Key PointsQuestionDo National Hockey League (NHL) enforcers with more career fights or penalty minutes differ in mortality rates or cause of death when compared with control NHL players?FindingsThis 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).MeaningThese findings suggest that NHL enforcers with 50 or more career fights or 3 or more penalty minutes per game died 10 years earlier and more often of drug overdose and suicide when compared with age-matched NHL player controls.