Alexander B H, Checkoway H, Nagahama S I, Domino K B
Department of Anesthesiology, School of Medicine, and the Department of Environmental Health, School of Public Health, University of Washington, Seattle, Washington, USA.
Anesthesiology. 2000 Oct;93(4):922-30. doi: 10.1097/00000542-200010000-00008.
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.
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.
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.
Substance abuse and suicide represent significant occupational hazards for anesthesiologists. New methods to combat substance abuse among anesthesiologists should be developed.
手术室环境对健康的影响尚不清楚。作者比较了1979年至1995年间麻醉医生与内科医生的死亡风险。
使用医生主档案数据库（一份美国所有医生的名单）来识别麻醉医生和普通内科医生。内科医生队列（n = 40,211）是所有内科医生的分层随机样本，按性别、出生年代和美国公民身份与麻醉医生队列（n = 40,242）进行频率匹配。使用国家死亡指数确认死亡状态并确定具体死因。采用Cox比例风险回归模型比较调整年龄、性别和种族后的死亡风险。
除自杀外，所有医生的标准化死亡比均远低于1.0。麻醉医生和内科医生的全因死亡率以及癌症和心脏病导致的死亡风险没有差异。麻醉医生自杀死亡风险增加（率比[RR] = 1.45，95%置信区间[CI] = 1.07 - 1.97）、药物相关死亡风险增加（RR = 2.79，95% CI = 1.87 - 4.15）、其他外部原因导致的死亡风险增加（RR = 1.53，95% CI = 1.05 - 2.22）以及脑血管疾病导致的死亡风险增加（RR = 1.39，95% CI = 1.08 - 1.79）。男性麻醉医生感染艾滋病毒死亡风险增加（RR = 1.82，95% CI = 1.09 - 3.02）以及病毒性肝炎死亡风险增加（RR = 7.98，95% CI = 1.0 - 63.84）。尽管麻醉医生药物相关死亡风险在医学院毕业后的头5年最高，但在整个职业生涯中仍高于内科医生。
药物滥用和自杀是麻醉医生的重大职业危害。应开发新方法来对抗麻醉医生中的药物滥用问题。
