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Braga F, Medeiros PD, Neno AC, Meira D, Magalhães J, Emery MS. Ethnic Differences in Survival among Brazilian Modern-era Olympic Medalists from 1920 to 1992: A Cohort Study. Arq Bras Cardiol 2024; 121:e20230524. [PMID: 38597535 DOI: 10.36660/abc.20230524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/14/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Disparities in health outcomes among racial groups warrant investigation, even among elite athletes. Therefore, understanding the impact of race upon post-medal survival in Brazilian Olympians becomes essential. OBJECTIVE To compare post-medal survival between white and non-white Brazilian Olympic medalists from 1920 to 1992. METHODS This study used publicly available data for a retrospective cohort study on all Brazilian Olympic medalists from 1920 to 1992 (males only). Athletes were classified into white and non-white groups using structured ethnicity determination. Kaplan-Meier analyses computed the restricted mean survival time (RMST) for each ethnic group. A Cox proportional hazards analysis assessed ethnicity-based survival differences, adjusting for medal-winning age and birth year (p<0.05). RESULTS Among 123 athletes (73.9% white), the mean age of medal achievement was 25.03±4.8 years. During the study, 18.7% of white and 37.5% of non-white athletes died (p=0.031). White athletes had a mean age at death of 75.10±18.01 years, while non-white athletes had an age of 67.13±14.90 years (p=0.109). The RMST for white athletes was 51.59 (95% CI 49.79-53.39) years, while for non-white athletes, it was 45.026 (95% CI 41.31-48.74) years, resulting in a ΔRMST of 6.56 (95% CI 2.43-10.70; p=0.0018). Multivariate analysis showed that non-white athletes had a higher mortality risk than did white athletes (HR 5.58; 95% CI, 2.18-14.31). CONCLUSION Following their first medal, white Brazilian Olympians typically enjoy a six-year longer lifespan than their non-white counterparts, illustrating a marked mortality gap and health disparities among healthy individuals in Brazil.
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Affiliation(s)
- Fabricio Braga
- Laboratório de Performance Humana, Rio de Janeiro, RJ - Brasil
- Casa de Saúde São José, Rio de Janeiro, RJ - Brasil
- Universidade do Estado do Rio de Janeiro - Faculdade de Ciências Médicas, Rio de Janeiro, RJ - Brasil
| | | | | | - Diogo Meira
- Laboratório de Performance Humana, Rio de Janeiro, RJ - Brasil
- Casa de Saúde São José, Rio de Janeiro, RJ - Brasil
| | - João Magalhães
- Laboratório de Performance Humana, Rio de Janeiro, RJ - Brasil
| | - Michael S Emery
- Cleveland Clinic - Sports Cardiology Center - Department of Cardiovascular Medicine - Heart, Vascular and Thoracic Institute, Cleveland, Ohio - EUA
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Kliethermes SA, Asif IM, Blauwet C, Christensen L, Coleman N, Lavallee ME, Moeller JL, Phillips SF, Rao A, Rizzone KH, Sund S, Tanji JL, Tuakli-Wosornu YA, Stafford CD. Focus areas and methodological characteristics of North American-based health disparity research in sports medicine: a scoping review. Br J Sports Med 2024; 58:164-171. [PMID: 38216322 PMCID: PMC10961938 DOI: 10.1136/bjsports-2023-107607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE Health disparities are widely prevalent; however, little has been done to examine and address their causes and effects in sports and exercise medicine (SEM). We aimed to summarise the focus areas and methodology used for existing North American health disparity research in SEM and to identify gaps in the evidence base. DESIGN Scoping review. DATA SOURCES Systematic literature search of PubMed, Scopus, SPORTDiscus, CINAHL Plus with Full Text, Web of Science Core Collection and Cochrane Central Register of Controlled Trials. ELIGIBILITY CRITERIA Full-text, peer-reviewed manuscripts of primary research, conducted in North America; published in the year 2000 or after, in English; and focusing on organised sports were included. RESULTS 103 articles met inclusion criteria. Articles were classified into five focus areas: access to and participation in sports (n=45), access to SEM care (n=28), health-related outcomes in SEM (n=24), provider representation in SEM (n=5) and methodology (n=1). Race/ethnicity (n=39), socioeconomic status (n=28) and sex (n=27) were the most studied potential causes of health disparities, whereas sexual orientation (n=5), location (rural/urban/suburban, n=5), education level (n=5), body composition (n=5), gender identity (n=4) and language (n=2) were the least studied. Most articles (n=74) were cross-sectional, conducted on youth (n=55) and originated in the USA (n=90). CONCLUSION Health disparity research relevant to SEM in North America is limited. The overall volume and breadth of research required to identify patterns in a heterogeneous sports landscape, which can then be used to inform positive change, need expansion. Intentional research focused on assessing the intersectionality, causes and consequences of health disparities in SEM is necessary.
