The Impact of Concussion History on Long-Term Health in Former NFL Players

The UNC-Chapel Hill study shows concussion history predicts long-term physical and mental health in former NFL players more accurately than career length or playing position. The team compared documented concussion counts directly with common proxies to improve individual risk assessment; methods and implications follow below.

Using the multisite NFL-LONG project framework, investigators analyzed more than 1,500 former NFL players. Key exposures were concussion history, total years played, and playing position; outcomes spanned long-term mental and physical health domains (including sleep and pain). A multivariable predictor model adjusted for confounders and modeled exposures concurrently to isolate concussion history from proxy measures.

Concussion history emerged as the strongest predictor of long-term mental and physical health, with a larger effect size than either years played or playing position. Once concussion history was accounted for, neither career length nor position remained associated with worse long-term outcomes. These results support centering documented concussion history when stratifying risk in retired athletes.

Clinically, the findings challenge the routine use of years played or position as surrogates for head-injury exposure and argue for concussion-history–driven assessments. Follow-up pathways should prioritize targeted neurological, sleep, and pain evaluations for players with documented concussions to detect and manage sequelae earlier. This evidence may prompt revisions to guideline content and clinical triage for former contact-sport athletes.

Key Takeaways:

• Concussion history outperforms career length and position as a predictor of long-term health in former NFL players.
• Former NFL players and other contact-sport retirees with documented concussions warrant higher priority for targeted follow-up.
• Risk stratification and screening should center on documented concussion history, informing guideline updates and targeted follow-up.