Summary: A multi-institutional team evaluated health records spanning six decades. The investigators discovered that while former players have lower all-cause mortality rates overall, they are four times more likely to die from neurodegenerative diseases, such as all-cause dementia and Parkinson’s disease, than the general population, establishing an undeniable, dose-response environmental threat.
Key Facts
- The Fourfold Surge Confirmed: Across every official cause of death tracked, NFL veterans exhibited a 3.94-times higher overall rate of neurodegenerative mortality. This includes a 3.80-times higher rate of all-cause dementia and a 3.88-times higher rate of Parkinson’s disease.
- The STARS Effect Unmasked: The study introduces a novel epidemiological concept: the Selection Through Athletic Resilience Survivor (STARS) effect. This explains that the unique genetic, medical, behavioral, and financial advantages required to make an NFL roster should naturally shield players from disease, making their high rates of brain degeneration even more striking.
- Underrepresenting the True Danger: Because the STARS effect proves that NFL veterans are fundamentally healthier baseline individuals (showing significantly lower rates of cancer, cardiovascular conditions, and suicide), researchers emphasize that a 4x increase may actually underrepresent the true neurological damage caused by the sport.
- The Youth Threat (Under 60): The spike in brain-related mortality was most devastating among younger athletes. Former NFL players who passed away before the age of 60 exhibited a shocking 12-fold (1,200%) increase in neurodegenerative death compared to age-matched peers in the general public.
- The Career Dose-Response Curve: Reinforcing previous clinical frameworks surrounding Chronic Traumatic Encephalopathy (CTE), a strict dose-response pattern was found: veterans with longer careers (5 or more seasons) faced double the risk of neurodegenerative death compared to players who departed after 1 to 4 seasons.
- Worse Than Environmental Toxins: Dr. Jesse Mez compared the scale of this danger to heavy lead exposure, which was globally banned due to its toxicity. Lead exposure increases dementia rates by 2-to-3 times; playing in the NFL exceeds that threshold, tracking primarily to underlying CTE pathology.
Source: Mass General
A new study from Mass General Brigham, Boston University, and the Concussion & CTE Foundation found that National Football League (NFL) players had higher rates of neurodegenerative disease-caused mortality than the general population. A cohort study of nearly 20,000 NFL players revealed that, while players had lower mortality on average compared to national rates, they were four times more likely to experience neurodegenerative mortality.
Results are published in eClinicalMedicine.
“This is the clearest population-level evidence we have ever had that NFL players are dying due to neurodegenerative disease at real and measurably higher rates,” said co-senior author Daniel Daneshvar, MD, PhD, Chair of Physical Medicine and Rehabilitation at Mass General Brigham and Harvard Medical School and director of the HealthSpan Lab.
“This study demonstrates that, when looking at athletes who have played in an NFL game, including nearly 20,000 players, across every official cause of death, the result is the same: NFL players are dying of dementia and Parkinson’s disease three to four times more often than they should.”
Neurodegenerative diseases, like dementia, ALS, or Parkinson’s, affect tens of millions of people worldwide. Typically, age is the biggest risk factor for developing neurodegenerative diseases, but studies have revealed individuals with repetitive head impact exposure—like NFL players—also have higher incidence of the diseases. In the biggest retrospective cohort study to date, researchers looked at health records of 19,824 NFL players who competed between 1960 and 2019 to determine exactly how much higher.
They found that players had lower all-cause mortality but nearly four-times higher neurodegenerative mortality, including all-cause dementia (3.8-times higher) and Parkinson’s (3.88-times higher). When accounting for other known risk factors, neurodegenerative mortality was still three times higher for players compared to the general population.
The increase was even more significant for younger NFL players. Those who died before age 60 had more than 12-fold increased rates of neurodegenerative death compared to the general population. Players with longer careers (5+ seasons) had nearly double the risk of neurodegenerative death compared to those with shorter careers (1–4 seasons), reinforcing a dose-response relationship between years of play and brain disease risk identified in studies of chronic traumatic encephalopathy (CTE).
