Lower Excess Mortality Seen for Physicians vs General Public During COVID Pandemic

Physicians had substantially lower excess mortality compared with the general population during the COVID-19 pandemic, researchers found.

From March 2020 through December 2021, there were 4,511 deaths among a monthly mean of 785,631 physicians ages 45 to 84, representing 622 more deaths than expected (95% CI 476-769), reported Mathew Kiang, ScD, MPH, of Stanford University School of Medicine in California, and colleagues.

Among physicians, there were 43 (95% CI 33-53) excess deaths per 100,000 person-years, while the excess mortality rate in the general population was 294 (95% CI 292-296), they noted in a research letter published in JAMA Internal Medicine.

There was a "strong age gradient" among active physicians who provided direct patient care, with excess deaths per 100,000 person-years of 10 (95% CI 3-17) in the youngest group and 182 (95% CI 98-267) in the oldest group, they said.

Nonactive physicians had the highest excess deaths per 100,000 person-years, at 140, versus active physicians who provided direct patient care (27) and active physicians who did not provide direct patient care (22).

"Despite physicians being at a much higher risk of contracting COVID-19, they experienced much lower excess mortality than the general population," Kiang told MedPage Today. "Obviously, some of this is due to higher income, access to care, and other socioeconomic factors, but it's also likely much of this protection came from workplace policies," such as use of personal protective equipment, vaccination requirements, infection prevention protocols, adequate staffing, and other protective measures.

"Understanding how this workforce was impacted will hopefully better prepare us for future epidemics," he added. "COVID-19 won't be the last epidemic, and a better understanding of how we can protect healthcare professionals is pivotal to also protecting the general population," since, as he and his colleagues noted, conditions during COVID surges may strain hospitals, likely resulting in excess deaths in the general population.

Among all active physicians, excess deaths peaked at more than 70 in December 2020 "and then had a rapid monotonic decrease in 2021," Kiang and colleagues wrote. There was no statistically significant excess mortality in physicians after April 2021, which coincided with COVID vaccines becoming widely available, they noted.

"Increased excess deaths among older active physicians providing direct patient care suggest that workplace policies should prioritize mitigating risk in this group," they added.

For this study, Kiang and colleagues used the American Medical Association (AMA) Masterfile and corresponding Deceased Physician File to estimate monthly mortality rates from January 2016 through February 2020 and from March 2020 through December 2021 for physicians ages 45 to 84 (65.3% men) and calculated differences between observed and expected deaths to identify excess deaths. They excluded younger physicians because they experienced fewer than five deaths per month during the study period.

Limitations to the study included unidentified physician deaths and pandemic-related workforce changes (e.g., early retirement among older physicians), which likely resulted in underestimation of mortality, Kiang and colleagues noted.

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