Playing position and long-term mortality among elite male football players, 1930-1990

BackgroundConcern about long-term health effects of repetitive head impacts in football has increased, but it remains unclear whether position-specific exposure patterns were associated with differential long-term all-cause mortality among elite players across the 20th century. MethodsWe conducted two retrospective cohort studies of elite male professional football players. The World Cup cohort included all players on the team rosters from FIFA World Cup tournaments (1930-1990), and the UEFA European Cup cohort included all players who appeared in annual quarterfinal, semifinal, or final matches (1956-1991). Vital status was ascertained through archival linkage. Playing position was harmonized into six categories. Age was the time scale. Cox proportional hazards models were stratified by birth cohort and adjusted for origin region; interaction models were used to estimate region-specific marginal hazard ratios. FindingsThe World Cup cohort included 4,223 players (2,330 deaths), and the European Cup cohort included 2,710 players (1,126 deaths). In the World Cup cohort, goalkeepers had lower mortality than midfielders (hazard ratio [HR] 0.73, 95% CI 0.63-0.84), whereas center-forwards had higher mortality (HR 1.27, 95% CI 1.08-1.50); mortality among center-backs was elevated but not statistically significant (HR 1.13, 95% CI 0.98-1.31). In the European Cup cohort, center-backs (HR 1.28, 95% CI 1.07-1.55) and other defenders (HR 1.20, 95% CI 1.02-1.42) had higher mortality than midfielders. Region-stratified marginal estimates indicated that elevated risks for central playing roles were greatest in Northwestern Europe and Central/Eastern Europe. InterpretationAmong footballers active during the 20th century, long-term all-cause mortality differed by playing position and varied by region, with higher risks concentrated in central attacking and defensive roles. These patterns were most pronounced in regions where aerial contests historically predominated, suggesting that long-term health risks associated with professional football participation vary by role-specific exposure profiles.