This matched cohort study of 6039 NHL players from 1967 to 2022 confirmed that NHL enforcers died at similar rates but approximately 10 years earlier when compared with NHL controls. Furthermore, the causes of death in the 21 enforcers included neurodegenerative disorders, drug overdose, suicide, and motor vehicle crashes, whereas only 1 of the 24 age-matched controls died of any of these causes (motor vehicle crash).