Key Takeaways
- Across a range of measures, former NFL players from the 1988 season report being in worse health and experiencing more frequent pain and higher levels of disability compared to men their age in the general population, even when controlling for race. Former players are about three times as likely as other men their age to report living with a disability (60% v. 21%) and about twice as likely to report experiencing pain all or most days in the past three months (69% v. 33%). In open-ended responses players describe the isolating effects of pain and the toll it has taken on their daily life and mental health.
- Just over half (55%) of players say they have experienced confusion or memory loss in the past year that is happening more often or getting worse – more than three times the share of men their age who say the same (16%). A notable share of former players report having been diagnosed with a neurological disorder, including about three in ten (28%) who say a health provider has told them they have post-concussion syndrome (28%) and 15% who report being diagnosed with dementia, including Alzheimer’s disease. Nearly one in five (18%) say a doctor or other health care provider has told them they have chronic traumatic encephalopathy (CTE), although CTE cannot definitively be diagnosed until after death. Defensive players are more likely than those in offensive positions to report worsening confusion and memory loss in the past year (63% v. 50%) and being diagnosed with a neurological condition (52% v. 37%), including post-concussion syndrome (36% v. 23%). Incidence of these neurological health issues does not differ consistently by other position groupings, such as linemen v. skill positions. Analysis by individual positions is not possible due to insufficient sample sizes.
- Among former ’88 NFL players, there are consistent, stark racial disparities when it comes to physical and neurological health outcomes. Black players are more likely than White players to report living with some kind of disability (69% v. 48%), particularly those related to difficulty concentrating, remembering, or making decisions (60% v. 30%), and difficulty walking or climbing stairs (45% v. 27%). Notably, these wide racial disparities are not present among men in the same age range in the general population. Black players are twice as likely as White players to say they’ve been told by a doctor that they have CTE (25% v. 10%) or dementia (21% v. 9%), and significantly more likely to say they’ve been diagnosed with post-concussion syndrome (36% v. 19%). Though Black players are more likely than White players to have played in positions that previous research has linked to increased risk for cognitive problems, Black players’ higher incidence of disability and worsening confusion and memory problems remain significant compared to White players even when controlling for other factors, including higher risk position groups , income, age, and years played, suggesting other socioeconomic factors or experiences may be a contributing factor.
- While Black players are more likely to report disability and pain that limits their life activities, White players report having a higher number of football-related surgeries compared to Black players, with half of White players compared to a third of Black players saying they’ve had five or more. Higher incidence of surgeries among White players may reflect disparities in health care access and financial situation. Black players are more likely than White players to say they did not have health insurance coverage for a year or more after their NFL career.
Racial Disparities Between Black and White Players
This survey finds stark differences between Black and White former NFL players across a wide array of physical, neurological, and cognitive health measures. These disparities are consistent with previous research and likely reflect several different and often interrelated factors, including racial differences in positions played (See Appendix Fig. 4), post-NFL income, access to health care, and social determinants of health.
Among 1988 NFL players, Black players are more likely than White players to have played in positions that previous research has linked to increased risk for cognitive problems, including running back, linebacker, and defensive line. Nearly half (47%) of Black 1988 players played in one of these positions compared to 31% of White players. Previous research from the Football Players Health Study at Harvard University shows that Black players have historically been more likely to play in these higher-risk positions – a phenomenon called “racial stacking,” which has been observed across different professional sports.
Differences in positions played, however, do not account for all of the differences in outcomes between Black and White players. Previous research among former NFL players has found that Black players are more likely than White players to experience physical and cognitive health issues even when controlling for a variety of factors, including positions and years played and concussion incidence. Similarly, among players from the 1988 season, Black players were more likely than their White counterparts to report having a disability and to report having worsening confusion and memory problems even when controlling for age, current income, higher-risk position groups, and years played in the NFL1 , suggesting that other factors, including injury incidence, access to health care, and socioeconomic factors play a role in these disparities.
Black players from the 1988 season are also more likely than White players to report lower average incomes, financial difficulties, and being uninsured at some point since they stopped playing. These differences mirror inequities seen in the U.S. population more generally, with studies documenting the racial wealth gap that continues in the U.S. today, and research highlighting employment discrimination experienced by Black adults. Moreover, studies indicate that some of these wealth and economic differences between Black and White players are present before they even reach the professional football stage of their careers. For example, Black NFL players are more likely than White players to have attended high schools with higher share of low-income students and are more likely to come from more economically disadvantaged areas.
See Appendix for more details on player race and ethnicity
Overall Health and Disability
About six in ten (62%) players from the 1988 season describe their physical health as either “excellent,” “very good,” or “good,” while about four in ten (38%) describe their physical health as “fair” or “poor.” Compared to men in their age cohort in the population overall, these former NFL players are more likely to describe their health negatively (38% v. 24%). These differences hold among Black players and White players when compared to their respective peers in the general population. (See Methodology for additional details on general population data.)
