Our study shows that life-expectancy for Olympians varies by event with high-jumpers and marathon runners living longer than discus throwers and sprinters. There were also large differences in weight between athlete types which explained some of the differences in survival, particularly between high-jumpers and discus throwers. High jumpers were lighter than discus throwers and lighter athletes, in general, lived longer than heavier athletes. In addition, high jumpers and marathon runners lived longer than similarly aged members of the general population for both men women. Female, but not male, discus throwers lived longer than the general population. There was no survival benefit for sprinters compared to the general population.
Past research has evaluated the survival of Olympic athletes in comparison with the general public. A systematic review by Lemez found that survival for athletes was better than the general population in many but not all studies (5). In a recent study by Antero-Jacquemin et al. , Olympic rowers lived longer than the general French population. The standardized mortality ratio (SMR) was 0.58 (95% confidence interval: 0.43–0.78) indicating that mortality was 42% lower for the Olympic athletes than the average French resident. Deaths from cardiovascular disease were also lower than expected for Olympic athletes in this study (SMR 0.41 (95% CI 0.16–0.84)). There was a trend toward reduced cancer mortality (SMR 0.59 (95% CI 0.29–1.07)). Other causes of death were no different between Olympic athletes and the general population of France. Our study was consistent with these findings, but shows that certain athlete types (high jumpers and marathon runners) but not others (sprinters) live longer than the general populations of their respective countries.
Among Olympic athletes, those winning medals may have the best outcome. In a study by Clarke, Olympic medalists lived longer than the general population regardless of country.  Specifically, Olympic medalists lived an average of 2.8 years longer than controls of the general population. There was no survival advantage by type of medal (Gold, Silver, and Bronze) though the study had limited power to detect differences in these groups. Those who medaled in endurance sports (long distance running, cross-country skiing) and mixed sports (track and field jumping, soccer, ice hockey, basketball, and short distance running) had a greater survival advantage than medalists in power sports (field throwing, weightlifting, wrestling, and boxing). We did not observe a difference in outcome between medalists and non-medalists though the sample size limited our ability to find small to moderate differences.
One of the main differences between the athlete types was weight, and to a lesser extent height. This difference in weight is important in interpreting survival differences between athlete types because weight was associated with mortality in our study as well as in others [12–14] The impact on mortality may depend on athlete age with lighter weight being more beneficial for the young than for the elderly. Dahl et al.  reported that individuals between 70–95 years with a higher BMI had approximately 20% lower mortality than those with lower BMI. A similar study by Flicker et al.  showed that older individuals with higher BMI had lower mortality related to heart disease. However, Rosengren et al.  reported that among young to middle aged individuals, weight gain after the age of 20 raised a person’s risk of coronary death. Our study is consistent with the latter, in which lighter athletes had greater survival than heavier athletes. This difference in weight explained much of the mortality difference between high jumpers and discus throwers though it explained little of the survival difference between marathon runners and sprinters.
Numerous public health organizations have established recommendations for ideal body weight. For example, the World Health Organization recommended that individuals maintain a body mass index of 18 – 25 kg per meters squared . This recommendation is independent of age, based on findings that in midlife, a higher BMI is associated with higher mortality. However, an “obesity paradox” exists for particularly elderly groups, in which higher weight is associated with better survival. Ideal body weight may also differ for elite athletes. For example, heavier elite athletes may have an extremely low percentage of body fat, and thus the relationship between weight and survival may be attenuated. While we do not know the mechanism for increased mortality for different athlete types there are several implications for athletes and coaches. Those athletes with a larger body habitus may have more weight gain following competitive athletics and associated complications such as metabolic syndrome and diabetes. Larger athletes can be counseled that maintaining a healthy lifestyle, while recommended for all, may be of particular importance for them.
Our study has several potential limitations. We were unable to control for socioeconomic status within countries which is known to be associated with survival [16, 17]. It is possible that discus throwers had a lower socio-economic status than high-jumpers, and this may have explained some of the difference in mortality. Our power was limited to detect interactions between athlete characteristics (e.g. gender and sport) and small to moderate interactions may exist. In addition, cause of death was not available, and there may be differences in cardiovascular or cancer mortality between the two athlete types. There may be benefits related to being an Olympian that are unrelated to training and health behaviors and additional investigations are needed to explore these potential mechanisms . Changes in health behaviors and medical care over time may impact health status and future studies are needed to determine how recent trends are impacting mortality. Finally, women were not eligible for long-distance races during the Olympics we examined.