MORTALITY OF DOCTORS IN DIFFERENT SPECIALTIES - FINDINGS FROM A COHORT OF 20000 NHS HOSPITAL CONSULTANTS

Objectives-To examine patterns of cause specific mortality in NHS hosp ital consultants according to their specialty and to assess these in t he context of potential occupational exposures. Methods-A historical c ohort assembled from Department of Health records with follow up throu gh the NHS Central Register involving 18 358 male and 2168 female NHS hospital consultants employed in England and Wales between 1962 and 19 79. Main outcome measures examined were cause specific mortality durin g 1962-92 in all consultants combined, and separately for 17 specialty groups, with age, sex, and calendar year adjusted standardised mortal ity ratios (SMRs) for comparison with national rates, and rate ratios (RRs) for comparison with rates in all consultants combined. Results-T he 2798 deaths at ages 25 to 74 reported during the 30 year study peri od were less than half the number expected on the basis of national ra tes (SMR 48, 95% confidence interval (95% CI) 46 to 49). Low mortality was evident for cardiovascular disease, lung cancer, other diseases r elated to smoking, and particularly for diabetes (SMR 14, 95% CI 6 to 29). Death rates from accidental poisoning were significantly raised a mong male consultants (SMR 227, 95% CI 135 to 359), the excess being m ost apparent in obstetricians and gynaecologists (SMR 934); almost all deaths from accidental poisoning involved prescription drugs. A signi ficantly raised death rate from injury and poisoning among female cons ultants was due largely to a twofold excess of suicide (SMR 215, 95% C I 93 to 423), the rate for this cause being significantly raised in an aesthetists (SMR 405). Compared with all consultants, significantly ra ised 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 sign ificant excesses of colon cancer in psychiatrists (RR 1.67, compared w ith all consultants) and ear, nose, and throat surgeons (RR 2.25); mel anoma in anaesthetists (RR 3.33); bladder cancer in general surgeons ( RR 2.40); and laryngeal cancer in ophthalmologists (RR 7.63). Conclusi ons-Lower rates of smoking will have contributed substantially to the low overall death rates found in consultants, but other beneficial hea lth related behaviours, and better access to health care, mag have als o played a part. The increased risks of accidental poisoning in male c onsultants, and of suicide in female consultants are of concern, and b etter preventive measures are needed. The few significant excesses of specific cancers found in certain specialties have no obvious explanat ion other than chance. A significant excess mortality from cirrhosis i n anaesthetists might reflect an occupational hazard and may warrant f urther investigation.