Owora Arthur H, Kmush Brittany L, Walia Bhavneet, Sanders Shane
Department of Public Health, Falk College, Syracuse University, Syracuse, New York, USA.
Department of Sport Management, Falk College, Syracuse University, Syracuse, New York, USA.
Orthop J Sports Med. 2018 Dec 19;6(12):2325967118813312. doi: 10.1177/2325967118813312. eCollection 2018 Dec.
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.
To identify etiological risk factors associated with all-cause and cause-specific mortality among National Football League (NFL) players.
Systematic review; Level of evidence, 3.
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.
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) were associated with elevated all-cause and cardiovascular mortality risks.
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 ("healthy worker effect") 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.
多种风险使职业足球运动员易出现不良健康后果，在极端情况下会导致过早死亡；然而，我们对与过早死亡相关的病因风险因素的了解有限。
确定与美国国家橄榄球联盟（NFL）球员全因死亡率和特定病因死亡率相关的病因风险因素。
系统评价；证据等级，3级。
通过系统检索1990年至2017年期间的PubMed、PsycINFO、科学网和谷歌学术，确定研究前NFL球员全因死亡率和特定病因死亡率风险因素的文章。使用加强流行病学观察性研究报告（STROBE）指南评估研究的纳入标准和质量。
通过我们的检索策略共识别出801项非重复研究。其中，9项研究共检验了11种不同的风险因素，被纳入系统评价。总体而言，NFL球员的全因死亡率和特定病因死亡率风险低于美国普通男性人群。非白人运动员、担任权力职位的运动员以及比赛期间体重指数较高（≥30 kg/m）的运动员，全因死亡率和心血管疾病死亡率风险升高。
与所研究的全因死亡率和特定病因死亡率风险因素相关的方法学问题妨碍了对病因性保护或风险效应得出明确结论。需要采用不易产生选择偏倚的比较组（“健康工人效应”）以及对可疑风险因素进行生命历程评估的方法，以确定与NFL球员过早死亡相关的病因因素。
