D. M. McElvenny1, W. Mueller1, F. S. Carson1, F. Brooker1, I. Basinas2, M. U. van Tongeren2, V. Gallo3

1IOM, Edinburgh, UK

2University of Manchester, UK

3University of Groningen, The Netherlands

Evidence is growing that former professional athletes, in particular association footballers, are at an increased risk of neurological disorders compared with the general population.  A study of over 7000 former professional footballers in Scotland found a 5-fold relative risk of mortality from Alzheimer’s disease compared to the general population RR = 5.07 (95% CI: 2.92 to 8.82) (1).  Similarly, an increased risk of Alzheimer’s disease was reported in a study in Sweden containing around 6000 former footballers: hazards ratio 1.62 (1.47 to 1.58) (2).  A French study examined mortality from dementia in around 6,000 former professional footballers and found a threefold excess compared with the general population RR 3.38 (2.49 to 4.46) (3).

Mortality rates of this cohort will be compared to those of the general population, additionally the effects of the length of a player’s professional career will be investigated.

We will use an exposure matrix developed for a cross-sectional study of cognition in former professional footballers (4) to estimate footballers’ lifetime history of heading footballs and other head-related impacts during training and playing.  This will allow an internal analysis where we can compare the neurological mortality in those who headed footballs more with those that headed them less.

This study is more powerful than the previous three studies combined and will incorporate an exposure assessment for heading footballs and other head impacts into its analysis.  Work is expected to be complete towards the end of 2024.


  1. Mackay DF, Russell ER, Stewart K, MacLean JA, Pell JP, Stewart W. Neurodegenerative Disease Mortality among Former Professional Soccer Players. New England Journal of Medicine. 2019;381(19):1801-8.
  2. Ueda P, Pasternak B, Lim CE, Neovius M, Kader M, Forssblad M, et al. Neurodegenerative disease among male elite football (soccer) players in Sweden: a cohort study. Lancet Public Health. 2023;8(4):e256-e65.
  3. Orhant E, Carling C, Chapellier JF, Marchand JL, Pradat PF, Elbaz A, et al. A retrospective analysis of all-cause and cause-specific mortality rates in French male professional footballers. Scand J Med Sci Sports. 2022;32(9):1389-99.
  4. Basinas I, McElvenny DM, Brooker F, Robertson S, van Hoecke Y, Kemp S, et al. Exposure assessment for repeated sub-concussive head impacts in soccer: The HEalth and Ageing Data IN the Game of football (HEADING) study. Int J Hyg Environ Health. 2023;253:114235.
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