Sports Nut

The Most Dangerous Game

Is baseball really more hazardous to players’ health than football?

Defensive tackle Warren Sapp #99 of the Oakland Raiders celebrates with teammate cornerback Ray Buchanan #34 in the third quarter against the Tennessee Titans on December 19, 2004 in Oakland, California.
Why might professional football be less deadly over the long term than professional baseball?

Photo by Lisa Blumenfeld/Getty Images.

Last Thursday, Grantland’s Bill Barnwell published an informal study of mortality rates among professional football and baseball players. The results were surprising: Among the 3,088 ex-football players who played for parts of at least five seasons between 1959 and 1988, 12.8 percent had died; in a sample of 1,494 baseball players active during the same era, the death rate was 15.9 percent.

The study was meant to serve as a clarification or maybe a rebuke of a similar study published last spring. That one, conducted by the National Institute for Occupational Safety and Health (and then peer-reviewed), compared mortality among retired football players and nonathletes matched for age and race and found that the ex-athletes were dying about half as often as one might expect. In other words, the health risks associated with playing football were being more than outweighed by the benefits of being a pro athlete—excellent training and nutrition, a good salary, top-quality medical care, and so on.

We know that other sports confer survival benefits to their athletes, too—a study of more than 5,000 Italian soccer players who were active at some point between 1975 and 2003 found a reduced mortality of almost one-third. But the bigger issue for Barnwell and just about everyone else who saw those NIOSH data was how they might relate to football’s concussion panic. What do the mortality numbers mean, asks Barnwell, for “the group of retired [NFL] players that had spent the past two years launching lawsuits against their former employer”—i.e., the ones who have alleged a league-wide conspiracy to conceal the long-term effects of brain damage?

If the Grantland study had shown that, comparing “apples to apples,” football players die younger than baseball players, we would all have assumed that head injuries were a major reason why. But Barnwell’s numbers went in the opposite direction and left us with a perplexing question: Why might baseball, the gentleman’s game, be more deadly than football over the long term?

It could be that cumulative wear-and-tear is worse for your health than acute injuries. Football players get dinged multiple times per game, but their careers tend to be quite short—3.5 years, on average—and each season comprises just 16 to 20 games. Baseball players are less vulnerable to injuries on the field, but they’re asked to perform 10 times as often, and their careers tend to last 60 percent longer.

Or maybe the difference in mortality rates has more to do with nonathletic behaviors. Football players don’t shorten their lives with cigarettes, for example: A 2009 study in the Journal of the American Medical Association found that just 0.2 percent of NFL athletes smoke, compared with 30.5 percent of equivalent nonathletes. Meanwhile, a 2003 survey of Major League Baseball players found that about 36 percent are regular users of chewing tobacco or snuff.

The link between smoking and high blood pressure may explain why professional football players are half as likely as baseball players to have high blood pressure, despite being larger and heavier overall. And this comparative risk factor begins long before players make it to the professional leagues: One study looked at the use of chewing tobacco among varsity athletes in California and found a prevalence of 52 percent in college baseball versus 26 percent in college football. (Despite recent efforts at a sport-wide ban, MLB still allows its players to use chewing tobacco during games, so long as they don’t carry the tobacco in their uniform pockets or spit while giving pregame and postgame interviews.)

The difference in mortality rates could also be a result of broad demographic factors in professional sports. Across the U.S. population, for example, white males tend to live about six years longer than black males, a gap that is mitigated—but not eliminated—among paid athletes. A team of researchers in the United Kingdom compared mortality rates among white and black NBA players who were active between 1946 and 2005. Overall, these athletes outlived nonathletes by about 4.5 years, but the white players lived about 1.5 years longer than their black teammates. That disparity persists even in the absence of any major wage discrimination between the two groups.

But if race were the key factor, then Barnwell’s findings about baseball and football should have been reversed. According to the Institute for Diversity and Ethics in Sport, 67 percent of NFL players are black and 31 percent are white, compared with 9 percent and 61 percent in baseball. Add in the fact that the NFL is just 1 percent Latino, compared with 27 percent in MLB, and the bias should be even more pronounced, since Hispanic males tend to live longer than either non-Hispanic blacks or non-Hispanic whites. If the longevity of athletes were based entirely on their race, baseball players would have the longest life spans by far, and basketball players the shortest.

Other socioeconomic factors could be at play. For a 2007 paper in the journal Death Studies, a pair of economists in Shippensburg, Pa., examined the longevity of MLB players of the baby-boomer generation. As a rule, the athletes in the study lived longer than equivalent nonathletes, but their life spans were strongly dependent on their level of education. Baseball players who skipped college had twice the risk of death as those who attended a four-year university.

Comparing one sport to another, football players do tend to have more education than baseball players, but the difference is not so dramatic. Among MLB draftees, between 35 and 56 percent are selected right out of high school with no baccalaureate training at all. Meanwhile, about half of the players in the NFL arrive having completed their undergraduate degrees.

Finally, there are dozens, if not hundreds or thousands, of other factors that could explain Barnwell’s results. Consider that Barnwell is comparing players from a certain time period rather than athletes of a certain age. As a consequence, you might expect more MLBers from that time period to have died given that pro baseball players are, on average, older than NFL players. Each sport is also likely to have different training regimens, different rates of anabolic steroid use, and different post-retirement health care options. (Barnwell points to evidence that ex-NFL players are especially likely to have insurance.)

Whatever the explanation, studies like this one tell us nothing about the specific impact of head injuries or whether these sports are dangerous in absolute terms. Nor do they get at the bigger issue that underlies all of the hand-wringing about concussions and players leading with the helmet. Is professional football, or indeed any other sport, simply too dangerous for the athletes involved? If the NFL doesn’t do more to protect its players, should we give up watching in protest?

The exact, long-term effects of head trauma are still unknown, with mixed evidence on whether football players are more likely to develop the symptoms of Parkinson’s disease, Alzheimer’s disease, and dementia. The original NIOSH study broke down individual causes of death for ex-NFL players, but the sample wasn’t big enough to determine whether they were at increased risk of dying from neurodegenerative disease. Taken in aggregate, however, the government data offer some degree of comfort. Considering all the many dangers of the game, a man who takes a job in the NFL has a good chance of living a longer life as a result. That may be apples-to-oranges, as Barnwell points out. But for fans, it’s the stat that counts the most.