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== Longevity and factors of mortality == In 2015, a systematic review of a sample of fifty-four peer-reviewed publications and three articles on elite athletesβ mortality and longevity, resulted in major longevity outcomes for the elite athletes (baseball, football, soccer, basketball, and cycling) "compared to age and sex-matched controls from the general population and other athletes." The span longevities were influenced by factors like the type of sport, the playing position, the race, and the energy system.<ref>{{cite journal | first1 = Srdjan |last1 = Lemez | first2 = Joseph |last2 = Baker | title = Do Elite Athletes Live Longer? A Systematic Review of Mortality and Longevity in Elite Athletes | journal = Sports Medicine - Open | date =December 1, 2015 | volume = 1 | issue = 1 | page = 16 | doi = 10.1186/s40798-015-0024-x | pmid = 26301178 | oclc = 7659615440 | issn = 2199-1170 | publisher = [[Springer Open]] | pmc = 4534511 |doi-access = free }}</ref> === International level === An [[observational study]] held from professional footballers -active (during their career) and recently retired (post-career, aged more than 45 years)- in 70 countries between 2007 and 2013, elaborated on data from the World Footballers' Union (FIFPro), recorded 214 deaths of which 25% was caused by accidents, 11% by suicides and 33% by a suspected [[cardiac disease|cardiac]] [[pathology]] (on an overall 55% of deaths caused by some sort of disease).<ref>{{cite journal | author = V Gouttebarge | author2 = W Ooms | author3 = T Tummers | author4 = H Inklaar | url = https://www.minervamedica.it/en/journals/sports-med-physical-fitness/article.php?cod=R40Y2015N11A1376 | title = Mortality in international professional football (soccer): a descriptive study | journal = The Journal of Sports Medicine and Physical Fitness | date = November 1, 2015 | volume = 55 | issue = 11 | pages = 1376β82 | pmid = 25289716 | format = PDF | access-date = September 12, 2020 | oclc = 8086984568 | issn = 0022-4707}}</ref> Clinical evaluation, [[ECG]], and [[echocardiography]] are required for the athletes as pre-participation tools in order to prevent [[Sudden cardiac death of athletes|sudden cardiac deaths]] in people aged less than 35. To evaluate the risk of [[myocardial fibrosis]], may use and recommend the additional use of [[Cardiac magnetic resonance imaging#Late gadolinium enhancement|late gadolinium enhancement]] (LGE) with pre- and post-contrast and [[Sodium MRI|extracellular volume fraction]] (ECV) images.<ref>{{cite journal | title = Sudden cardiac death in football players: Towards a new pre-participation algorithm | author = Sophie I. Mavrogeni | author2 = Konstantinos Tsarouhas | author3 = Demetrios A. Spandidos | author4 = Christina Kanaka-Gantenbein | author5 = Flora Bacopoulou | pmid = 30679986 | doi = 10.3892/etm.2018.7041 | journal = Experimental and Therapeutic Medicine | date = February 1, 2019 | volume = 17 | issue = 2 | pages = 1792β0981| issn = 1792-1015 | publisher = [[Spandidos Publications]] | pmc = 6327574 | oclc = 7991416583}}</ref> Even encouraged, it wasn't yet made mandatory. === North America === In 2015, 205 deaths among North American professional athletes who were registered as active at the time of their decease were analysed. Data were collected for the four major sports: [[National Basketball Association]] (NBA), [[National Football League]] (NFL), [[National Hockey League]] (NHL), and [[Major League Baseball]] (MLB). The NFL and NBA active players had "a higher likelihood of dying in a [[car accident]]" and a significantly higher likelihood of dying from a cardiac-related illness compared to the NHL and MLB active populations.<ref>{{cite journal | url = https://pubmed.ncbi.nlm.nih.gov/25996659/ | title = Early death in active professional athletes: Trends and causes | author = S. Lemez | author2 = N. Wattie | author3 = J. Baker | journal = Scandinavian Journal of Medicine & Science in Sports | date = May 1, 2016 | volume = 26 | issue = 5 | pages = 544β9 | doi = 10.1111/sms.12480 | pmid = 25996659 | format = PDF | publisher = [[Wiley Online Library]] | s2cid = 41743986 | via = Google | issn = 0905-7188 | oclc = 6189719938 | archive-url = https://archive.today/20200912082333/https://www.google.com/search?channel=fs&client=ubuntu&q=Early+death+in+active+professional+athletes:+Trends+and+causes | archive-date = 12 September 2020 | url-status = live }}</ref> In 2013, a study on 3,439 retired athletes of the National Football Leagues with at least five credited playing seasons between 1959 and 1988 did not show a statistical correlation between suicide mortality and professional activity, particularly football-related compared with the general control sample. No [[Stratification (clinical trials)|stratification]] was reported between speed and non-speed position players.<ref>{{cite journal | author = Everett J. Lehman | author2 = Misty J. Hein | author3 = Christine M. Gersic | url = https://stacks.cdc.gov/view/cdc/42170/cdc_42170_DS1.pdf? | format = PDF | title = Suicide Mortality Among Retired National Football League Players Who Played 5 or More Seasons | doi = 10.1177/0363546516645093 | journal = Am J Sports Med | date = October 1, 2016 | volume = 44 | issue = 10 | pages = 2486β2491 | pmid = 27159317 | pmc = 5048489 | oclc = 8147151940 | issn = 0363-5465}}</ref> === Italy === Until the 2000s a very limited number of formal studies has been published on mortality from all causes in soccer players, despite the high interest of the public to the matter. An extended study held in Italy between 1975 and 2003 on a total of 5.389 players, aged 14β35 years, highlighted that, while the mortality for [[cancer]] and [[cardiovascular disease]]s among the football players cohort was significantly lower than the general Italian population, the "mortality rates for [[amyotrophic lateral sclerosis]] and [[car accident]]s were significantly higher than expected, and for ALS the risk is 18 times than expected."<ref>{{cite book | first = Emanuela | last= Taioli | url = https://academic.oup.com/eurpub/article/17/6/600/475352?searchresult=1 | title = All causes mortality in male professional soccer player | journal = [[European Journal of Public Health]] | volume = 17 | issue = 6 | date = December 2007 | pages = 600β604 | doi = 10.1093/eurpub/ckm035 | publisher = [[Oxford University Press]]| pmid= 17434875 }}</ref>
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