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Affiliation(s)
- Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
- The American Medical Society For Sports Medicine, Leawood, Kansas, USA
| | - Irfan M Asif
- Family and Community Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Cheri Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation; Spaulding Hospital/Brigham and Women's Hospital, Harvard Medical School, Charlestown, Massachusetts, USA
- Kelley Adaptive Sports Research Institute, Boston, Massachusetts, USA
| | - Leslie Christensen
- Department of Library Science, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nailah Coleman
- Pediatric Primary Care, Children's National Hospital, Washington, District of Columbia, USA
| | - Mark E Lavallee
- Department of Orthopedics, UPMC, Harrisburg, Pennsylvania, USA
| | - James L Moeller
- Orthopaedic Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Shawn F Phillips
- Department of Family and Community Medicine, Penn State Health, Mount Joy, Pennsylvania, USA
| | - Ashwin Rao
- Family Medicine, University of Washington, Seattle, Washington, USA
| | - Katherine H Rizzone
- Orthopaedics, University of Rochester Medical Center, Rochester, New York, USA
| | - Sarah Sund
- The American Medical Society For Sports Medicine, Leawood, Kansas, USA
| | - Jeffrey L Tanji
- Orthopedics, UC Davis Sports Medicine, Sacramento, California, USA
| | - Yetsa A Tuakli-Wosornu
- Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Cleo D Stafford
- Department of Orthopaedics and Rehabilitations Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Response to Comment on "Health Consequences of an Elite Sporting Career: Long-Term Detriment or Long-Term Gain? A Meta-Analysis of 165,000 Former Athletes". Sports Med 2021; 51:2233-2234. [PMID: 34191250 DOI: 10.1007/s40279-021-01507-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
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Runacres A, Mackintosh KA, McNarry MA. Health Consequences of an Elite Sporting Career: Long-Term Detriment or Long-Term Gain? A Meta-Analysis of 165,000 Former Athletes. Sports Med 2021; 51:289-301. [PMID: 33368029 PMCID: PMC7846545 DOI: 10.1007/s40279-020-01379-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Exercise is widely accepted to improve health, reducing the risk of premature mortality, cardiovascular disease (CVD) and cancer. However, several epidemiological studies suggest that the exercise-longevity relationship may be 'J' shaped; with elite athlete's likely training above these intensity and volume thresholds. Therefore, the aim of this meta-analysis was to examine this relationship in former elite athletes. METHODS 38,047 English language articles were retrieved from Web of Science, PubMed and SportDiscus databases published after 1970, of which 44 and 24 were included in the systematic review and meta-analysis, respectively. Athletes were split into three groups depending on primary sport: Endurance (END), Mixed/Team, or power (POW). Standard mortality ratio's (SMR) and standard proportionate mortality ratio (SPMR) were obtained, or calculated, and combined for the meta-analysis. RESULTS Athletes lived significantly longer than the general population (male SMR 0.69 [95% CI 0.61-0.78]; female SMR 0.51 [95% CI 0.40-0.65]; both p < 0.01). There was no survival benefit for male POW athletes compared to the general population (SMR 1.04 [95% CI 0.91-1.12]). Although male athlete's CVD (SMR 0.73 [95% CI 0.62-0.85]) and cancer mortality (SMR 0.75 [95% CI 0.63-0.89]), were significantly reduced compared to the general population, there was no risk-reduction for POW athletes CVD mortality (SMR 1.10 [0.86-1.40]) or END athletes cancer mortality (SMR 0.73 [0.50-1.07]). There was insufficient data to calculate female sport-specific SMR's. DISCUSSION Overall, athletes live longer and have a reduced incidence of both CVD and cancer mortality compared to the general population, refuting the 'J' shape hypothesis. However, different health risks may be apparent according to sports classification, and between sexes, warranting further investigation. Trial registration PROSPERO (registration number: CRD42019130688).
