Airline pilot medical disability: a comparison between three airlines with different approaches to medical monitoring.

To study the impact of airline medical departments on pilot disability, three major U.S. airlines, nominally airlines A, B, and C, were chosen because they had distinctly different medical programs. Airline A provided essentially no medical review. Airline B performed preemployment screening and assessment of individual disability claims, along with an irregular pilot review. Airline C provided basically the same services as airline B but also screened pilots annually. The total cohort comprised 12,866 pilots providing 79,797 person-years of experience. Between 1 January 1975 and 31 December 1982, medical losses in all three airlines increased rapidly after pilots reached the age of 45 years, with cardiovascular disease responsible for approximately 50% of the losses. For pilots 45 years old or older, the age-specific disability rates in airline A were significantly higher than those in airlines B and C; rates for airlines B and C were not significantly different. The data suggest that airlines with active medical departments have lower pilot medical disability rates than do airlines without such departments. Data also suggest that preemployment screening and assessment of individual disability claims are more important determinants of long-term disability rates than are regular (annual) pilot health reviews.