At least one in four NFL players who died between 2016 and 2021 had the degenerative brain disease known as CTE, a new study has revealed.

The study, published Tuesday by the British Medical Journal, focused on how common chronic traumatic encephalopathy might be among NFL players. What they found is that of the 878 players who appeared in at least one NFL game and died in that six-year period, at least 25% had CTE.

CTE can be diagnosed only after death, so most research has depended on brains donated by players or their families. This study drew on samples donated between 2008 and 2021, 93% of which had been diagnosed with CTE, then narrowed the sample based on when donations were highest and factored in demographic data and information from death certificates.

The estimate of 25% is on the “low end,” mentioned Dr. Daniel Daneshvar, the study’s lead author. The study found that the maximum possible prevalence of CTE was around 97%, but the true rate “is somewhere in the middle,” Daneshvar mentioned.

The NFL “continuously strives to make the game of football safer, including by implementing strategies to reduce concussions and head impacts,” the league mentioned in a statement. “The NFL remains committed to ensuring that the NFL community has access to a robust — and expanding — set of resources to enhance their physical and mental well-being.”

Texans LB Azeez Al-Shaair, who’s entering his eighth NFL season, was asked recently about whether he worried about getting CTE.

“The reality of the game is that it’s aggressive. It’s violent,” he mentioned. “We’re out here running at each other. These are the best athletes in the world playing on one field. You’re going full speed running into each other. That’s the type of stuff that can happen.”

When asked whether he worried about life after football, Al-Shaair mentioned, “That’s the reality of the game. I think we all know what we sign up for. … You have to make sure that you’re taking care of your body, doing the things that you can off the field to give yourself the best chance to stay healthy.”

The study also looked at the link between CTE and dementia, and found that more than 90% of samples of the most advanced stage of CTE, Stage IV, were also diagnosed with dementia.

Daneshvar noted that since the biggest predictor or CTE is the cumulative force of hits to the head, that risk can be mitigated by things such as eliminating hits during practices, and children not playing tackle football.

The study’s researchers hope to have a study in the coming months that estimates the overall rate of CTE in all NFL players at the time of their death.

ESPN’s Kevin Seifert contributed to this report.

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