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Affiliation(s)
- Adam Runacres
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, UK
| | - Kelly A Mackintosh
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, UK.
| | - Melitta A McNarry
- Applied Sports, Technology, Exercise and Medicine (A-STEM) Research Centre, Swansea University, Swansea, UK
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Roberts AL, Taylor HA, Whittington AJ, Zafonte RD, Speizer FE, Pascual-Leone A, Baggish A, Weisskopf MG. Race in association with physical and mental health among former professional American-style football players: findings from the Football Players Health Study. Ann Epidemiol 2020; 51:48-52.e2. [PMID: 32738401 DOI: 10.1016/j.annepidem.2020.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Race differences in health are pervasive in the United States. American-style football players are a racially diverse group with social status and other benefits that may reduce health disparities. Whether race disparities in health exist among former professional football players, and whether they differ by era of play, is unknown. METHODS We examined the association of self-reported race with health outcomes (e.g., physical and cognitive function, pain, depression, and anxiety), among 3747 participants in the Football Players Health Study, comprising former National Football League players who played since 1960. We conducted analyses stratified by age. RESULTS Black players had increased risk of all five adverse health outcomes versus white players (risk ratio range = 1.36 to 1.89). Native Hawaiians and men of other races had greater risk of all health outcomes except impaired physical functioning, compared with white players (risk ratio range = 1.25 to 1.64). No clear patterns were observed by era of play. In general, race disparities were not accounted for by health-related exposures during playing years. Adjustment for current BMI somewhat attenuated associations. CONCLUSIONS Social and economic advantages of playing professional football did not appear to equalize race disparities in health.
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Affiliation(s)
- Andrea L Roberts
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Herman A Taylor
- Cardiovascular Research Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Ross D Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
| | - Frank E Speizer
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | - Aaron Baggish
- Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center, Boston, MA, USA
| | - Marc G Weisskopf
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, USA
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Lemez S, Wattie N, Baker J. The end game: Mortality outcomes in North American professional athletes. Scand J Med Sci Sports 2018; 28:1722-1730. [PMID: 29394512 DOI: 10.1111/sms.13066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2018] [Indexed: 01/18/2023]
Abstract
Comprehensive investigations into the mortality outcomes of elite athletes can assist in decoding risk factors for premature mortality and provide avenues for exploring human health through engagement in sport. As such, the purpose of this study was to comprehensively examine lifespan trends of athletes from the 4 major sports in North America: Major League Baseball (MLB), National Basketball Association (NBA), National Football League (NFL), and National Hockey League (NHL). We hypothesized that proportional death rates would be similar across the 4 sports, when standardizing the data by debut years. Overall, 17 523 of 50 515 (34.7%) athletes were deceased as of the respective data collection cutoff date for their sport, with MLB players having the highest risk of imminent mortality. Professional basketball players generally had the highest relative proportion of death when standardizing data by debut year, although NHL and NFL players who debuted after 2005 had the highest proportion of death. In addition, a 1-year increase in career length significantly decreased the risk of death (HR: 0.982, 95% CI: 0.978-0.985), even after adjusting for sport type (HR: 0.977, 95% CI: 0.974-0.980). Meaningful significance should be considered given the historical and unique nature of the sample. Nevertheless, investigating risk of death differences through different occupational and biological variables can help highlight aversive trends to lifespan that permeate throughout high-performance athlete populations.
