The suicide mortality of working physicians and dentists.

BACKGROUND: Some studies have shown that physicians and dentists have elevated risks of suicide, while other studies have not. AIMS: Using all deaths and corresponding census data in 26 US states, we examine the suicide risk for working physicians and dentists. METHODS: Death and census data for working people were obtained from 1984 through 1992. Directly age-standardized suicide rate ratios (SRRs) were calculated for white male and white female physicians and white male dentists. RESULTS: For white female physicians, the suicide rate was elevated compared to the working US population (SRR = 2.39, 95% CI = 1.52-3.77). For white male physicians and dentists, the overall suicide rates were reduced (SRR = 0.80, 95% CI = 0.53-1.20 and 0.68, 95% CI = 0.52-0.89, respectively). For older white male physicians and dentists, however, observed suicide rates were elevated. CONCLUSIONS: White female physicians have an elevated suicide rate. Only older white male physicians and dentists have elevated suicide rates, which partially explains the varied conclusions in the literature.

Truck drivers and heart disease in the United States, 1979-1990.

BACKGROUND: Studies of truck drivers and cardiovascular disease (CVD), myocardial infarction, or ischemic heart disease (IHD) are limited, although studies of other professional drivers reported increased risk. METHODS: US mortality data from 1979 to 1990 for ages 15-90 were used to calculate proportional mortality ratios (PMRs) for heart disease and lung cancer for short and long haul truck drivers. Analysis was performed for Black (998 short haul and 13,241 long haul) truck drivers and White (4,929 short and 74,315 long haul) truck drivers separately. RESULTS: The highest significantly elevated proportionate heart disease (IHD, acute myocardial infarction (AMI), and other forms of heart disease) and lung cancer mortality was found for White and Black male long haul truck drivers age 15-54. Mortality was not significantly elevated for short haul truck drivers of either race or gender, nor for truck drivers who died after age 65, except for lung cancer among White males. An indirect adjustment suggested that smoking could explain the excess IHD mortality, but no direct data for smoking or the other known risk factors for heart disease were available and occupational exposures were not measured. CONCLUSIONS: The highest significant excess proportionate mortality for lung cancer, IHD and AMI was found for long haul truck drivers who were under age 55 at death. A cohort or longitudinal study of heart disease among long haul truck drivers, that obtains data for occupational exposures as well as lifestyle risk factors, could help explain inconsistencies between the findings of this and previous studies.

Proportionate mortality of crop and livestock farmers in the United States, 1984-1993.

BACKGROUND: Livestock farmers are more likely to be exposed to a variety of different farming hazards than crop farmers. An analysis of occupation and industry-coded U.S. death certificate data from 26 states for the years 1984-1993 was conducted to evaluate mortality patterns among crop and livestock farmers. METHODS: Cause-specific proportionate mortality ratios (PMRs) were calculated using a National Institute for Occupational Safety and Health (NIOSH) computer program designed to calculate sex and race specific PMRs for occupations and industries in population-based data. RESULTS: Among white male (WM) livestock farmers, there was a significantly higher mortality from cancer of the pancreas, prostate and brain, non-Hodgkin's lymphoma (NHL), multiple myeloma, acute and chronic lymphoid leukemia, and Parkinson's disease. WM crop farmers showed significantly higher mortality risk for cancer of the lip, skin, multiple myeloma, and chronic lymphoid leukemia. CONCLUSIONS: These disease trends suggested that livestock farmers might be exposed to more carcinogens or agricultural chemicals than crop farmers.

The recording of demographic information on death certificates: a national survey of funeral directors.

OBJECTIVE: The authors sought to ascertain the methods used by funeral directors to determine the demographic information recorded on death certificates. METHODS: Standardized questionnaires were administered to funeral directors in five urban locations in the U.S. In addition, personnel on four Indian reservations were interviewed. Study sites were selected for diverse racial/ethnic populations and variability in recording practices; funeral homes were selected by stratified random sampling. RESULTS: Fifty-two percent of responding funeral directors reported receiving no formal training in death certification. Seventy-nine percent of respondents reported finding certain demographic items difficult to complete--26% first specified race as the problematic item, and 25% first specified education. The decedent's race was "sometimes" or "often" determined through personal knowledge of the family by 58% of respondents; 43% reported "sometimes" or "often" determining race by observation. Only three respondents reported that occupation was a problematic item. CONCLUSIONS: The authors recommend that the importance of demographic data and the instructions for data collection be clarified for funeral directors, that standard data collection worksheets be developed, and that training videos be developed.