Summary: Male elite football players who competed in Sweden’s top division showed a 1.5-fold higher risk of developing neurodegenerative disease—primarily Alzheimer’s disease and other dementias—compared with matched population controls.
Source: The Lancet
New cohort research published in The Lancet Public Health finds that male footballers who played in Sweden’s top division (Allsvenskan) between 1924 and 2019 had a higher incidence of neurodegenerative disease than comparable members of the general population. The increased risk was concentrated among outfield players and was most evident for Alzheimer’s disease and other dementias.
Researchers identified 6,007 male players who had appeared in at least one Allsvenskan match and compared them with 56,168 matched population controls selected by sex, age, and region of residence. During follow-up through the end of 2020, 8.9% (537) of the football players were recorded with a neurodegenerative diagnosis versus 6.2% (3,485) of the controls, yielding a hazard ratio (HR) of 1.46 (95% CI 1.33–1.60).
The study included both amateur and professional players; historical context matters because Swedish clubs did not commonly pay salaries until the late 1960s. Many players from the mid-20th century competed at elite international levels, and the analysis relied on nationwide health registers to capture diagnoses recorded in death certificates, hospital admissions, outpatient visits, and prescriptions for dementia.
Key findings:
- Overall neurodegenerative disease risk: 1.46 times higher among players versus controls.
- Alzheimer’s disease and other dementias: HR 1.62 (95% CI 1.47–1.78); 8.2% of players (491 of 6,007) versus 5.1% of controls (2,889 of 56,168).
- Motor neuron disease (including ALS): no statistically significant increase observed.
- Parkinson’s disease: incidence was lower in players than in controls (HR 0.68 [0.52–0.89]).
- Position-specific risk: outfield players had a 1.50-fold increased risk compared with controls, while goalkeepers did not show a significant increase (HR 1.07). When compared directly, outfield players had a higher risk than goalkeepers (HR 1.43).
- All-cause mortality was slightly lower among footballers (40%) than controls (42%), consistent with better overall fitness among players (HR 0.95 [0.91–0.99]).
Investigators suggest the positional difference—higher risk in outfield players but not in goalkeepers—may point to repetitive mild head trauma from heading the ball as a contributing factor. Peter Ueda, assistant professor at Karolinska Institutet, commented that although the increased risk is smaller than in some prior studies, the evidence supports concern for brain health in elite players and can help guide protective measures.
Björn Pasternak, senior researcher at Karolinska Institutet, noted that lower overall mortality among footballers likely reflects long-term physical fitness, which is associated with reduced dementia risk and may partly offset risks related to head impacts. He also suggested fitness might explain the comparatively lower Parkinson’s disease incidence in players.
Strengths of the study include comprehensive, nationwide register data and a large sample of elite players spanning nearly a century. The analysis separated disease subtypes and compared positional roles, adding nuance to the connection between football and later-life brain health.
The authors also highlight important limitations. Because neurodegenerative conditions predominantly affect older adults, most players who developed these diseases competed in the mid-20th century. Football has changed substantially since then—synthetic balls, different training loads, equipment improvements, and tactical evolution may alter exposure to head impacts. Conversely, younger generations may face greater cumulative exposure from more intensive training at earlier ages. The study focused only on male elite players, so findings cannot be directly generalized to women, youth, or amateur players.
The researchers caution that the percentages reported reflect diagnoses observed up to the end of follow-up; many participants were still alive at that time, so lifetime risks for both players and controls will likely be higher.
Funding: Karolinska Institutet (Strategic Research Area in Epidemiology), The Swedish Research Council for Sport Science, Folksam Research Foundation, Hedberg Foundation, Neurofonden, and Åhlen Foundation. The study was conducted by researchers at Karolinska Institutet.
About this sports and dementia research news
Author: Press Office
Source: The Lancet
Contact: Press Office – The Lancet
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Original Research: Open access. “Neurodegenerative disease among male elite football (soccer) players in Sweden: a cohort study” by Björn Pasternak et al. The Lancet Public Health
Abstract
Neurodegenerative disease among male elite football (soccer) players in Sweden: a cohort study
Background
Questions about the safety of football and the long-term effects of head impacts have prompted research into whether players face higher risks of neurodegenerative disease. This study assessed risk among male players in Sweden’s top division (Allsvenskan) compared with matched population controls.
Methods
The cohort included male players who appeared in at least one Allsvenskan match from Aug 1, 1924, to Dec 31, 2019. Players without retrievable identity numbers or who immigrated after age 15 were excluded. Each player was matched with up to ten controls by sex, age, and region. Nationwide registers provided diagnostic data (death certificates, hospital and outpatient records, and prescriptions) to evaluate neurodegenerative outcomes and to compare risks by disease subtype and by playing position (outfield players versus goalkeepers).
Findings
After exclusions, 6,007 football players (including 510 goalkeepers) and 56,168 matched controls were followed to Dec 31, 2020. During follow-up, 537 players (8.9%) and 3,485 controls (6.2%) received neurodegenerative diagnoses. Overall risk was higher for players (HR 1.46). Alzheimer’s disease and other dementias were more frequent among players (HR 1.62), motor neuron disease showed no significant difference, and Parkinson’s disease was less frequent among players (HR 0.68). Outfield players carried the elevated risk (HR 1.50), whereas goalkeepers did not show a significant increase.
Interpretation
Male elite football players who competed in Sweden’s top division had an elevated risk of neurodegenerative disease, particularly Alzheimer’s disease and other dementias. The increased risk was concentrated among outfield players, which may implicate exposure to repetitive head impacts such as heading. These findings contribute to the evidence base for assessing and managing brain health risks in football.
Funding
Karolinska Institutet, The Swedish Research Council for Sport Science, Folksam Research Foundation, Hedberg Foundation, Neurofonden, and Åhlen Foundation.