Importance Neurodegenerative disease mortality is higher among former professional soccer players than general population controls. However, the factors contributing to increased neurodegenerative disease mortality in this population remain uncertain. Objective To investigate the association of field position, professional career length, and playing era with risk of neurodegenerative disease among male former professional soccer players. Design, Setting, and Participants This cohort study used population-based health record linkage in Scotland to evaluate risk among 7676 male former professional soccer players born between January 1, 1900, and January 1, 1977, and 23 028 general population control individuals matched by year of birth, sex, and area socioeconomic status providing 1 812 722 person-years of follow-up. Scottish Morbidity Record and death certification data were available from January 1, 1981, to December 31, 2016, and prescribing data were available from January 1, 2009, to December 31, 2016. Database interrogation was performed on December 10, 2018, and data were analyzed between April 2020 and May 2021. Exposures Participation in men's soccer at a professional level. Main Outcomes and Measures Outcomes were obtained by individual-level record linkage to national electronic records of mental health and general hospital inpatient and day-case admissions as well as prescribing information and death certification. Risk of neurodegenerative disease was evaluated between former professional soccer players and matched general population control individuals. Results In this cohort study of 30 704 male individuals, 386 of 7676 former soccer players (5.0%) and 366 of 23 028 matched population control individuals (1.6%) were identified with a neurodegenerative disease diagnosis (hazard ratio [HR], 3.66; 95% CI, 2.88-4.65; P < .001). Compared with the risk among general population control individuals, risk of neurodegenerative disease was highest for defenders (HR, 4.98; 95% CI, 3.18-7.79; P < .001) and lowest for goalkeepers (HR, 1.83; 95% CI, 0.93-3.60; P = .08). Regarding career length, risk was highest among former soccer players with professional career lengths longer than 15 years (HR, 5.20; 95% CI, 3.17-8.51; P < .001). Regarding playing era, risk remained similar for all players born between 1910 and 1969. Conclusions and Relevance The differences in risk of neurodegenerative disease observed in this cohort study imply increased risk with exposure to factors more often associated with nongoalkeeper positions, with no evidence this association has changed over the era studied. While investigations to confirm specific factors contributing to increased risk of neurodegenerative disease among professional soccer players are required, strategies directed toward reducing head impact exposure may be advisable in the meantime.

中文翻译：

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男性前职业足球运动员的场位和职业生涯长度与神经退行性疾病风险的关联。

重要性 前职业足球运动员的神经退行性疾病死亡率高于普通人群。然而，导致该人群神经退行性疾病死亡率增加的因素仍不确定。目的探讨前职业足球运动员的场位、职业生涯长度和上场时间与神经退行性疾病风险的关系。设计、设置和参与者 本队列研究使用苏格兰基于人群的健康记录关联来评估出生于 1900 年 1 月 1 日至 1977 年 1 月 1 日之间的 7676 名男性前职业足球运动员和 23028 名普通人群对照个体的风险出生年份、性别和地区社会经济地位提供了 1 812 722 人年的随访。苏格兰发病记录和死亡证明数据从 1981 年 1 月 1 日到 2016 年 12 月 31 日提供，处方数据从 2009 年 1 月 1 日到 2016 年 12 月 31 日提供。数据库查询于 2018 年 12 月 10 日进行，数据在 2020 年 4 月至 2021 年 5 月之间进行了分析。主要成果和措施成果是通过个人层面的记录与全国精神健康电子记录和综合医院住院和日间入院以及处方信息和死亡证明的电子记录相链接获得的。在前职业足球运动员和匹配的一般人群控制个体之间评估了神经退行性疾病的风险。结果 在这项对 30 704 名男性个体的队列研究中，7676 名前足球运动员中的 386 名 (5.0%) 和 23028 名匹配的人口控制个体中的 366 名 (1.6%) 被确定为神经退行性疾病诊断 (风险比 [HR], 3.66; 95% CI, 2.88-4.65; P < . 001)。与一般人群控制个体的风险相比，后卫的神经退行性疾病风险最高（HR，4.98；95% CI，3.18-7.79；P < .001），守门员最低（HR，1.83；95% CI，0.93） -3.60；P = .08）。关于职业生涯，职业生涯超过 15 年的前足球运动员的风险最高（HR，5.20；95% CI，3.17-8.51；P < .001）。关于比赛时代，1910 年至 1969 年间出生的所有球员的风险仍然相似。结论和相关性 在这项队列研究中观察到的神经退行性疾病风险差异意味着暴露于更多与非守门员位置相关的因素会增加风险，但没有证据表明这种关联在所研究的时代发生了变化。虽然需要进行调查以确认导致职业足球运动员患神经退行性疾病风险增加的特定因素，但同时可能建议采取旨在减少头部撞击暴露的策略。