Olfson Mark, Cosgrove Candace M, Wall Melanie M, Blanco Carlos
Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York.
United States Census Bureau, Mortality Research Group, Suitland, Maryland.
Am J Prev Med. 2025 Jun;68(6):1080-1090. doi: 10.1016/j.amepre.2024.11.005. Epub 2024 Nov 28.
Physicians and nurses have lower annual mortality rates than the general population. One explanation for the low mortality rates of these healthcare workers emphasizes their specialized medical knowledge and greater access to healthcare while a second emphasizes their generally higher level of education. This study evaluated the extent to which general educational level accounts for the lower all-cause mortality rates of U.S. healthcare than non-healthcare workers. It also compared cause-specific mortality risks of healthcare and non-healthcare workers.
A nationally representative sample of healthcare workers (n=176,000) and non-healthcare workers (n=1,662,000) from the 2008 American Community Survey (n=3,310,000) was followed through 2019 for mortality. Cox models estimated hazard ratios of all-cause and cause-specific mortality for 6 healthcare worker groups. Analyses were performed in 2024.
Age- and sex-standardized all-cause death rates per 100,000 were lower for healthcare (370.7; 95% CI=361.5, 379.9) than non-healthcare (442.2; 95% CI=439.2, 445.2) workers (p<0.001). However, this difference was not evident after additionally adjusting for level of education (aHR=1.00; 0.97, 1.02). In fully adjusted models, hazards of mortality were lower for healthcare than non-healthcare workers for cardiovascular disease (aHR=0.94; 0.89, 0.99) and lung cancer (aHR=0.89; 0.81, 0.98), but higher for pancreatic cancer (aHR=1.21; 1.05, 1.39) and external causes of death (aHR=1.20; 1.10, 1.30).
Higher educational attainment accounted for the longer life expectancy of U.S. healthcare workers than other workers. Nevertheless, healthcare work relative to non-healthcare work was associated with lower hazards of deaths due to cardiovascular diseases and lung cancer, but higher hazards of deaths due to external causes.
医生和护士的年死亡率低于普通人群。对这些医护人员低死亡率的一种解释强调他们的专业医学知识以及获得医疗保健的更多机会，而另一种解释则强调他们普遍较高的教育水平。本研究评估了一般教育水平在美国医护人员全因死亡率低于非医护人员方面所起作用的程度。它还比较了医护人员和非医护人员特定病因的死亡风险。
从2008年美国社区调查（样本量为3310000）中选取具有全国代表性的医护人员样本（n = 176000）和非医护人员样本（n = 1662000），随访至2019年以了解死亡率情况。Cox模型估计了6个医护人员群体全因和特定病因死亡率的风险比。分析于2024年进行。
每100000人中，医护人员的年龄和性别标准化全因死亡率（370.7；95%置信区间 = 361.5，379.9）低于非医护人员（442.2；95%置信区间 = 439.2，445.2）（p < 0.001）。然而，在进一步调整教育水平后，这种差异并不明显（调整后风险比 = 1.00；0.97，1.02）。在完全调整模型中，医护人员死于心血管疾病（调整后风险比 = 0.94；0.89，0.99）和肺癌（调整后风险比 = 0.89；0.81，0.98）的死亡率低于非医护人员，但死于胰腺癌（调整后风险比 = 1.21；1.05，1.39）和外部死因（调整后风险比 = 1.20；1.10，1.30）的死亡率高于非医护人员。
较高的教育程度是美国医护人员预期寿命长于其他职业人员的原因。尽管如此，相对于非医护工作，医护工作与心血管疾病和肺癌导致的死亡风险较低相关，但与外部原因导致的死亡风险较高相关。
