ArticleFrontiers in neurology2025
Mortality and chronic traumatic encephalopathy (CTE) among enforcers and non-enforcers in the National Hockey League (NHL).
Article in Frontiers in neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Many 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. Methods: In 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, Results: The 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 ( Conclusion: This 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.
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