Physicians enjoy lower mortality rates despite rampant racial, gender inequities

Key takeaways:

• Physicians had the lowest mortality rate among other health care workers and all non-health care workers.
• However, the data also indicated significant mortality inequities among women and diverse groups.

Most health care workers, particularly physicians, had a lower mortality rate compared with the general population, an analysis published in JAMA Internal Medicine revealed.

This benefit was not present among women and diverse groups, however, with the results showing “the broader effect of structural racism and sexism in society at large,” the researchers wrote.

Past research has suggested that physicians possess longer life spans, but such analyses “largely predated the 21st century and had several limitations,” according to Vishal R. Patel, MD, MPH, from Harvard Medical School, and colleagues.

Factors like record-high levels of stress and burnout and impacts from the COVID-19 pandemic “may be associated with the health of physicians and other health care workers, warranting an updated, large-scale evaluation of their mortality, they added.

In the cross-sectional study, the researchers assessed mortality rates among eight types of health care and non-health care occupations using death certificate data, taken from the National Vital Statistics System from 2020 to 2022. The study sample included adults aged 25 to 74 years (n = 3,606,791).

Researchers evaluated overall and cause-specific mortality rates for each occupation and by sex, race and ethnicity.

Most health care workers had a lower rate of mortality vs. non-health care workers. For example, the analysis showed age- and sex-adjusted annual mortality rates per 100,000 people of:

• 269.3 for physicians (of whom had the lowest mortality rate among all health care workers);
• 499.2 for high-income non-health care workers; and
• 730.6 for all non-health care workers.

Physicians had substantially lower rates for all causes of death vs. non-health care workers except for suicide and Parkinson’s disease.

The researchers pointed out that although women had a lower mortality rate vs. men among all non-health care occupations (female-to-male morality rate ratio [MRR] = 0.55; 95% CI, 0.55-0.55) and high-income non-health care occupations (MRR = 0.6; 95% CI, 0.6-0.6), they did not observe this difference for some health care occupations, including physicians.

Instead, female physicians experienced higher mortality related to neoplasms (MRR = 1.45; 95% CI, 1.36-1.54) and chronic lower respiratory diseases (MRR = 2.75; 95% CI, 1.67-3.84) compared with male physicians, despite women in high-income non-health care occupations dying less frequently from these two causes vs. their male counterparts.

Patel and colleagues also pointed out that the Black to white MRR (2.13; 95% CI, 1.99-2.29) and Hispanic to white MRR (1.18; 95% CI, 1.09-1.27) was higher for physicians than lawyers, scientists, engineers, high-income non-health care workers and non-health care workers overall.

Heart disease, neoplasms and COVID-19 contributed to the largest differences in the Black to white MRR among physicians and were more pronounced in women (2.23; 95% CI, 2-2.5) vs. men (2.08; 95% CI, 1.9-2.27) physicians.

The causes of the observed inequities “are likely multifaceted,” the researchers wrote.

“One associated factor may be the disproportionate health effects of the medical profession on female practitioners,” they added. “Workplace stress and exposure have been implicated as reasons for higher cancer incidence, poor birth outcomes, and depression among female physicians.”

Factors tied to systematic biases, demanding work hours and policies of exclusion may also contribute to the findings.

Patel and colleagues concluded that the mortality inequities seen among physicians, “whose health care knowledge, financial resources, and access to medical care, on average, exceeds that of the general population,” necessitate further research.