title: Cause-specific mortality risks of anesthesiologists.
abstract: BACKGROUND
  The health-related effects of the operating room environment are unclear. The authors compared mortality risks of anesthesiologists to those 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 internists, frequency-matched to the cohort of anesthesiologists (n = 40,242) by gender, decade of birth, and US citizenship. The National Death Index was used to confirm death status and to determine specific causes of death. Mortality risks, adjusted for age, gender, and race, were compared using the Cox proportional hazards regression model.
  
  
  RESULTS
  The standardized mortality ratios for all physicians were well below 1.0, except for suicide. The all-cause mortality ratios, and the risks of death caused by cancer and heart disease, did not differ between anesthesiologists 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 other external causes (RR = 1.53, 95% CI = 1.05 - 2.22), and death from cerebrovascular disease (RR = 1.39, 95% CI = 1.08 - 1.79). Male anesthesiologists 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 to anesthesiologists of drug-related deaths was highest in the first 5 years after medical school graduation, it remained increased over that of internists 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.
authors.affiliation: Department of Anesthesiology, School of Medicine, and the Department of Environmental Health, School of Public Health, University of Washington, Seattle, Washington, USA.
authors.forename: B H
authors.initials: BH
authors.lastname: Alexander
authors.forename: H
authors.initials: H
authors.lastname: Checkoway
authors.forename: S I
authors.initials: SI
authors.lastname: Nagahama
authors.forename: K B
authors.initials: KB
authors.lastname: Domino
mesh_terms: D000776:Anesthesiology / Q000706:statistics & numerical data; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000401:mortality; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D015658:HIV Infections / Q000401:mortality; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009784:Occupational Diseases / Q000401:mortality; D016016:Proportional Hazards Models; D012306:Risk; D019966:Substance-Related Disorders / Q000401:mortality; D013405:Suicide / Q000706:statistics & numerical data