Low mortality and myocardial infarction incidence among flying personnel during working career and beyond

Linnersjö, Anette; Brodin, Lars‐Åke; Andersson, Carin; Alfredsson, Lars; Hammar, Niklas

doi:10.5271/sjweh.3134

Cited by 15 publications

(18 citation statements)

References 21 publications

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“…Standardized incidence ratios (SIR) and standardized mortality ratios (SMR) for most ICD codes indicate signifi cantly lower mortality from cardiovascular disease ( 72 ), cirrhosis, most cancers, diabetes, suicide, AIDS, and " all causes " ( 5 , 10 , 90 ). In contrast, a small but signifi cant elevation of risk is observed for malignant melanoma and breast cancer.…”

Section: Methodsmentioning

confidence: 99%

The Occupational Health and Safety of Flight Attendants

Griffiths¹,

Powell²

2012

aviat space environ med

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In order to perform safety-critical roles in emergency situations, flight attendants should meet minimum health standards and not be impaired by factors such as fatigue. In addition, the unique occupational and environmental characteristics of flight attendant employment may have consequential occupational health and safety implications, including radiation exposure, cancer, mental ill-health, musculoskeletal injury, reproductive disorders, and symptoms from cabin air contamination. The respective roles of governments and employers in managing these are controversial. A structured literature review was undertaken to identify key themes for promoting a future agenda for flight attendant health and safety. Recommendations include breast cancer health promotion, implementation of Fatigue Risk Management Systems, standardization of data collection on radiation exposure and health outcomes, and more coordinated approaches to occupational health and safety risk management. Research is ongoing into cabin air contamination incidents, cancer, and fatigue as health and safety concerns. Concerns are raised that statutory medical certification for flight attendants will not benefit either flight safety or occupational health.

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Section: Methodsmentioning

confidence: 99%

The Occupational Health and Safety of Flight Attendants

Griffiths¹,

Powell²

2012

aviat space environ med

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“…(52,53) The changes in developments seen in the older pilots in our sample may therefore simply reflect these trends. On the other hand, given that abnormal cardiovascular risk factor levels during aeromedical examinations usually lead to further diagnostic measures and in some cases to license revocations or restrictions (particularly, a requirement to fly multipilot only), a "healthy worker survivor" selection process (25,54) may also contribute to the beneficial changes observed in the older pilots.…”

Section: Discussionmentioning

confidence: 99%

“…(55) Overall incidence is a more relevant outcome concerning flight safety than fatal event incidence, which underestimates the expected number of pilot incapacitations. On the other hand, available cardiovascular risk scores are calibrated to the general population, where incidence is higher than in professional pilots, (25,56) so that these biases tend to cancel each other out. (57) We chose SCORE as it allowed estimation of six-month risks instead of the usual 10-year risks, thus giving a more realistic approximation of the actual risk of cardiovascular incapacitation during the certificate validity period.…”

Section: Discussionmentioning

confidence: 99%

“…(24) Furthermore, applicability of findings in the general population might be restricted for professional pilots, who are tightly monitored and display a markedly lower cardiovascular morbidity and mortality, with age-standardized mortality ratios relative to the general population usually at or below 0.5. (25,26) The only available systematic review on age and medical-cause incapacitation in professional pilots indicated an age-related increase; however, only one of the reviewed studies included active pilots aged 60 and over, and found no adverse events in this group. (27)…”

Section: Occupational Old-age Limits As a Regulatory Risk Management mentioning

confidence: 99%

“…Although the argument seems plausible at first glance due to the well‐established age‐related increase of cardiometabolic risk in the general population, the choice of the age threshold is essentially arbitrary—at the population level, cardiometabolic risk markers and cardiovascular mortality start to increase well before age 60; for example, the 2015 Global Burden of Disease study estimated the annual cardiovascular mortality in the United States at 71, 124, 194, and 287 per 100,000 persons at ages 45–49, 50–54, 55–59, and 60–64, respectively . Furthermore, applicability of findings in the general population might be restricted for professional pilots, who are tightly monitored and display a markedly lower cardiovascular morbidity and mortality, with age‐standardized mortality ratios relative to the general population usually at or below 0.5 . The only available systematic review on age and medical‐cause incapacitation in professional pilots indicated an age‐related increase; however, only one of the reviewed studies included active pilots aged 60 and over, and found no adverse events in this group …”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Aging and Cardiometabolic Risk in European HEMS Pilots: An Assessment of Occupational Old‐Age Limits as a Regulatory Risk Management Strategy

2017

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Old-age limits are imposed in some occupations in an effort to ensure public safety. In aviation, the "Age 60 Rule" limits permissible flight operations conducted by pilots aged 60 and over. Using a retrospective cohort design, we assessed this rule's validity by comparing age-related change rates of cardiometabolic incapacitation risk markers in European helicopter emergency medical service (HEMS) pilots near age 60 with those in younger pilots. Specifically, individual clinical, laboratory, and electrocardiogram (ECG)-based risk markers and an overall cardiovascular event risk score were determined from aeromedical examination records of 66 German, Austrian, Polish, and Czech HEMS pilots (average follow-up 8.52 years). Risk marker change rates were assessed using linear mixed models and generalized additive models. Body mass index increases over time were slower in pilots near age 60 compared to younger pilots, and fasting glucose levels increased only in the latter. Whereas the lipid profile remained unchanged in the latter, it improved in the former. An ECG-based arrhythmia risk marker increased in younger pilots, which persisted in the older pilots. Six-month risk of a fatal cardiovascular event (in or out of cockpit) was estimated between 0% and 0.3%. Between 41% and 95% of risk marker variability was due to unexplained time-stable between-person differences. To conclude, the cardiometabolic risk marker profile of HEMS pilots appears to improve over time in pilots near age 60, compared to younger pilots. Given large stable interindividual differences, we recommend individualized risk assessment of HEMS pilots near age 60 instead of general grounding.

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