Combat Sports Law

A major Columbia University study was published this month finding that many NHL players die young and enforcers die younger.

The study, titled Fighting and Penalty Minutes Associated With Long-term Mortality Among National Hockey League Players, 1967 to 2022, reviewed mortality rates among NHL players and broke down the findings based on the number of fights those athletes had. An interesting subject as the NHL not only has legal collisions such as checking but also quasi-legal professional fighting with some players taking on the role of enforcer where they engage in serial bare knuckle fights in their career.

The study reviewed over 6,000 players who participated in at least one NHL game. They broke down the group by how many fights they had. The authors found that players who had more than 50 career fights died 10 years earlier than the others. 21 enforcers were indentured in this group with the authors concluding that “being an NHL enforcer was associated with dying a mean of 10 years earlier and more frequently of suicide and drug overdose than matched controls“.

The authors noted “Of the 21 enforcers who died, 11 died of causes often associated with CTE pathology…Fighting exposes players to repetitive head trauma and may be associated with increased risk of developing CTE. Therefore, it is not surprising that NHL enforcers died via mechanisms consistent with CTE pathology“.

The NHL is reluctant to admit that their brand of hockey is linked with CTE. There is no reason to think there is any magic on the ice that makes their players immune to the known consequences of serial brain rattling. This study adds substantial fuel to that fire.

The full abstract reads as follows:

Importance  National Hockey League (NHL) players are exposed to frequent head trauma. The long-term consequences of repetitive brain injury, especially for players who frequently engage in fighting, remains unknown.

Objective  To investigate the mortality rates and causes of death among NHL enforcers with more career fights and penalty minutes as compared with matched controls.

Design, Setting, and Participants  This matched cohort study examined 6039 NHL players who participated in at least 1 game in the seasons between October 11, 1967, and April 29, 2022, using official NHL data. Cohorts designated as enforcer-fighter (E-F) and enforcer-penalties (E-P) were selected. The E-F cohort consisted of players who participated in 50 or more career fights (n = 331). The E-P cohort included players with 3 or more penalty minutes per game (n = 183). Control-matched NHL players were identified for each E-F player (control-fighter [C-F]) (n = 331) and each E-P player (control-penalties [C-P]) (n = 183).

Exposures  Fighting and penalty minutes were both used as proxies for head trauma exposure. Players with significantly increased exposure to fighting and penalties (E-F and E-P cohorts) were compared with NHL players with less frequent exposure to head trauma (C-F and C-P cohorts).

Main Outcomes and Measures  Mortality rates and age at death of the enforcer and control cohorts, and their causes of death using data obtained from publicly available sources such as online and national news sources, including NHL.com.

Results  Among the 6039 NHL players identified (mean [SD] age, 47.1 [15.2] years), the mean (SD) number of fights was 9.7 (24.5). The mortality rates of E-F and C-F players (13 [3.9%] vs 14 [4.2%], respectively; P = .84) or E-P and C-P players (13 [7.1.%] vs 10 [5.5%]; P = .34) were not significantly different. The mean (SD) age at death was 10 years younger for E-F players (47.5 [13.8] years) and E-P players (45.2 [10.5] years) compared with C-F players (57.5 [7.1] years) and C-P players (55.2 [8.4] years). There was a difference in causes of death between the control and enforcer players (2 neurodegenerative disorders, 2 drug overdoses, 3 suicides, and 4 vehicular crashes among enforcers vs 1 motor vehicle crash among controls; P = .03), with enforcers dying at higher rates of overdose (2 of 21 [9.5%] vs 0 of 24) and suicide (3 of 21 [14.3%] vs 0 of 24) (P = .02).

Conclusions and Relevance  The findings of this matched cohort study indicate that there is no difference in overall mortality rates between NHL enforcers and controls. However, being an enforcer was associated with dying approximately 10 years earlier and more frequently of suicide and drug overdose.