Elite male football players have a lower risk of alcohol and drug related disorders than men from the general population, but this protective effect was seen only for those who first played in the 1960s and later, not for players from earlier eras, finds a study in the Christmas issue of The BMJ.
Questions also persist over the health impacts of alcohol marketing to millions of football fans around the globe, say authors of a linked editorial.
Alcohol consumption has been deeply ingrained in football culture for both players and fans, and several well known players have experienced alcohol addiction during and after their playing careers.
Constant pressure to perform at a high level, public attention and fame have been suggested to increase the risk of alcohol related disorders among active and retired elite athletes, but large scale studies assessing such outcomes are scarce.
To explore this further, researchers tracked the health of 6,007 male football players who had played in the Swedish top division, Allsvenskan, from 1924 to 2019 and 56,168 men from the general population matched to players based on age and region of residence.
They identified any alcohol and drug related disorders recorded in death certificates, during hospital admissions and outpatient visits, or use of prescription drugs for alcohol addiction.
They also assessed whether any increased risk would vary according to year of first top tier playing season, age, career length, and goal scoring abilities.
Participants were followed for an average of 27 years, during which time 257 (4.3%) football players and 3,528 (6.3%) men from the general population received diagnoses of alcohol related disorders.
In analyses accounting for age, region of residence, and calendar time, risk of alcohol related disorders was about 30% lower among football players than among men from the general population.
This reduced risk was seen among football players who played their first season in the top tier from the early 1960s onwards, while football players from earlier eras had a similar risk as men from the general population.
The risk of alcohol related disorders was lowest at around age 35 years, and then increased with age. At around age 75, football players had a higher risk of alcohol related disorders than men from the general population.
No significant association was seen between goal scoring, number of games, and seasons played in the top tier and the risk of alcohol related disorders.
Risk of disorders related to other drug misuse was significantly lower (78%) among football players than the general population.
This is an observational study and the researchers acknowledge that individuals could have had alcohol related disorders without receiving a diagnosis, and that their findings may not apply to female elite players and to male and female amateur and youth players (who constitute most football players worldwide).
But they conclude: "In this nationwide cohort study, male football players who had played in the Swedish top tier of competition had a significantly lower risk of alcohol related disorders than men from the general population."
These findings are likely to reflect the economic changes in football, altering players' drinking habits since the 1960s and mitigating alcohol related health harms, say researchers in a linked editorial.
In contrast, they point out that football clubs, competitions, and leagues continue to promote alcohol and other unhealthy commodities to football fans, which evidence indicates is directly linked with higher consumption, particularly among young people.
Further research might be able to compare the incidence of alcohol related disorders between the general population and football fans to ascertain the impact of football related marketing, they write. It could also look at how and when elite footballers object to alcohol sponsorship and whether elite footballers pushing back on alcohol can influence the consumption habits of fans.
"While fans could not buy alcohol at the matches at the Qatar World Cup, digital advertising boards alongside the pitch promoted beer to millions of global television viewers," they note. "Playing football might be healthy but watching it could be the very opposite."
Ueda, P., et al. (2022) Alcohol related disorders among elite male football players in Sweden: nationwide cohort study. The BMJ. doi.org/10.1136/bmj-2022-074093.