“A fourfold increase in dementia rates from a presumed environmental cause is immense—and brain bank studies indicate that CTE is the primary explanation,” said study co-senior author Jesse Mez, MD, MS, Associate Director of the Boston University Alzheimer’s Disease Research Center and Co-Director of Clinical Research at the BU CTE Center.
“To put that in perspective, heavy lead exposure, which was banned from paint and gasoline in the U.S. due to its neurological and cardiovascular consequences, leads to a 2-to-3 times greater rate of dementia and a 1.5 times greater rate of cardiovascular death.”
The study shows that NFL players had significantly lower overall mortality than the general population despite their dramatically elevated neurodegenerative disease rates. NFL players were less likely to die from cancer, cardiovascular disease, and suicide — underscoring that this is a population that is generally healthier yet still dying of brain disease at higher rates.
The study also introduces a new concept called the Selection Through Athletic Resilience Survivor (STARS) effect to explain why former NFL players tend to live longer overall. The STARS effect suggests that the same genetic, environmental, medical, and behavioral characteristics that enable individuals to become professional athletes—such as exceptional physical and cognitive performance, resilience, self-discipline, as well as lower rates of smoking and serious early illnesses and injuries—also contribute to longer overall survival. Higher educational attainment and better access to medical care may further offset the effects of other health conditions later in life.
Those advantages make the elevated rates of neurodegenerative disease even more striking because NFL players would otherwise be expected to have lower rates of brain disease than the general population due to these health advantages.
Taken together, the STARS effect suggests that the fourfold increase in neurodegenerative disease found in NFL players may actually underrepresent the true relationship between playing in the NFL and neurodegenerative disease, as NFL players would otherwise be expected to have lower rates of brain disease, in the same way that they have lower rates of cancer and cardiovascular disease.
In fact, neurodegenerative disease deaths were highest in athletes who tend to have the fewest comorbidities; linemen, who tend to be heavier, with higher body mass index, and related comorbidities including sleep apnea, had half the dementia mortality compared to non-linemen.
Former NFL players who are concerned about their brain health or neurodegenerative disease risk are encouraged to seek evaluation from clinicians specializing in neurodegenerative disease. Many conditions can cause symptoms that resemble neurodegenerative disease, and many of these conditions are treatable.
Even when long-term risk cannot be eliminated, identifying and managing modifiable risk factors can help support overall brain health and quality of life. Players seeking guidance, specialist referrals, or support in managing health concerns are encouraged to utilize available resources, including The Trust Powered by the NFL Players Association (NFLPA), the NFLPA’s Professional Athletes Foundation, and the Concussion & CTE Foundation HelpLine.
Authorship: In addition to Daneshvar, authors include Charlotte B. Luster, Bobak Abdolmohammadi, Michael J. Mastrodicasa, Christopher J. Nowinski, Evan D. Feigel, Brenna Finegan, Adam J. White, Eric J. Connors, Craig Rovito, Ross D. Zafonte, Michael L. Alosco, Ann C. McKee, Jesse Mez.
Disclosures: The study authors disclosed relationships with the Player Advocacy Committee for the NFL Concussion Settlement, the NFL Players Association (NFLPA), the Brain and Body Program Powered by the NFLPA, the Mackey-White Committee of NFLPA, World Rugby, World Wrestling Entertainment (WWE), All Elite Wrestling (AEW), and the Professional Footballers’ Association. Additional disclosures can be found in the paper.
Funding: The National Institute of Neurological Disorders and Stroke (U54NS115266; U01NS086659), the National Institute on Aging (P30AG13846; P30AG072978), and the Maloney/Carpenter Trauma-Related Neurodegenerative Disease Research Fund.
Key Questions Answered:
A: This is what the researchers call the STARS effect (Selection Through Athletic Resilience Survivor effect). To make it to the NFL, you have to possess elite genetic traits, extreme self-discipline, and peak physical conditioning. After retiring, veterans generally enjoy higher wealth, better health insurance, and lower smoking rates, which shields them from cancer and heart attacks. However, this study proves that despite being vastly healthier than the public, the sheer volume of repetitive head impacts completely breaks this “athletic shield”, selectively destroying their brains while the rest of their bodies remain strong.
