Skip to main content
PMC home page
Occupational and Environmental Medicine logoLink to Occupational and Environmental Medicine
. 1997 Jun;54(6):388–395. doi: 10.1136/oem.54.6.388

Mortality of doctors in different specialties: findings from a cohort of 20000 NHS hospital consultants.

L M Carpenter 1, A J Swerdlow 1, N T Fear 1
PMCID: PMC1128798  PMID: 9245944

Abstract

OBJECTIVES: To examine patterns of cause specific mortality in NHS hospital consultants according to their specialty and to assess these in the context of potential occupational exposures. METHODS: A historical cohort assembled from Department of Health records with follow up through the NHS Central Register involving 18,358 male and 2168 female NHS hospital consultants employed in England and Wales between 1962 and 1979. Main outcome measures examined were cause specific mortality during 1962-92 in all consultants combined, and separately for 17 specialty groups, with age, sex, and calendar year adjusted standardised mortality ratios (SMRs) for comparison with national rates, and rate ratios (RRs) for comparison with rates in all consultants combined. RESULTS: The 2798 deaths at ages 25 to 74 reported during the 30 year study period were less than half the number expected on the basis of national rates (SMR 48, 95% confidence interval (95% CI) 46 to 49). Low mortality was evident for cardiovascular disease, lung cancer, other diseases related to smoking, and particularly for diabetes (SMR 14, 95% CI 6 to 29). Death rates from accidental poisoning were significantly raised among male consultants (SMR 227, 95% CI 135 to 359), the excess being most apparent in obstetricians and gynaecologists (SMR 934); almost all deaths from accidental poisoning involved prescription drugs. A significantly raised death rate from injury and poisoning among female consultants was due largely to a twofold excess of suicide (SMR 215, 95% CI 93 to 423), the rate for this cause being significantly raised in anaesthetists (SMR 405). Compared with all consultants, significantly raised mortality was found in psychiatrists for all causes combined (RR 1.12), ischaemic heart disease (RR 1.18), and injury and poisoning (RR 1.46); in anaesthetists for cirrhosis (RR 2.22); and in radiologists and radiotherapists for respiratory disease (RR 1.68). There were significant excesses of colon cancer in psychiatrists (RR 1.67, compared with all consultants) and ear, nose, and throat surgeons (RR 2.25); melanoma in anaesthetists (RR 3.33); bladder cancer in general surgeons (RR 2.40); and laryngeal cancer in ophthalmologists (RR 7.63). CONCLUSIONS: Lower rates of smoking will have contributed substantially to the low overall death rates found in consultants, but other beneficial health related behaviours, and better access to health care, may have also played a part. The increased risks of accidental poisoning in male consultants, and of suicide in female consultants are of concern, and better preventive measures are needed. The few significant excesses of specific cancers found in certain specialties have no obvious explanation other than chance. A significant excess mortality from cirrhosis in anaesthetists might reflect an occupational hazard and may warrant further investigation.

