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.

目的：由于观察到意大利职业足球运动员中有几例因肌萎缩性侧索硬化症（ALS）死亡，因此推测ALS与足球之间存在关联。这项研究的目的是调查大量长期随访的前职业足球运动员中职业足球与ALS风险之间的关系。方法：通过一家意大利足球卡发行商的档案确定了1959–2000年期间所有职业足球运动员的身份。对于每个球员，记录其出生日期和地点，所扮演的角色以及球队的历史。自15岁起就一直关注每位球员。ALS事件都是在1959年至2018年期间首次诊断出的所有足球运动员。预期发病率是该队列中预期的ALS病例数/ 100,000人年。SIR是观察到的与预期发病率之间的比率。结果：检测到34例ALS病例。预期病例数为17.8。整个样本的SIR为1.91（95％CI 1.32–2.67），年龄小于45岁的受试者的SIR为4.66（95％CI 2.66–7.57）。诊断时的平均年龄为45.0岁。与一般人群ALS的平均发病年龄（65.2岁）相比，前足球运动员的疾病发病时间早20.2年。结论：职业足球运动员患ALS的风险比一般人群高。患有ALS的足球运动员比预期年龄年轻。