@article{ref1,
title="A systematic review of etiological risk factors associated with early mortality among National Football League players",
journal="Orthopaedic journal of sports medicine",
year="2018",
author="Owora, Arthur H. and Kmush, Brittany L. and Walia, Bhavneet and Sanders, Shane",
volume="6",
number="12",
pages="e2325967118813312-e2325967118813312",
abstract="BACKGROUND: Multiple risks predispose professional football players to adverse health outcomes and, in extreme cases, early death; however, our understanding of etiological risk factors related to early mortality is limited. <br><br>PURPOSE: To identify etiological risk factors associated with all-cause and cause-specific mortality among National Football League (NFL) players. STUDY DESIGN: Systematic review; Level of evidence, 3. <br><br>METHODS: Articles examining all-cause and cause-specific mortality risk factors among previous NFL players were identified by systematically searching: PubMed, PsycINFO, Web of Science, and Google Scholar from 1990 to 2017. Study eligibility and quality were evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. <br><br>RESULTS: A total of 801 nonduplicated studies were identified through our search strategy. Of these, 9 studies examining 11 different risk factors were included in the systematic review. Overall, the risk of all-cause and cause-specific mortality was lower among NFL players than among the general male population in the United States. Nonwhite athletes, those in power positions, and those with a high playing-time body mass index (≥30 kg/m<sup>2</sup>) were associated with elevated all-cause and cardiovascular mortality risks. <br><br>CONCLUSION: Methodological issues associated with the examined all-cause and cause-specific mortality risk factors preclude a definitive conclusion of etiological protective or risk effects. Comparison groups less prone to selection bias (&quot;healthy worker effect&quot;) and a life-course approach to the evaluation of suspected risk factors are warranted to identify etiological factors associated with early mortality among NFL players.<p /> <p>Language: en</p>",
language="en",
issn="2325-9671",
doi="10.1177/2325967118813312",
url="http://dx.doi.org/10.1177/2325967118813312"
}