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Affiliation(s)
- S Lemez
- School of Kinesiology and Nutritional Science, California State University, Los Angeles, CA, USA
| | - N Wattie
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
| | - J Baker
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
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Lemez S, Wattie N, Lawler T, Baker J. Vital statistics and early death predictors of North American professional basketball players: A historical examination. J Sports Sci 2017; 36:1648-1655. [PMID: 29183260 DOI: 10.1080/02640414.2017.1409607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
While empirical evidence suggests that elite athletes have superior lifespan outcomes relative to the general population, less is known regarding their causes of death. The purpose of this study was to critically examine the mortality outcomes of deceased National Basketball Association and American Basketball Association players. Death data were collected from publicly available sources until 11 December 2015, and causes of death were categorized using the International Classification of Diseases, Tenth Revision (ICD). Mortality was measured through: i) cause-specific crude death rates (CDR), ii) estimates of death rates per athlete-year (AY), and iii) binary and multinomial regression analyses. We identified 514 causes of death from 787 deceased players (M = 68.1 y ± 16.0) from 16 different ICD groups, 432 of which were from natural causes. Findings showed similar leading causes of death and CDRs to sex- and race-matched controls, higher death rate differences per AY within time-dependent variables (i.e., birth decade, race, and height), and a higher likelihood of dying below the median age of death for black and taller players, although this was highly confounded by birth decade. More complete knowledge of mortality outcomes would provide broad public health applications and disarm harmful stereotypes of elite athlete health.
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Affiliation(s)
- Srdjan Lemez
- a School of Kinesiology and Nutritional Science , California State University - Los Angeles , Los Angeles , USA
| | - Nick Wattie
- b Faculty of Health Sciences , University of Ontario Institute of Technology , Oshawa , Canada
| | - Tyler Lawler
- c Division of Epidemiology and Public Health , City Hospital , Nottingham , UK
| | - Joseph Baker
- d School of Kinesiology and Health Science , York University , Toronto , Canada
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Lemez S, Wattie N, Baker J. Do "big guys" really die younger? An examination of height and lifespan in former professional basketball players. PLoS One 2017; 12:e0185617. [PMID: 28968418 PMCID: PMC5624604 DOI: 10.1371/journal.pone.0185617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/16/2017] [Indexed: 11/19/2022] Open
Abstract
While factors such as genetics may mediate the relationship between height and mortality, evidence suggests that larger body size may be an important risk indicator of reduced lifespan longevity in particular. This study critically examined this relationship in professional basketball players. We examined living and deceased players who have played in the National Basketball Association (debut between 1946-2010) and/or the American Basketball Association (1967-1976) using descriptive and Kaplan-Meier and Cox regression analyses. The cut-off date for death data collection was December 11, 2015. Overall, 3,901 living and deceased players were identified and had a mean height of 197.78 cm (± 9.29, Range: 160.02-231.14), and of those, 787 former players were identified as deceased with a mean height of 193.88 cm (± 8.83, Range: 167.6-228.6). Descriptive findings indicated that the tallest players (top 5%) died younger than the shortest players (bottom 5%) in all but one birth decade (1941-1950). Similarly, survival analyses showed a significant relationship between height and lifespan longevity when both dichotomizing [χ2 (1) = 13.04, p < .05] and trichotomizing [χ2 (2) = 18.05, p < .05] the predictor variable height per birth decade, where taller players had a significantly higher mortality risk compared to shorter players through median (HR: 1.30, 95% CI: 1.13-1.50, p < .05) and trichotomized tertile split (HR: 1.40, 95% CI: 1.18-1.68, p <. 05; tallest 33.3% compared to shortest 33.3%) analyses. The uniqueness of examining the height-longevity hypothesis in this relatively homogeneous sub-population should be considered when interpreting these results. Further understanding of the potential risks of early mortality can help generate discourse regarding potential at-risk cohorts of the athlete population.