Players from the 1988 season are much more likely than men their age to report living with a disability, especially those related to cognition and mobility. Overall, six in ten players from the 1988 season report currently living with a disability — three times the share of men in their age range overall (21%). Players living with a disability include those who say they have difficulty concentrating, remembering, or making decisions (47%), serious difficulty walking or climbing stairs (36%), difficulty dressing or bathing (18%), are deaf or have serious difficulty hearing (14%), or are blind or have serious difficulty seeing even when wearing glasses (8%). Players are about eight times as likely as men their age to report serious difficulty concentrating, remembering or making decisions, and at least three times as likely to report serious difficulty walking or climbing stairs or difficulty dressing or bathing. The higher incidence of disability among 1988 players compared to men their age holds when controlling for race, with both Black players and White players more likely than their peers in the general population to report living with a disability. Players who played in defensive positions are somewhat more likely than offensive players to report difficulty concentrating, remembering, or making decisions (55% v. 42%). The share who reports living with a disability overall, however, does not significantly differ by defensive v. offensive positions or linemen v. skill positions. Incidence of reported disability by specific positions is not possible due to insufficient sample sizes.
Larger shares of Black players compared to White players report having some type of disability (69% v. 48%), with Black players twice as likely to report serious difficulties concentrating or remembering (60% v. 30%). Larger shares of Black players than White players also report serious difficulty walking or climbing stairs, difficulty dressing or bathing, or being blind or having serious difficulty seeing. These large racial disparities are not similarly observed among men in this age range in the general population.
Black players’ higher incidence of disability compared to White players remains significant when controlling for other factors, including higher risk position groups, income, age, and years played. The higher incidence of disabilities – and other adverse health outcomes – among Black players could be attributed to a number of factors, including racial differences in positions played (See Appendix Fig. 4), injury incidence, and access to health care and other services. Notably, Black players are more likely than White players to say they did not have health insurance coverage for a year or more after their NFL career.
Chronic Pain
Seven in ten (69%) players say they experienced pain either “every day” or “most days” in the past three months, twice the share of men their age in the general population (33%) – a difference that holds among both Black players and White players compared to their peers in the general population. This includes about a third (35%) of players who say they experienced pain that limited their life or work activities every or most days in the past three months, compared to about half that share among men their age overall (13%). While similar shares of Black players and White players report experiencing pain all or most days (71% and 67%, respectively), Black players are more likely than White players to report experiencing pain that limited their life or work activities all or most days in the past three months (41% v. 28%). Similar racial disparities are not present among men in a similar age range in the general population. The share who reports living with chronic pain does not notably differ by different position groupings, such as linemen v. skill positions or offensive v. defensive. Incidence of chronic pain by specific positions is unreportable due to insufficient sample sizes.
In open-ended responses, many players describe the enormous toll pain has had on their daily life, inhibiting their ability to spend time with family and friends, partake in hobbies, and work. Alongside these isolating effects of chronic pain, many describe negative impacts on their mental health and emotional well-being.
In Their Own Words: How Chronic Pain Has Limited Former Players’ Life and Work Activities
Quotes have been edited to protect player confidentiality and for clarity.
“I used to love going out with friends and now I’m always in pain. Over the past several years I’ve not associated with any of my friends and family because I don’t want them to see me like this. Mentally it’s killing me. So what do I do? I have become a loner and not even realizing it…I’ve always been so happy and friendly with everyone that I’ve ever had the pleasure of interacting with and I am not who I used to be. I would love to go back to work at some point but my memory often fails me and being around other people may not end well. This is when anxiety and mental pain enters my life. I do believe that if I had a job I would feel emotionally, psychologically and physically so much better.”
“I have serious back and knee and shoulder problems. I don’t like masking it with pills because a lot of my friends have become addicted to them. The sport pays well, but it doesn’t pay as well now.”
“My pain these days is enormous…Arthritis, back, hip, brain fog … If I was not able to get relief, I would most likely end my life… there is no way I could live with this pain & function.”
“After…years of playing in the NFL, with 2 surgically repaired knees…back and neck injuries… concussions that I can’t even count… it has been very difficult to do normal activities now that I have become older, by the grace of God. Football has been a blessing to me, but it has also been a curse in the long run. Sometimes I wish that I never played this dear sport that I loved. The sport of football gave me so much…but it took even more from me. In ways you can’t explain, unless you played yourself.”
“In general, walking is painful, standing and exercising is painful. I have stressful thought processing issues. I lose my concentration, I get panicky and it makes it worse. It’s hard for me to go anywhere because constantly the slightest thought can throw me into a panic and causes anxiety. I like playing golf but I shy away from it and don’t go anywhere because of this situation.”
