Why Do Spanish Doctors Die More From Cancer and Violent Deaths?

Dr Javier Cotelo

December 02, 2019

MADRID - Physicians in Spain die more from cancer (5%), according to a study comparing the causes of death of these professionals with the general population. It is also surprising that another 5% die from traffic accidents, suicide and other violent deaths.

Specifically, female doctors have 7.5% more suicides than women in the general population. On the other hand, life expectancy in the profession is 1 more year in men, and 2 in women.

Spain’s Consejo  General de Colegios Oficiales de Médicos (CGCOM) presented data from the Study of Mortality in the Medical Profession , in which the causes of death and the life expectancy of Spanish doctors were analysed for the first time. This study was based on data from the registries of medical colleges and Spain’s National Statistics Institute.

This was a retrospective study in which the causes of death of 9184 Spanish doctors were recorded during the 8-year period between 2005 and 2014. This represents an annual average of 918 physicians. Data gathered did not include the deaths of doctors in Barcelona as this information was unavailable.

The International Statistical Classification of Diseases and Related Health Problems (ICD)-10, established by the World Health Organisation, was used to code the causes of death. Statistical information on medical mortality is offered, compared with the general population mortality of adults aged 30 or over, based on the principal cause of death.

The direct method was chosen among the different rate standardisation methods.

In this study two variables should be clarified: the results refer almost entirely to men over 30 years old, but in the section of deaths due to external causes there is a percentage of doctors sufficiently comparable with the general female population.

Causes of Death: Main Culprits - Lung, Colon and Prostate

The main causes of death in doctors were tumours, followed by circulatory system disease, and respiratory conditions.

In the indicated decade there were 3151 (38.6%) deaths from tumours in doctors, and 652,103 (33.1%) deaths in the general male population, which means that the mortality from this cause was 5.5% superior in doctors.

By subtypes, trachea, bronchial or lungtumours represented 27.3% of deaths in doctors, and 26.4% in the general population.

Colon cancer was 9.8% versus 9.7%, and prostate cancer 9% versus 8.8%, occupying the second and third causes of tumour mortality, with very similar percentages in both populations.

In this section it is striking that pancreatic tumours, which rank fourth among doctors, were 6.3% more frequent than in men in the general population (4.4%). This was the largest difference found among the tumour types that were analysed.

To a lesser extent, rectal and anal tumours (3.3% versus 1.9%) and oropharyngeal tumours (2.7% vs. 1.6%), were found to be discretely more frequent in the general population males than in male physicians. In fifth place of tumour mortality in doctors were bladder tumours (5.7%), compared to 6% in the general population, in which they rank fourth.

With regard to tumour mortality according to the age group among men, it should be noted that in all decades an average of 4% was higher in doctors when compared to the general population, moreover the difference was striking in the age range from 40 to 49 years, exceeding 12%.

In general, among the main causes of death according to age, tumours were the main cause of death in doctors between 40 and 79 years. More than half of the deaths of physicians between 50 and 59 years were attributed to this cause.

Diseases of the circulatory system were the main cause of death in those over 80 years.

Doctors More Exposed to Tumour Risk

Dr Aitana Clavo, scientific secretary of the Spanish Society of Medical Oncology, a medical oncologist at the General University Hospital Gregorio Marañón in Madrid, told Medscape Spanish Edition : "In the figures shown in this study some differences seem to be identified, although they might not be statistically significant, and could be attributed to other random factors.

"However, 40% of tumours are due to preventable causes, and the circumstance could occur that the medical population could be more exposed to important risk factors, such as tobacco, alcohol, improper diet, sedentary lifestyle, or obesity", added the oncologist.
 

"In fact, recent data from European studies suggest that approximately 85% of oncologists experience signs of burnout. And Spanish data suggest that the care overload, the lack of time to balance work and personal life, social pressure, and instability at work are sources of stress, among other more specific aspects related to the profession, such as giving bad news or dealing with death, as well as being a daily witness to patients’ suffering," she said.

Also, Dr Calvo indicated, "according to data from the European Society for Medical Oncology and the American Society of Clinical Oncology, these symptoms are often associated with inadequate professional care for patients, and also to behaviours, such as an excessive use of alcohol or tobacco. In any case, the differences could be due to chance, and should be confirmed…, since at the moment there is no similar data from other countries around us."

