Survival and longevity among male Australian elite athletes: A retrospective cohort study

Objectives: To quantify and compare survival and longevity in three populations of male Australian elite athletes, relative to sex- and age-matched referents from the general population. Design: Retrospective cohort study. Methods: This study comprised a census of three populations of male Australian elite athletes (i.e. N = 10,502 Australian Football League players, N = 803 national team rugby union players, and N = 1527 Olympic athletes) who debuted from 1-JAN-1921 to 31-DEC-2023. Nonparametric relative survival analysis was conducted using the Kaplan-Meier estimator to generate survival curves, the Pohar Perme method and a log-rank type test to estimate and compare net survival, and the life years difference measure to estimate longevity gains or losses. Results: Olympic athletes had a continuous gain in net survival post-debut, with an average life years difference of 3.40 (95 % confidence interval 2.30 to 4.49) years at the maximum follow-up time. Australian football and rugby union players initially had modest gains in net survival post-debut, followed by a gradual decline in net survival, with average life years differences of 0.31 (95 % confidence interval 0.03 to 0.65) and 0.67 (95 % confidence interval 1.87 to 0.53) years at the maximum follow-up time, respectively. Net survival was significantly different across the three cohorts (test statistic 21.8; degrees of freedom = 2; p < 0.001). Conclusions: Expected survival benefits were offset in elite male Australian football and rugby union players. Further research examining cause-specific mortality is warranted to elucidate the underlying reasons for the observed lack of expected survival benefit in Australian football and rugby union players. (c) 2024 The Author(s). Published by Elsevier Ltd on behalf of Sports Medicine Australia.