Ten (Years) For Fighting. The Deadly Toll of Fighting in Ice Hockey: An Analysis of Premature Mortality Among NHL Players.

When I first discovered NHL ice hockey as a teenager, I thought the fighting was kind of cool. These goons were willing to beat each other up and risk losing a tooth or ten, just to defend the honor of their teammates.

Now that I’m a physician and public health researcher, it’s decidedly less charming to me. We’ve all learned about the tragic toll that repeat head injuries take on NFL players. But until now, there has been less research on the NHL.

A paper out in JAMA Network Open last week quantified the effects of fighting in the NHL. The paper has one of my favorite Introduction sections I’ve ever read.

“Fighting has been implicitly accepted in the National Hockey League (NHL) for more than 100 years. Players participating in a fight are reprimanded with a brief 5-minute penalty but return to play shortly after their altercation. Proponents of fighting argue that it promotes ticket sales, deters other acts of violence, and positively impacts team momentum. Meanwhile, others have noted the deleterious effects of repetitive head trauma. Enforcers in the NHL are players who engage in fights to intimidate opponents or gain momentum for their team. The premature deaths of multiple NHL enforcers, including Rick Rypien (aged 27 years), Derek Boogaard (aged 28 years), Wade Belak (aged 35 years), Steve Montador (aged 35 years), and Bob Probert (aged 45 years), have drawn attention to the potential health consequences of fighting.” —Dr. Charles Popkin and colleagues, JAMA Network Open.

When I read that, I could not help but roll my eyes. That the NHL permits this to go on in the year 2023 is just so ludicrous.

Researchers from Columbia University looked at every player who played in the NHL from 1967-2022. They found the fighters (players who got into 50 or more fights) and then compared their death rates to players who did not fight—at least not that much. Turns out that the mortality rate was not statistically different between the two groups.

But there’s a catch. Among the players in each group who did die, the age of death was far lower in the fighter group, to the tune of 10 years (the average age of death among deceased fighters was 47.5 years versus 57.5 years for the deceased lovers non-fighters).

The causes of death were quite different, too. Among the deceased fighters, over one-third were due to overdose, suicide, or a neurodegenerative condition (like CTE, or  chronic traumatic encephalopathy). The non-fighters virtually never died from those causes. Car accidents were higher in the fighter group as well. The non-fighters basically lived long enough to die of normal causes (like cancer, at >54%), whereas the fighters had lower cancer rates because they didn’t live long enough. (Cancer is frequently the bargain we make in exchange for surviving into old age).

So why did the mortality rates not differ between the fighters and non-fighters in the NHL? Probably because it’s too soon to see the differences. And eventually, it’ll be too late! Every one of these men will someday die, for one reason or another. The mortality rate among fighters and non-fighters will inevitably rise (from approximately 4% in the study so far) to 100%. Once that happens, we’ll be able to look at the mean age of death in the fighter versus non-fighter group. I imagine at that point, we’ll see that the differences in the ages of death found in this study will have continued to play out, worsening over time.

Of course, the other question is whether NHL players die younger than average? That’s going to be interesting as well, because you’ll have competing forces at work. These NHL pros are top-tier athletes in great condition during their adult years and they have access to medical care. That gives them a longevity advantage compared to the general male population. So, the eventual study that someone will need to do is to compare the lifespan of men who played in the NHL to an appropriate control group—say, a cohort of men who stopped playing hockey after playing in Division I of the NCAA. The control cohort will likely have been affluent enough to have the medical care access through adulthood—even if they didn’t retain the advantage of having stayed in peak physical shape during their mid-20s and 30s. I won’t be surprised if the NHL players (fighters in particular) will be found to have lower life-expectancies than those who hung up their skates after college.

Hockey is great. I still enjoy watching from time to time. But the doctor in me says that the full-force checking and fighting comes at too high a cost. If my kids ever wanted to play full contact hockey where checking was permitted, I’d probably say no.