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Disease-Specific Mortality Among Elite Athletes
To the Editor: Studies on the long-term survival of athletes have yielded conflicting results.1-2 We investigated whether the mortality rates of elite athletes varies by participation in different types of sports and how they differ from those of the general population.
Methods
We assessed the mortality of all 2009 male athletes who had represented Finland in international competitions from 1920 to 19653 and were alive in January 1971. Cause-specific deaths from 1971 through 1995 were obtained from Statistics Finland. This database provides virtually complete population mortality data so that cause of death was undefined in only 0.2% of cases. We ranked sports based on average maximal oxygen uptake4 as follows: endurance (highest maximal oxygen uptake), mixed (medium maximal oxygen uptake), and power (lowest maximal oxygen uptake). We computed the standardized mortality ratios (SMRs) for each subgroup of athletes and also compared ratios of the SMRs of the subgroups.
Results
Table 1 shows the SMRs for cause of death when the mortality in at least 1 specific athlete group was statistically significantly different from the mortality in the general population. All-cause SMRs were low among the athletes generally, particularly for those with high or medium oxygen uptake (the endurance and mixed sports groups). The SMRs for coronary heart disease were low for endurance and mixed sports athletes but not for power athletes; SMRs for pulmonary diseases were low for all athlete groups and were again lowest for endurance athletes. All athletes had fewer cancer deaths, which was due to fewer deaths from smoking-related cancers, mainly lung cancer.
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Table. Standardized Mortality Ratios of Elite Finnish Male Athletes Compared With the General Population by Cause of Death and Type of Sport*
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Compared with power athletes, the ratio of all-cause SMR was lower for endurance (0.63; 95% confidence interval [CI], 0.51-0.79) and mixed sports athletes (0.76; 95% CI, 0.65-0.89); the respective ratios of SMRs for coronary heart disease were 0.59 (95% CI, 0.39-0.85) and 0.63 (95% CI, 0.47-0.84) for the same groups, respectively.
Comment
Athletes are a select group because people in poor health are less likely to become athletes and because specific physical characteristics may make it easier for some individuals to excel in specific sports. However, athletes also tend to smoke less and are physically more active as they age than age-matched control subjects.3 These health habits are likely to explain some of the reduction of coronary heart disease, pulmonary disease, and cancer mortality in this sample. Although differences among the athletic groups in leisure physical activities and other health habits appear to be less pronounced in old age,3 in this sample all-cause and coronary heart disease mortality were lower among endurance athletes than power athletes. Thus, differences in biological characteristics between endurance and power athletes may explain the selection of specific types of sports as well as some of the difference in risk of developing coronary heart disease that has been previously reported.5
AUTHOR INFORMATION
Funding/Support: This study was supported by the Finnish Ministry of Education, Juho Vainio Foundation, and Academy of Finland (grant 42044).
Urho M. Kujala, MD,PhD;
Heikki O. Tikkanen, MD,PhD
Unit for Sports and Exercise Medicine, Institute of Clinical Medicine
Seppo Sarna, PhD
Department of Public Health
University of Helsinki
Helsinki, Finland
Eero Pukkala, PhD
Institute for Statistical and Epidemiological Cancer Research, Finnish Cancer Registry
Helsinki
Jaakko Kaprio, MD,PhD
Department of Public Health, University of Oulu
Oulu, Finland
Markku Koskenvuo, MD,PhD
Department of Public Health, University of Turku
Turku, Finland
1. Yamaji K, Shephard RJ. Longevity and causes of death of athletes. J Hum Ergol (Tokyo). 1977;6:15-27.
2. Sarna S, Kaprio J. Life expectancy of former elite athletes. Sports Med. 1994;17:149-151.
PUBMED
3. Sarna S, Sahi T, Koskenvuo M, Kaprio J. Increased life expectancy of world class male athletes. Med Sci Sports Exerc. 1993;25:237-244.
ISI
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4. Åstrand P-O, ed, Rodahl K, ed. Textbook of Work Physiology: Physiological Bases of Exercise. New York, NY: McGraw-Hill Book Co; 1986:412-415.
5. Kujala UM, Sarna S, Kaprio J, Tikkanen HO, Koskenvuo M. Natural selection to sports, later physical activity habits and coronary heart disease. Br J Sports Med. 2000;6:445-449.
Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
JAMA. 2001;285:44-45.
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