Full text

PDF
388

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ackermann-Liebrich U., Wick S. M., Spuhler T. Survival of female doctors in Switzerland. BMJ. 1991 Apr 20;302(6782):959–959. doi: 10.1136/bmj.302.6782.959. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Araki S., Murata K., Kumagai K., Nagasu M. Mortality of medical practitioners in Japan: social class and the "healthy worker effect". Am J Ind Med. 1986;10(1):91–99. doi: 10.1002/ajim.4700100110. [DOI] [PubMed] [Google Scholar]
  3. Bruce D. L., Eide K. A., Linde H. W., Eckenhoff J. E. Causes of death among anesthesiologists: a 20-year survey. Anesthesiology. 1968 May-Jun;29(3):565–569. doi: 10.1097/00000542-196805000-00039. [DOI] [PubMed] [Google Scholar]
  4. Caplan R. P. Stress, anxiety, and depression in hospital consultants, general practitioners, and senior health service managers. BMJ. 1994 Nov 12;309(6964):1261–1263. doi: 10.1136/bmj.309.6964.1261. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Carpenter L. M. Some observations on the healthy worker effect. Br J Ind Med. 1987 May;44(5):289–291. doi: 10.1136/oem.44.5.289. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Cohen E. N., Gift H. C., Brown B. W., Greenfield W., Wu M. L., Jones T. W., Whitcher C. E., Driscoll E. J., Brodsky J. B. Occupational disease in dentistry and chronic exposure to trace anesthetic gases. J Am Dent Assoc. 1980 Jul;101(1):21–31. doi: 10.14219/jada.archive.1980.0345. [DOI] [PubMed] [Google Scholar]
  7. Doll R., Peto R. Mortality among doctors in different occupations. Br Med J. 1977 Jun 4;1(6074):1433–1436. doi: 10.1136/bmj.1.6074.1433. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Doll R., Peto R., Wheatley K., Gray R., Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors. BMJ. 1994 Oct 8;309(6959):901–911. doi: 10.1136/bmj.309.6959.901. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Guirguis S. S., Pelmear P. L., Roy M. L., Wong L. Health effects associated with exposure to anaesthetic gases in Ontario hospital personnel. Br J Ind Med. 1990 Jul;47(7):490–497. doi: 10.1136/oem.47.7.490. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Hall A., Harrington J. M., Aw T. C. Mortality study of British pathologists. Am J Ind Med. 1991;20(1):83–89. doi: 10.1002/ajim.4700200108. [DOI] [PubMed] [Google Scholar]
  11. Harrington J. M., Oakes D. Mortality study of British pathologists 1974-80. Br J Ind Med. 1984 May;41(2):188–191. doi: 10.1136/oem.41.2.188. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Harrington J. M. The health of anaesthetists. Anaesthesia. 1987 Feb;42(2):131–132. doi: 10.1111/j.1365-2044.1987.tb02984.x. [DOI] [PubMed] [Google Scholar]
  13. Hill G. B., Harvey W. The mortality of dentists. Br Dent J. 1972 Mar 7;132(5):179–182. doi: 10.1038/sj.bdj.4802818. [DOI] [PubMed] [Google Scholar]
  14. Lew E. A. Mortality experience among anesthesiologists, 1954-1976. Anesthesiology. 1979 Sep;51(3):195–199. doi: 10.1097/00000542-197909000-00003. [DOI] [PubMed] [Google Scholar]
  15. Logue J. N., Barrick M. K., Jessup G. L., Jr Mortality of radiologists and pathologists in the Radiation Registry of Physicians. J Occup Med. 1986 Feb;28(2):91–99. [PubMed] [Google Scholar]
  16. Matanoski G. M., Seltser R., Sartwell P. E., Diamond E. L., Elliott E. A. The current mortality rates of radiologists and other physician specialists: deaths from all causes and from cancer. Am J Epidemiol. 1975 Mar;101(3):188–198. doi: 10.1093/oxfordjournals.aje.a112086. [DOI] [PubMed] [Google Scholar]
  17. Matanoski G. M., Seltser R., Sartwell P. E., Diamond E. L., Elliott E. A. The current mortality rates of radiologists and other physician specialists: specific causes of death. Am J Epidemiol. 1975 Mar;101(3):199–210. doi: 10.1093/oxfordjournals.aje.a112087. [DOI] [PubMed] [Google Scholar]
  18. Neil H. A., Fairer J. G., Coleman M. P., Thurston A., Vessey M. P. Mortality among male anaesthetists in the United Kingdom, 1957-83. Br Med J (Clin Res Ed) 1987 Aug 8;295(6594):360–362. doi: 10.1136/bmj.295.6594.360. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Rich C. L., Pitts F. N., Jr Suicide by psychiatrists: a study of medical specialists among 18,730 consecutive physician deaths during a five-year period, 1967-72. J Clin Psychiatry. 1980 Aug;41(8):261–263. [PubMed] [Google Scholar]
  20. Rimpelä A. H., Nurminen M. M., Pulkkinen P. O., Rimpelä M. K., Valkonen T. Mortality of doctors: do doctors benefit from their medical knowledge? Lancet. 1987 Jan 10;1(8524):84–86. doi: 10.1016/s0140-6736(87)91919-2. [DOI] [PubMed] [Google Scholar]
  21. Smith P. G., Doll R. Mortality from cancer and all causes among British radiologists. Br J Radiol. 1981 Mar;54(639):187–194. doi: 10.1259/0007-1285-54-639-187. [DOI] [PubMed] [Google Scholar]
  22. Spence A. A., Cohen E. N., Brown B. W., Jr, Knill-Jones R. P., Himmelberger D. U. Occupational hazards for operating room-based physicians. Analysis of data from the United States and the United Kingdom. JAMA. 1977 Aug 29;238(9):955–959. [PubMed] [Google Scholar]
  23. Vessey M. P., Nunn J. F. Occupational hazards of anesthesia. Br Med J. 1980 Sep 13;281(6242):696–698. doi: 10.1136/bmj.281.6242.696. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Williams S. V., Munford R. S., Colton T., Murphy D. A., Poskanzer D. C. MOrtality among physicians: a cohort study. J Chronic Dis. 1971 Aug;24(6):393–401. doi: 10.1016/0021-9681(71)90139-1. [DOI] [PubMed] [Google Scholar]

Articles from Occupational and Environmental Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES