Causes of death in NBA players: a competing risks analysis

Objective To analyse the causes of death and factors associated with mortality among NBA players using verifiable open-source data and a time-to-event approach accounting for competing risks. Methods This retrospective cohort study included all 4374 former and active NBA players from 1946 to July 2019. Players who exclusively played in the American Basketball Association were excluded. The main exposure was participation in the NBA. The primary outcome was cause-specific death, categorised into: neoplasms, cardiovascular diseases, external causes and idiopathic. Ethnicity and height were assessed as predictors using cause-specific adjusted Cox models. Results By July 2019, 864 players (19.8%) had died, 855 of them identified as African ancestry or European ancestry. Among these, 47.6% of deaths were idiopathic, 20.1% due to neoplasms, 17.6% due to cardiovascular diseases, 8.1% due to external causes and 6.5% due to other specified causes. From age 60 years onwards, neoplasms and cardiovascular diseases were the leading causes of death. At age 85 years, the estimated cardiovascular disease-related mortality was higher in African ancestry players (27%) than in European ancestry players (20%). African ancestry ethnicity was associated with increased risk of cardiovascular death (adjusted HR 1.32; 95% CI 1.06 to 1.65), and height was positively associated with mortality from both neoplasms and cardiovascular diseases. Conclusions In this cohort of NBA players, neoplasms and cardiovascular diseases emerged as the primary causes of death, particularly among African ancestry athletes and taller individuals. These findings underscore the need to view the long-term health of elite athletes as a public health priority.