title: Mortality in female and male French Olympians: a 1948-2013 cohort study.
abstract: BACKGROUND
  Whereas intense physical activity has been associated with deleterious effects on elite athletes' health, in particular due to cardiovascular anomalies, long-term follow-ups have suggested lower mortality rates among elite athletes. Causes of death for French Olympic athletes and female elite athletes have not been studied.
  
  
  OBJECTIVE
  We aimed to measure overall and disease-specific mortality of French female and male Olympians compared with the French general population. We hypothesize that Olympians, both women and men, have lower mortality rates.
  
  
  METHODS
  Cohort study; Level of evidence, 3.
  
  
  METHODS
  French elite athletes (601 women and 1802 men) participating in summer or winter Olympic Games from 1948 to 2010 had their vital status verified by national sources and were followed until 2013. Causes of death were obtained via the National Death registry from 1968 to 2012. Overall and disease-specific mortalities of Olympians were compared with those of the French general population through standardized mortality ratios (SMRs) and 95% CIs. Olympians' observed and expected survivals were illustrated by Kaplan-Meier curves.
  
  
  RESULTS
  At the endpoint of the study, 13 women and 222 men had died. Overall mortality in Olympians compared with that of their compatriots was 51% lower (SMR, 0.49; 95% CI, 0.26-0.85) among women and 49% lower (SMR, 0.51; 95% CI, 0.45-0.59) among men. Olympic athletes' survival is significantly superior to that of the French general population (women, P = .03; men, P < .001). According to the total deaths occurring from 1968 to 2012 (12 among women, 202 among men), female Olympians died from neoplasm (50.0%), external causes (33.3%), and cardiovascular diseases (16.6%). The main causes of death among men were related to neoplasms (36.1%), cardiovascular diseases (24.3%), and external causes (14.4%). Regarding the main causes of mortality among male Olympic athletes, the SMRs were as follows: 0.55 for neoplasms (95% CI, 0.43-0.69), 0.55 for cardiovascular diseases (95% CI, 0.41-0.73), and 0.66 for external causes (95% CI, 0.44-0.94).
  
  
  CONCLUSIONS
  French Olympians live longer than their compatriots: A lower overall mortality of similar magnitude is observed among male and female athletes compared with the general population. The main causes of death in French Olympians are neoplasms, cardiovascular diseases, and external causes.
authors: Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France Université Paris Descartes, Paris, France juliana.antero@insep.fr.
authors: Juliana
authors: J
authors: Antero-Jacquemin
authors: INSERM, Centre for Epidemiology on Medical Causes of Death (CépiDc), Le Kremlin-Bicêtre, France.
authors: Grégoire
authors: G
authors: Rey
authors: Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France.
authors: Andy
authors: A
authors: Marc
authors: Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France.
authors: Frédéric
authors: F
authors: Dor
authors: Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France Université de Rouen, Rouen, France.
authors: Amal
authors: A
authors: Haïda
authors: Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France.
authors: Adrien
authors: A
authors: Marck
authors: Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France Université Paris Descartes, Paris, France.
authors: Geoffroy
authors: G
authors: Berthelot
authors: Comité National Olympique Sportif Français (CNOSF), Paris, France.
authors: Alain
authors: A
authors: Calmat
authors: Conservatoire National des Arts et Métiers (cnam), Paris, France.
authors: Aurélien
authors: A
authors: Latouche
authors: Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport de l'Expertise et de la Performance (INSEP), Paris, France Université Paris Descartes, Paris, France Centre d'investigations en médécine du sport (CIMS), Paris, France.
authors: Jean-François
authors: JF
authors: Toussaint
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D056352:Athletes / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D002908:Chronic Disease / Q000401:mortality*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008136:Longevity; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D013177:Sports / Q000706:statistics & numerical data*
keywords: disease-specific mortality; elite athletes; epidemiology; overall mortality