To identify combatants within a population of active boxers at greater risk for morbidity and mortality by analysis of prior fight win-loss records.

Prior studies have suggested that boxing losses which occur via knockout (KO) or technical knockout (TKO) are associated with greater neurological damage and higher rates of mortality among professional boxers.

Professional boxing fight records were reviewed for all boxing fights that took place in the United States during a 6 month period in 2017. Fights ending in a draw or non-contest ruling were excluded. Data was collected regarding fight location, win-loss records of the participants, and final outcome of the fight (KO, TKO, judges’ decision, etc).

A total of 1690 professional boxing fights were included in the analysis. 46.5% (n=786) of fights ended in a judges’ decision outcome, 35.1% (n=594) ended in TKO, 18.1% (n=306) ended in KO, 0.2% (n=4) ended in a participant disqualification outcome. For the subgroup of fighters with 30+ losses (n=56), 60.7% of them lost their fights via judges’ decision outcome.

Variability in KO/TKO rates between states may be a result of variability in pre-fight licensing requirements for fighters between different states, signaling the need for further research and implementation of interventions aimed at guiding licensure of fighters deemed to be at higher risk for injury. Boxers with greater than 30 losses on their record did not exhibit an increased likelihood of KO/TKO loss in their next fight, but still may incur significant cumulative injury and neurological damage over the course of their career. Winless boxers were at increased likelihood for losing by KO/TKO with winless fighters who had 4 losses on their record losing by KO/TKO more than 75% of the time in our study.