Increased risk and early onset of ALS in professional players from Italian Soccer Teams

Abstract

Objective: Since the observation of several deaths from amyotrophic lateral sclerosis (ALS) among Italian professional soccer players, an association between ALS and soccer has been postulated. The objective of the study is to investigate the association between professional soccer and the risk of ALS in a large cohort of former professional soccer players with prolonged follow-up. Methods: All professional soccer players practicing in the period 1959–2000 were identified through the archives of an Italian soccer cards publisher. For each player, date and place of birth, playing role, and team history were recorded. Each player was followed since 15 years of age. Incident ALS cases were all soccer players first diagnosed during the period 1959–2018. The expected incidence rate was the number of ALS cases/100,000 person-years expected in the cohort. SIR was the ratio between observed and expected incidence rate. Results: 34 ALS cases were detected. The number of expected cases was 17.8. The SIR was 1.91 (95% CI 1.32–2.67) in the entire sample and 4.66 (95% CI 2.66–7.57) in subjects aged less than 45 years. The mean age at diagnosis was 45.0 years. Compared to the mean age of onset of ALS in the general population (65.2 years), the disease in former soccer players occurred 20.2 years earlier. Conclusions: Professional soccer players are at higher risk of developing ALS than the general population. Soccer players with ALS develop the disease at a younger than expected age.

Keywords:

• Amyotrophic lateral sclerosis
• soccer
• trauma
• physical exercise

Acknowledgements

The authors are very grateful to the Italian Union of Professional Football Players for data cleaning and verification; Roberto Vinciguerra for ALS case ascertainment; Rizzoli Corriere della Sera for providing access to Almanacchi Panini.

Declaration of interest

Elisabetta Pupillo, Elisa Bianchi, Carla Montalto, Giuseppe Ricca, Nicola Vanacore, Francesco Saverio Robustelli della Cuna, Fabio Fumagalli, Fabio Poli, Francesco Romeo, Damiano Tommasi, Pino Lazzaro, and Massimo Castellani have nothing to disclose.

Additional information

Funding

Ettore Beghi reports grants from Italian Ministry of Health, grants from SOBI, personal fees from Arvelle Therapeutics, outside the submitted work. The study was supported by the Istituto di Ricerche Farmacologiche Mario Negri IRCCS.