A: Dr. Jesse Mez provided a sobering comparison: heavy lead exposure was completely banned by the U.S. government because it was a neurological disaster that increased a person’s long-term risk of dementia by 2-to-3 times. This study of nearly 20,000 players reveals that playing in the NFL carries a fourfold (nearly 4 times) increase in dementia mortality. This means the structural, accumulative brain trauma forced by professional football is an environmental hazard that is significantly more destructive to long-term cognitive survival than heavy lead poisoning.
A: Your risk is not an absolute prison sentence. Dr. Daniel Daneshvar and clinical teams emphasize that while past head impacts cannot be erased, many treatable conditions (like sleep apnea, nutritional deficiencies, or chronic depression) can mimic the early symptoms of dementia or Parkinson’s. Former players are urged to get comprehensive evaluations from specialized neurodegenerative clinicians. Managing modifiable risk factors, optimization of sleep, and targeting underlying inflammation can dramatically protect your cognitive reserves and elevate your everyday quality of life.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- Journal paper reviewed in full.
- Additional context added by our staff.
About this CTE and neurology research news
Author: Tim Sullivan
Source: Mass General Brigham
Contact: Tim Sullivan – Mass General Brigham
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Neurodegenerative Mortality Among National Football League Players” by Adam J. White, Ann C. McKee, Bobak Abdolmohammadi, Brenna Finegan, Charlotte B. Luster, Craig A. Rovito, Daniel H. Daneshvar, Eric J. Connors, Evan D. Feigel, Jesse Mez, Michael J. Mastrodicasa, Michael L. Alosco, Christopher J. Nowinski, Ross D. Zafonte. eClinicalMedicine
DOI:10.1016/j.eclinm.2026.104051
Abstract
Neurodegenerative Mortality Among National Football League Players
Background
Empirical research demonstrates elevated neurodegenerative mortality among individuals with repetitive head impact (RHI) exposure, including National Football League (NFL) players. This investigation addressed prior methodological limitations, including selection bias, subjective diagnoses, and retrospective reporting, by analyzing the relationship between RHI exposure and neurodegenerative mortality in a fully enumerated, 5.8-fold larger cohort of NFL players.
Methods
A population-based retrospective cohort study was conducted comprising all current and former NFL athletes who debuted between 1960 and 2019 and played at least one regular or postseason NFL game, with National Death Index records (1979–2023) matched to Sports Reference, LLC data. Standardized mortality ratios (SMRs) were calculated from National Institute for Occupational Safety and Health data compared to an age-, sex-, race-, and calendar-year-standardized general population. Sensitivity analysis assessed whether the observed excess neurodegenerative mortality could be attributed to competing risks using a cause-specific hazard simulation.
Findings
A total of 19,824 athletes had a cumulative 518,833 person-years (mean = 26.2 years, SD = 16.2), with 1994 decedents. NFL players exhibited lower all-cause mortality (SMR = 0.70; 95% CI: 0.67–0.74) but higher neurodegenerative mortality (SMR = 3.94; 95% CI: 3.38–4.56), including amyotrophic lateral sclerosis (SMR = 4.55; 95% CI = 3.13–6.38), all-cause dementia (SMR = 3.80; 95% CI = 3.11–4.60), and Parkinson’s disease (SMR = 3.88; 95% CI: 2.76–5.30). Cause-specific hazard simulation indicated that competing risks alone would inflate the expected NDD SMR by a factor of 1.30, yielding a residual neurodegenerative SMR of 3.04 (95% CI: 2.63–3.50).
Interpretation
Neurodegenerative mortality was nearly four times higher in NFL players compared to the general population and remained threefold higher after accounting for competing risks. Together, these findings strengthen the evidence for RHI exposure-related neurodegenerative mortality in NFL players that cannot be explained by differential survivorship.
Funding
The National Institute of Neurological Disorders and Stroke [U54NS115266; U01NS086659], the National Institute on Aging [P30AG13846; P30AG072978], and the Maloney/Carpenter Trauma-Related Neurodegenerative Disease Research Fund.
