Background: Despite the great public concern for the health status of professional soccer players, no formal study on mortality from all causes in soccer players has been performed so far. A study on mortality rates of professional soccer players in Italy between 1975 and 2003 was conducted.

Methods: A total of 5389 players, age 14-35 years at enrollment were identified from public sources, and actively followed up for vital status from birth up to 31 December 2003, for 204 125 subject-years of follow-up. Overall and cause-specific mortality rates were calculated; expected number of deaths was calculated by applying the calendar period and age cause-specific mortality rates for men to the cohort of soccer players. The ratios between the observed and expected deaths gave the Standardized Mortality Ratios.

Results: Deaths from diseases of the circulatory system, cancer and immune deficiency were significantly lower than expected. The SMR for car accidents was 2.23 (95% CI 1.46-3.27). There were four deaths for Amyotrophic Lateral Sclerosis (ALS), and 0.2 expected, giving a SMR of 18.18 (95% CI 5.00-46.55).

Conclusion: The pubic health impact of these findings has to be balanced against the significant observed lower mortality for cancer and cardiovascular disease. However, the early age at death, and the youthful composition of the cohort pose questions on the relative weight of ALS mortality in this population in the coming years.