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Comment & Response
July 3, 2018

Professional Football Participation and Mortality

Author Affiliations
  • 1Public Health Ontario, Toronto, Ontario, Canada
  • 2Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
JAMA. 2018;320(1):91. doi:10.1001/jama.2018.6701

To the Editor The retrospective cohort study by Dr Venkataramani and colleagues1 found a hazard ratio (HR) for mortality in career National Football League (NFL) players compared with NFL replacement players following NFL retirement of 1.38 (95% CI, 0.95-1.99); P = .09.

First, the main conclusion of the authors and editorialists2 was that there was no statistically significant difference in mortality between the 2 groups. The American Statistical Association has warned against interpreting scientific significance using a statistical threshold because of the myriad factors influencing precision of estimates.3 In this case, the study was insufficiently powered to detect a relative mortality hazard less than 1.4.1 The result is an underestimate of a potentially clinically meaningful finding. To put this finding into context, this HR is similar to the association between physical inactivity (HR, 1.43 [95% CI,1.34-1.53]) or hypertension (HR, 1.38 [95% CI, 1.30-1.46]) and mortality.4

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