University of Glasgow landmark study
Former footballers are at increased risk from dementia
Research: Dr Willie Stewart
Former professional footballers are three-and-a-half times more likely to die of dementia than others in the general population of a similar age, according to new research.
The University of Glasgow led the landmark FIELD study of over 7500 ex-pros which revealed the higher rate of death due to neurodegenerative disease.
The research was launched after claims that repeatedly heading a heavy leather football was the cause of former England international Jeff Astle’s death in 2002 at the age of 59.
In findings published today in The New England Journal of Medicine and funded by the English Football Association (FA) and the Professional Footballers’ Association (PFA), researchers compared the causes of death of 7,676 former Scottish male professionals who were born between 1900 and 1976 against those of more than 23,000 matched people from the general population.
Consultant neuropathologist Dr Willie Stewart, honorary clinical associate professor at the University of Glasgow, said: “This is the largest study to date looking in this detail at the incidence of neurodegenerative disease in any sport, not just professional footballers.
“A strength of our study design is that we could look in detail at rates of different neurodegenerative disease subtypes. This analysis revealed that risk ranged from a 5-fold increase in Alzheimer’s disease, through an approximately 4-fold increase in motor neurone disease, to a 2-fold Parkinson’s disease in former professional footballers compared to population controls.”
Although footballers had higher risk of death from neurodegenerative disease, they were less likely to die of other common diseases, such as heart disease and some cancers, including lung cancer.
Reflecting these findings, the study found that deaths in former footballers were lower than expected up to age 70, and higher than expected over that age.
Dr Stewart added: “An important aspect of this work has been the ability to look across a range of health outcomes in former professional footballers. This allows us to build a more complete picture of health in this population.
“Our data shows that while former footballers had higher dementia rates, they had lower rates of death due to other major diseases. As such, whilst every effort must be made to identify the factors contributing to the increased risk of neurodegenerative disease to allow this risk to be reduced, there are also wider potential health benefits of playing football to be considered.”
The association between contact sport participation and neurodegenerative disease has been subject to debate in recent years.
Post-mortem studies have identified a specific dementia pathology linked to exposure to brain injury, known as chronic traumatic encephalopathy (CTE), in a high proportion of brains of former contact sports athletes, including former footballers in parallel studies led by Dr Stewart.
The whole game must recognise that this is only the start of our understanding– Greg Clarke, English FA
However, until this study, it was not clear whether there was any evidence of an increase in neurodegenerative disease rate in former footballers.
Greg Clarke, English FA chairman, said: “This is the most comprehensive study ever commissioned into neurodegenerative disease in former professional footballers.
“The whole game must recognise that this is only the start of our understanding and there are many questions that still need to be answered. It is important that the global football family now unites to find the answers and provide a greater understanding of this complex issue. The FA is committed to doing all it can to make that happen.”
Gordon Taylor, PFA Chief Executive, said: “We are grateful to Dr Willie Stewart and his team for their work.
“The PFA co-funded FIELD, alongside The FA. It is now incumbent on football globally to come together to address this issue in a comprehensive and united manner. Research must continue to answer more specific questions about what needs to be done to identify and reduce risk factors.”
The work is supported by funding from The Football Association and The Professional Footballers’ Association Charity; and an NHS Research Scotland Career Researcher Fellowship.
Dr Carol Routledge, Director of Research at Alzheimer’s Research UK, said: “This well-conducted study of long-term health in ex-professional footballers is the largest of its kind and fills an important gap in our knowledge about football and dementia.
“Former professional footballers enjoy several health benefits, but the strong association with dementia justifies calls for a global focus on research to understand this link further.
“The study has not looked at what aspect of players’ lives on and off the pitch may be behind their increased dementia risk, but there is a pressing need for further high-quality research to address this question. Alzheimer’s Research UK is acting as an independent advisor to the FA to help prioritise the direction of future research.
“While the research is limited by the accuracy of historic medical records, it’s only due to the quality and availability of medical records in Scotland that this work has been possible.
“The results form a solid basis for wider expert discussion about the impact of professional football on long-term brain health, including head injury, and we hope to see more data from this study in the coming months and years.
“The study focused on former professional football players and doesn’t tell us anything about whether the modern professional or grassroots game should change or how.
“With football close to the hearts of so many of us, football associations across the world must take the findings seriously and review emerging evidence to ensure players can enjoy the game safely at all levels.”