Cause-specific mortality risks of anesthesiologists

Background: The health-related effects of the operating room environment ar e unclear. The authors compared mortality risks of anesthesiologists to tho se of internal medicine physicians between 1979 and 1995 Methods: The Physician Master File database, a listing of all US physicians , was used to identify anesthesiologists and general internists. The cohort of internists (n = 40,211) was a stratified random sample of all Internist s, frequency-matched to the cohort of anesthesiologists (n = 40,242) by gen der, decade of birth, and US citizenship. The National Death Index was used to confirm death status and to determine specific causes of death. Mortali ty risks, adjusted for age, gender, and race, were com pared using the Cox proportional hazards regression model. Results: The standardized mortality ratios for all physicians were well bel ow 1.0, except for suicide. The all-cause mortality ratios, and the risks o f death caused by cancer and heart disease, did not differ between anesthes iologists and internists, Anesthesiologists had an increased risk of death from suicide (rate ratio [RR] = 1.45, 95% confidence interval [CI] = 1.07 - 1.97), drug-related death (RR = 2.79, 95% CI = 1.87 - 4.15), death from ot her external causes (RR = 1.53, 95% CI = 1.05 - 2.22), and death from cereb rovascular disease (RR = 1.39, 95% CI = 1.08 - 1.79). Male anesthesiologist s had an increased risk of death from HIV (RR = 1.82, 95% CI = 1.09 - 3.02) and viral hepatitis (RR = 7.98, 95% CI = 1.0 - 63.84). Although the risk t o anesthesiologists of drug-related deaths was highest In the first 5 years after medical school graduation, it remained increased over that of intern ists throughout the career. Conclusions: Substance abuse and suicide represent significant occupational hazards for anesthesiologists. New methods to combat substance abuse among anesthesiologists should be developed.