“The pain also known as the stinger feels like a hot iron, pain and needles white hot pain that has been unbearable for years. I’ve used alcohol and opioids for the pain to cool off. I’ve bought opioids not prescription that I had to get off the street because I was declined and denied. My lower back interferes to this day to put on my socks and shoes and put on my underwear, it is embarrassing, debilitating and depressing…”
In addition to dealing with chronic pain in higher shares than men their age, players from the 1988 season are also more likely than men in their age cohort to say they’ve been diagnosed with arthritis and related disorders. Two-thirds (66%) of players say they have been told by a doctor or other health professional that they have arthritis, gout, lupus, or fibromyalgia compared to about four in ten (38%) men in a similar age range in the general population who report a diagnosis. This difference holds across racial groups, with both Black players and White players more likely than their peers to report a diagnosis. When it comes to other common chronic health conditions like hypertension, high cholesterol, and diabetes, somewhat similar shares of players and men their age overall report having been diagnosed.
One-third of players say they have been told by a doctor that they have obesity or are overweight, including similar shares of Black players and White players. Prior KFF polling found a similar share of men in this age range (38%) saying they were diagnosed as overweight or obese in the past five years.
The overwhelming majority (87%) of NFL players from the 1988 season say they have had at least one orthopedic surgery related to playing football, including three in ten (39%) who have had five or more surgeries. While Black players are more likely than White players to report adverse physical health issues including disabilities and chronic pain that limits their life and work, a somewhat larger share of White players compared to Black players say they have had at least one football-related surgery (91% v. 84%), with White players being more likely to say they’ve had five or more surgeries (50% v. 33%). These racial disparities may reflect differences between Black and White players in post-football income and access to health care, which in turn may contribute to the long-term effects of increased pain and disability among Black players.
Neurological Health, Confusion and Memory Loss
Many players from the 1988 season report cognitive issues, including worsening confusion or memory loss and being diagnosed with neurological conditions including chronic traumatic encephalopathy (CTE)2 and dementia. There are stark racial disparities when it comes to neurological health among these players, with much larger shares of Black players reporting dementia and CTE diagnoses. Black players are also more likely than White players to report worsening confusion and memory issues, a disparity that is not similarly observed among men their age in the general population. Players, including both Black and White players, are much more likely to report worsening confusion and memory loss issues compared to their peers in the general population.
Notably, nearly all players from the 1988 season (95%) report experiencing a head injury while playing football, which could include anything from “seeing stars,” a mild concussion, or fully losing consciousness. Past research has linked head injuries sustained while playing contact sports like football to the development of neurological issues, including CTE – a link that has been acknowledged by the National Football League (NFL).
About four in ten (43%) players from the 1988 season say they have been told by a doctor or other health professional that they have some type of neurological disease or condition, with the largest shares reporting diagnoses for post-concussion syndrome (28%), CTE (18%), and dementia, including Alzheimer’s disease (15%). Fewer players report being diagnosed with other neurological issues, including having a stroke (5%), Parkinson’s disease (5%), chronic fatigue syndrome (4%), or a seizure disorder (2%). Defensive players are more likely than those in offensive positions to have been diagnosed with a neurological condition (52% v. 37%), including post-concussion syndrome (36% v. 23%).
Black players are about twice as likely as White players to report neurological diagnoses, including for post-concussion syndrome (36% v. 19%), CTE (25% v. 10%), and dementia (21% v. 9%). Previous studies have shown that Black adults are more likely to develop dementia compared to White adults but less likely to receive a diagnosis.
About half (55%) of players from the 1988 season say they have experienced confusion or memory loss in the past year that is happening more often or getting worse, including larger shares of Black players compared to White players (65% v. 43%) – a disparity that is not present among men their age overall. Players are much more likely than men their age overall (55% v. 16%) to report worsening confusion or memory loss in the past year, a difference that holds among both Black players and White players when compared to their peers in the general population.
Beyond experiencing worsening confusion and memory issues, many players report that these issues have adversely affected their ability to carry out daily tasks, from household chores to working and socializing. About one-third of players say they have experienced worsening confusion or memory loss in the past year that has either caused them to give up day-to-day household activities at least “sometimes” (34%) or interfered with their ability to work, volunteer, or engage in social activities outside their home at least “sometimes” (37%). Black players are twice as likely as White players to report these adverse effects of worsening confusion and memory loss. Players who played in defensive positions are more likely than those who played offensive positions to report worsening confusion and memory loss in the past year (63% v. 50%). Incidence of reported worsening confusion or memory loss by specific positions is not possible due to insufficient sample sizes.