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Affiliation(s)
- Srdjan Lemez
- School of Kinesiology and Nutritional Science, California State University–Los Angeles, Los Angeles, United States of America
- * E-mail:
| | - Nick Wattie
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Canada
| | - Joseph Baker
- School of Kinesiology and Health Science, York University, Toronto, Canada
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Lemez S, Baker J. Do Elite Athletes Live Longer? A Systematic Review of Mortality and Longevity in Elite Athletes. SPORTS MEDICINE - OPEN 2015; 1:16. [PMID: 26301178 PMCID: PMC4534511 DOI: 10.1186/s40798-015-0024-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 06/16/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Understanding of an athlete's lifespan is limited with a much more sophisticated knowledge of their competitive careers and little knowledge of post-career outcomes. In this review, we consider the relationship between participation at elite levels of sport and mortality risk relative to other athletes and age- and sex-matched controls from the general population. Our objective was to identify, collate, and disseminate a comprehensive list of risk factors associated with longevity and trends and causes of mortality among elite athletes. METHODS English language articles were searched using the Web of Science database. Keywords athletes, death, elite, "high performance" life expect*, longevity, mortality, players, professional, and sport were used to locate research articles. Seventeen additional articles were retrieved from reference lists found in these papers and a general web search. The inclusion criteria were the following: (1) publication year 1980 or later; (2) the study examined elite-level athletes; and (3) outcome data measured mortality/longevity trends and/or causes. RESULTS Fifty-four peer-reviewed publications and three articles from online sources met the criteria for inclusion. Baseball, football, soccer, basketball, and cycling had the most reported data on elite athletes' lifespan longevities. A variety of mechanisms have attempted to explain mortality risk (e.g., handedness, playing position, achievement, etc.). Considerable support was found for superior longevity outcomes for elite athletes, particularly those in endurance and mixed sports. CONCLUSIONS Future research into the mechanisms that may affect mortality risk is important for a better understanding of life expectancies in both eminent and non-eminent populations. Participation in elite sport is generally favorable to lifespan longevity. KEY POINTS A majority of studies included in this review reported superior lifespan longevity outcomes for elite athletes compared to age- and sex-matched controls from the general population and other athletes.Several mechanisms within and between sports may have powerful effects on the overall lifespan longevities of players (e.g., type of sport, playing position, race, and energy system).Future research on mortality in elite athletes would benefit from more comprehensive statistical measures and reliable databases to determine potential mechanisms that may influence mortality trends and causes in both athlete and non-athlete samples.
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Affiliation(s)
- Srdjan Lemez
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, M3J 1P3 ON Canada
| | - Joseph Baker
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, M3J 1P3 ON Canada
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Hartal M, Kreiss Y, Yavnai N. Relative longevity among retired military personnel: a historical-cohort study. Mil Med Res 2015; 2:29. [PMID: 26526460 PMCID: PMC4628281 DOI: 10.1186/s40779-015-0057-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/15/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Occupation is a significant factor affecting life, health and well-being. Long-term military service is a unique career path that may have an influence on life expectancy, even after excluding obvious risks such as battlefield mortality. However, it remains unclear what the effects of a military career are on the life trajectory of personnel after retiring from service. This study compared life expectancy among retired military personnel (RMP) to their sex and birth cohort-specific reference populations. METHODS For this historical cohort study, we collected data on the sex, year of birth, year of death, time in service, and rank at end of service for 4862 Israeli RMPs. Data on reference populations were provided by the Israel Central Bureau of Statistics by birth decade from 1900 to 1989. We calculated the difference between each individual RMP's age at death and the "expected" age at death, based on sex and birth cohort-specific means in the reference populations. RESULTS Overall, 67.9 % of RMPs lived longer than average relative to their sex-specific birth cohort. This difference in life expectancy was more pronounced among women than among men. There was a significant trend of increasing differences between RMP males and reference males over time (P < 0.002), whereas no significant trend was identified among females. Length of service and rank were not associated with relative longevity for RMPs. CONCLUSIONS The mechanism of the protective effect of military service on life expectancy remains unknown, but our findings indicate that it affects men and women differently, with women being more likely to benefit from the potential protective effect of military service. The healthy worker effect is known to vary from one occupation to another, and to the best of our knowledge, this is the first attempt to quantify the magnitude of the healthy worker effect among career military servicemen and women.
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Affiliation(s)
- Michael Hartal
- Israel Defense Forces Medical Corps, Military PO Box 02149, Tel Hashomer, Israel ; Department of Military Medicine, Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Yitshak Kreiss
- Israel Defense Forces Medical Corps, Military PO Box 02149, Tel Hashomer, Israel ; Department of Military Medicine, Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Nirit Yavnai
- Israel Defense Forces Medical Corps, Military PO Box 02149, Tel Hashomer, Israel
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