Mortality and chronic traumatic encephalopathy (CTE) among enforcers and non-enforcers in the National Hockey League (NHL)
ObjectiveMany NHL teams roster players whose primary responsibility is fighting with opposing players. Over time, these “enforcers” may experience repetitive head impacts (RHI), a risk factor for serious long-term health consequences including neurodegenerative disease. This study examined whether r...
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Frontiers Media S.A.
2025-04-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1566819/full |
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| author | Jeffrey S. Markowitz |
| author_facet | Jeffrey S. Markowitz |
| author_sort | Jeffrey S. Markowitz |
| collection | DOAJ |
| description | ObjectiveMany NHL teams roster players whose primary responsibility is fighting with opposing players. Over time, these “enforcers” may experience repetitive head impacts (RHI), a risk factor for serious long-term health consequences including neurodegenerative disease. This study examined whether retired NHL enforcers and non-enforcers differ on two long-term health outcomes.MethodsIn this matched cohort study conducted with retrospective, publicly available data, cohorts of former NHL enforcers and non-enforcers were compared on mortality, and CTE diagnosis. NHL players were deemed enforcers (ENFs, n = 239) if listed in a Wikipedia piece entitled “List of NHL enforcers.” A randomly selected sample of non-enforcers (non-ENFs, n = 239) were matched to ENFs on year of birth and the first NHL season played. Goalies and players with less than 30 games of NHL experience were excluded.ResultsThe matching procedure resulted in equivalent cohorts with respect to birth year (1969.9) and first NHL season played (1991.3). Significantly more ENFs had died (n = 23, 9.6% vs. n = 9, 3.8%; p = 0.01) and significantly more ENFs had been given a diagnosis of CTE (n = 7, 2.9% vs. n = 1, 0.4%; p < 0.05). While not statistically significant, age at death averaged 9+ years younger among ENFs (mean = 53.6) compared to non-ENFs (mean = 63). Players born in Canada were over-represented in the ENF cohort.ConclusionThis study found higher mortality and more diagnoses of CTE in a cohort of enforcers relative to matched non-enforcers. Given expanding evidence linking RHI to life-threatening long-term health impacts, the NHL must protect players and mandate rule changes that minimize or eliminate fighting. |
| format | Article |
| id | doaj-art-1f2a28e6c7a4485ab2d3d89c0a69dac6 |
| institution | DOAJ |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj-art-1f2a28e6c7a4485ab2d3d89c0a69dac62025-08-20T02:53:43ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-04-011610.3389/fneur.2025.15668191566819Mortality and chronic traumatic encephalopathy (CTE) among enforcers and non-enforcers in the National Hockey League (NHL)Jeffrey S. MarkowitzObjectiveMany NHL teams roster players whose primary responsibility is fighting with opposing players. Over time, these “enforcers” may experience repetitive head impacts (RHI), a risk factor for serious long-term health consequences including neurodegenerative disease. This study examined whether retired NHL enforcers and non-enforcers differ on two long-term health outcomes.MethodsIn this matched cohort study conducted with retrospective, publicly available data, cohorts of former NHL enforcers and non-enforcers were compared on mortality, and CTE diagnosis. NHL players were deemed enforcers (ENFs, n = 239) if listed in a Wikipedia piece entitled “List of NHL enforcers.” A randomly selected sample of non-enforcers (non-ENFs, n = 239) were matched to ENFs on year of birth and the first NHL season played. Goalies and players with less than 30 games of NHL experience were excluded.ResultsThe matching procedure resulted in equivalent cohorts with respect to birth year (1969.9) and first NHL season played (1991.3). Significantly more ENFs had died (n = 23, 9.6% vs. n = 9, 3.8%; p = 0.01) and significantly more ENFs had been given a diagnosis of CTE (n = 7, 2.9% vs. n = 1, 0.4%; p < 0.05). While not statistically significant, age at death averaged 9+ years younger among ENFs (mean = 53.6) compared to non-ENFs (mean = 63). Players born in Canada were over-represented in the ENF cohort.ConclusionThis study found higher mortality and more diagnoses of CTE in a cohort of enforcers relative to matched non-enforcers. Given expanding evidence linking RHI to life-threatening long-term health impacts, the NHL must protect players and mandate rule changes that minimize or eliminate fighting.https://www.frontiersin.org/articles/10.3389/fneur.2025.1566819/fullNHL enforcers and mortalityNHL enforcers and CTENHL enforcers and RHIfighting and neurodegenerative diseaserelationship between RHI and CTE |
| spellingShingle | Jeffrey S. Markowitz Mortality and chronic traumatic encephalopathy (CTE) among enforcers and non-enforcers in the National Hockey League (NHL) Frontiers in Neurology NHL enforcers and mortality NHL enforcers and CTE NHL enforcers and RHI fighting and neurodegenerative disease relationship between RHI and CTE |
| title | Mortality and chronic traumatic encephalopathy (CTE) among enforcers and non-enforcers in the National Hockey League (NHL) |
| title_full | Mortality and chronic traumatic encephalopathy (CTE) among enforcers and non-enforcers in the National Hockey League (NHL) |
| title_fullStr | Mortality and chronic traumatic encephalopathy (CTE) among enforcers and non-enforcers in the National Hockey League (NHL) |
| title_full_unstemmed | Mortality and chronic traumatic encephalopathy (CTE) among enforcers and non-enforcers in the National Hockey League (NHL) |
| title_short | Mortality and chronic traumatic encephalopathy (CTE) among enforcers and non-enforcers in the National Hockey League (NHL) |
| title_sort | mortality and chronic traumatic encephalopathy cte among enforcers and non enforcers in the national hockey league nhl |
| topic | NHL enforcers and mortality NHL enforcers and CTE NHL enforcers and RHI fighting and neurodegenerative disease relationship between RHI and CTE |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1566819/full |
| work_keys_str_mv | AT jeffreysmarkowitz mortalityandchronictraumaticencephalopathycteamongenforcersandnonenforcersinthenationalhockeyleaguenhl |