More Myocardial Infarctions, but Fewer Strokes

The second cause of death among Spanish male doctors was due to diseases of the circulatory system. In those 10 years, 2351 doctors had died from this condition (28.8%). As for the general male population, 559,580 people (27.9%) died, representing also the second cause of death. Acute myocardial infarction accounted for 25% of deaths in doctors compared to 20.6% in the general population.

In second place, strokes accounted for 20.5% of deaths in doctors, and 23.5% in men in the general population; 10% (814 deaths) of male doctors deaths between 2005 and 2014 were due to respiratory system diseases, representing the third cause of death among male doctors, compared to 12.7% of the general male population (248,906 deaths), where it also ranked third.

In Spain, there are approximately 14,000 annual deaths due to external causes, with 13,911 deaths in 2014 caused by traffic accidents, suicide or other violent acts, as indicated by the ICD-10. When a death occurs due to any of these causes or there is room for suspicion, judicial intervention and an autopsy are necessary to determine the exact cause and circumstances of death.

Among women in the general population these causes accounted for 5.8% of deaths, and in female doctors it was 8.1% (2.3% higher). On the contrary, in men, deaths due to external causes of mortality represented 4.4% in the general population compared to 3.4% in male doctors (1% less).

Among the external causes of mortality, the main one was suicide in both populations, and traffic accidents were the second cause. The third external cause of death in medical men was drowning, as in the general population, but the same did not happen in female doctors.

Violent Deaths in Female Doctors

Although in male doctors suicide and traffic accidents had a higher percentage when compared to men in the general population (28.9% versus 27.4%, and 23.2% versus 20.8%, respectively), this percentage was much more pronounced in female doctors than in women in the general population; regarding to suicide it was 45.8% compared to 37.2% (8.6% more), and in traffic accidents 24.1% compared to 21.7% (2.4% higher).

The percentage of suicides was higher in the medical population (mean: 1.3%) than the general population (mean: 0.8%). During the 10 years observed, the average remained stable in the general population. In contrast, among doctors, the percentage ranges from a minimum of 0.47% in 2007, to almost 2% in 2013.

When comparing by gender, female doctors have a suicide rate 7.5% higher than women in the general population.

By age groups, suicides among doctors are more frequent between 40 and 59 years, while among the general population the highest percentage was found between 30 and 39 years; and 37% of deaths due to suicide by doctors occurred between 50 and 59 years.

Profession at High Risk of Suicide

Dr Celso Arango, president of the Spanish Psychiatric Society, told Medscape Spanish Edition that "suicide rates are almost always lower than real suicides; they are attributed to other causes (for example, to accidents of someone who wants to commit suicide actively or cardiorespiratory failure, or voluntary poisoning)".

"The medical profession has several risk factors: great stress due to night shifts, making important life decisions for others, the work overload with its implicit important repercussions, the continuous contact with death, the access to lethal methods, etc. Therefore, in all countries, suicide rates among doctors are higher than those in the general population", added the psychiatrist.

Regarding what the doctors themselves can do to alleviate this problem, Dr Arango said: "As our wise saying goes: 'In the blacksmith’s house, there’s a wooden knife'. It is essential to accept help, and to eliminate the stigma that exists even within our profession, to create consultations for health professionals, as they already exist in many of Spain’s autonomous communities, with mental health professionals. Prevention is also essential; in that sense, Balint groups and the training of professionals in relaxation techniques have proven to be effective tools."

Shielding Against Alzheimer's Disease?

The data from this study reflect the increasing weight in the health system from mental disorders and neurodegenerative diseases, such as Alzheimer's disease, which is the 10th cause of death among the general population and the 24th among the medical population. An average of 1.6% (142) doctors have died from this disease, compared to 3.6% from the general population (2% lower among doctors).

On organic mental disorders, the ICD-10 considers a wide, varied and complex set of psychological and behavioural disorders that originate in loss or abnormality of brain tissue structure and/or function. In this period, 139 doctors died due to these causes, 1.6% versus 4.6% of the general population.

Life Expectancy 1 and 2 Years Higher

Life expectancy is the most widely used indicator to make comparisons on the incidence of mortality among different populations.

Life expectancy was 1 year higher in doctors (81 years), compared to men in the general population (80 years), and 2 years higher in female doctors (83 years), compared to women in the general population (81 years old).

Translated and adapted from Medscape's Spanish edition.

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