apnea appears to be a contributing factor. Former NFL players have elevated rates of sleep apnea, and research suggests that the condition drives up blood pressure and enlarges the aorta in retired players, compounding their cardiovascular risk.9SLEEP. 0609 Cardiovascular Disease Risk Factors in Former National Football League Players: Impact of Obstructive Sleep Apnea A separate review noted that the chronic effects of untreated sleep apnea over years would worsen preexisting conditions like hypertension, metabolic syndrome, and coronary artery disease.10PubMed Central. Obstructive Sleep Apnea among Players in the National Football League: A Scoping Review An additional study found that about a third of retired NFL athletes displayed thickened heart walls and nearly half had early aortic dilation.11Sleep Health. Cardiovascular disease risk in former National Football League players: Impact of obstructive sleep apnea
When NFL players are compared to professional baseball players rather than to the general population, the cardiovascular picture gets worse. A study in JAMA Network Open found that NFL players had more than double the cardiovascular mortality rate of MLB players and nearly triple the neurodegenerative mortality rate, while cancer mortality was about the same between the two groups.12JAMA Network Open. Mortality Among Professional American-Style Football Players and Professional American Baseball Players Comparing one group of elite athletes to another removes much of the healthy worker bias, and when you do that, football’s cardiovascular toll becomes more visible.
Chronic Pain and Opioid Use
The physical damage from an NFL career doesn’t end at retirement. Traumatic injury rates among NFL players approach 100 percent, and chronic pain is the default state for many retirees. One study of former players found that chronic pain had persisted for an average of about 16 and a half years after retirement.13bioRxiv. The effect of focused muscle contraction therapy on chronic pain and Brodmann Area activity in former National Football League players Knees take the worst beating: a study of younger retired players found that nearly half had undergone knee surgery, with some having up to five procedures on a single joint.14PubMed Central. Whole-Person Impairment in Younger Retired NFL Players: The Orthopaedic Toll of a Professional Football Career
That level of chronic pain drives significant opioid use. Over half of former players in one survey reported using opioids during their NFL career, and 71 percent of those users said they had misused the drugs at some point. At the time of the survey, about 7 percent of retired players were currently using opioids, roughly three times the rate in the general population. Players with significant pain, undiagnosed concussions, and heavy drinking were at the highest risk of current misuse.15PubMed Central. Injury, pain, and prescription opioid use among former National Football League (NFL) players
A follow-up study found that opioid use during playing years was a strong predictor of continued use after retirement. Among retirees who were using opioids when first surveyed, nearly half were still using them nine years later. Those with a history of opioid use also had nearly six times the odds of experiencing moderate-to-severe depressive symptoms.16PubMed Central. History of opioid use as a risk factor for current use and mental health consequences among retired National Football League athletes: A 9-year follow-up investigation Separate research showed that using opioids to manage stress or anxiety while still in the league increased the odds of later misuse, suggesting that the context of use matters beyond simple pain management.17PubMed Central. Reasons for prescription opioid use while playing in the National Football League as risk factors for current use and misuse among former players
Suicide Rates Are Lower Than Expected
Given the prevalence of brain injury, chronic pain, and opioid use, many people assume that NFL players are at elevated risk of suicide. The data say otherwise. A study of retired players who played five or more seasons found 12 suicide deaths where roughly 26 would have been expected based on general population rates, a reduction of more than half.18PubMed Central. Suicide Mortality Among Retired National Football League Players Who Played 5 or More Seasons A review of the available epidemiological evidence confirmed that former NFL players are at lower, not greater, risk for suicide compared to men in the general population.19PubMed Central. Retired National Football League Players are Not at Greater Risk for Suicide
That said, the same review noted that a substantial minority of former players do suffer from depression, and that those with both chronic pain and depression also tend to have greater life stress and financial difficulties. The population-level statistic doesn’t mean individual players aren’t struggling. It means the factors that drive suicide in the general male population, things like social isolation and lack of healthcare access, may be partially offset by the financial resources and social networks that come with having played in the NFL.
Racial Disparities in Post-Career Health
The health toll of professional football does not fall equally across racial groups. A study from the Football Players Health Study found that Black former players had significantly higher risk across five adverse health outcomes compared to white former players, with risk ratios ranging from about 1.4 to 1.9. Native Hawaiian players and men of other racial backgrounds also showed increased risk on most measures.20Annals of Epidemiology. Race in association with physical and mental health among former professional American-style football players: findings from the Football Players Health Study These disparities persisted even after adjusting for age, which suggests that the differences are not simply explained by when players entered the league. Broader systemic factors in access to healthcare, wealth accumulation, and post-career support likely play a role.
When Players Start Playing Tackle Football
A growing area of research looks not just at what happens during and after an NFL career, but at what happened before it. Specifically, the age at which a player first began playing tackle football appears to influence later-life cognitive outcomes. A study of former NFL players found that those who started playing tackle football before age 12 performed significantly worse on tests of executive function, memory, and estimated verbal intelligence compared to those who started at 12 or older, even after controlling for total years of football played.21PubMed Central. Age of first exposure to football and later-life cognitive impairment in former NFL players
A separate NFL-LONG study found that younger age of first exposure to football was associated with higher scores on measures of anxiety, depression, sleep disturbances, pain interference, and emotional-behavioral problems. However, the same study found that age of first exposure was not associated with diagnosed dementia, depression, or mild cognitive impairment, while the player’s current age was a stronger predictor of those diagnoses. The researchers described age of first exposure as a significant but minor contributing factor for health-related quality of life in this group.22PubMed. Relating American Football Age of First Exposure to Patient-Reported Outcomes and Medical Diagnoses Among Former National Football League Players: An NFL-LONG study The picture is nuanced: early exposure seems to affect some dimensions of brain health but not others, and the effects may be modest relative to the cumulative impact of a professional career. Still, for parents weighing when to let a child play tackle football, these findings are worth knowing about.