AUTHOR=Markowitz Jeffrey S. 

TITLE=Mortality and chronic traumatic encephalopathy (CTE) among enforcers and non-enforcers in the National Hockey League (NHL)

JOURNAL=Frontiers in Neurology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1566819

DOI=10.3389/fneur.2025.1566819

ISSN=1664-2295

ABSTRACT=ObjectiveMany NHL teams roster players whose primary responsibility is fighting with opposing players. Over time, these “enforcers” may experience repetitive head impacts (RHI), a risk factor for serious long-term health consequences including neurodegenerative disease. This study examined whether retired NHL enforcers and non-enforcers differ on two long-term health outcomes.MethodsIn this matched cohort study conducted with retrospective, publicly available data, cohorts of former NHL enforcers and non-enforcers were compared on mortality, and CTE diagnosis. NHL players were deemed enforcers (ENFs, n = 239) if listed in a Wikipedia piece entitled “List of NHL enforcers.” A randomly selected sample of non-enforcers (non-ENFs, n = 239) were matched to ENFs on year of birth and the first NHL season played. Goalies and players with less than 30 games of NHL experience were excluded.ResultsThe matching procedure resulted in equivalent cohorts with respect to birth year (1969.9) and first NHL season played (1991.3). Significantly more ENFs had died (n = 23, 9.6% vs. n = 9, 3.8%; p = 0.01) and significantly more ENFs had been given a diagnosis of CTE (n = 7, 2.9% vs. n = 1, 0.4%; p < 0.05). While not statistically significant, age at death averaged 9+ years younger among ENFs (mean = 53.6) compared to non-ENFs (mean = 63). Players born in Canada were over-represented in the ENF cohort.ConclusionThis study found higher mortality and more diagnoses of CTE in a cohort of enforcers relative to matched non-enforcers. Given expanding evidence linking RHI to life-threatening long-term health impacts, the NHL must protect players and mandate rule changes that minimize or eliminate fighting.