In a recent research letter published in JAMA Internal Medicine, researchers evaluated excess coronavirus disease 2019 (COVID-19)-associated deaths between March 2020 and December 2021 among physicians in the United States (US).
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has caused unprecedented morbidity and mortality across the globe. The number of excess deaths is calculated by subtracting the estimated number of deaths from the total number of deaths in a particular period. Despite the key roles of physicians during the COVID-19 pandemic, data on excess mortality associated with SARS-CoV-2 infections among US physicians are limited.
About the study
In the present research letter, researchers estimated excess mortality among physicians due to the SARS-CoV-2 pandemic in the US.
American medical association (AMA) data, comprising the Masterfile and the deceased physicians’ file, were fit into quasi-Poisson-type models, considering long-term patterns, and annual seasonality, to evaluate month-wise COVID-19-associated deaths between January of 2016 and February of 2020 for US physicians aged between 45 years and 84 years.
The team annualized excess death estimates to excess COVID-19-associated deaths among every 100,000 individual-years. The study sample was analyzed by practice type and physician age. Sensitivity analyses were performed by fitting substitute model details. Excess COVID-19-associated deaths among US residents were also calculated to facilitate comparative assessments. Young physicians under 45 years were excluded from the analysis since they experienced less than five deaths monthly during the study period.
A total of 4,511.0 deaths were reported, with 622 excess deaths among US physicians, and the monthly average was 85,631 US physicians, among whom 65% were male, and 35% were female. In total, 43 COVID-19-associated excessive deaths were reported for every 100,000 individual-years. A sharp gradient was observed for active physician age providing direct care to patients, with excessive deaths of 10.0 and 182.0 for every 100,000 individual-years, among the youngest and oldest physicians, respectively.
Across ages, US physicians had considerably lower excessive deaths than the US population, and active US physicians had fewer excessive deaths than non-active physicians despite their greater risk of being infected with SARS-CoV-2.
Excess mortality was greatest among non-active US physicians for every 100,000 individual-years (n=140) than among active US physicians (n=27) extending direct support to patients and active physicians who did not provide direct care to patients (n=22). However, the excess death rate was much lesser than the excess death rate for the general public (n=294).
Among active US physicians, a peak in excess mortality with more than 70 deaths was observed in December of 2020 followed by a swift monotonic decline in the following year. No significant COVID-19-associated excess deaths were reported post-April of 2021, coinciding with the extensive accessibility of SARS-CoV-2 vaccines. Sensitivity analyses yielded similar results, indicative of the robustness of the main analysis findings.
The findings indicated that SARS-CoV-2 vaccinations, personal protective equipment usage, sufficient staffing, infection control strategies, and other COVID-19 mitigation measures effectively prevented excess deaths associated with SARS-CoV-2 infections. Additionally, the greater number of excess deaths among older-aged active US physicians who provided direct care to patients indicates that healthcare policies must prioritize COVID-19-associated mortality risk mitigation in the group.
Among physicians aged 45 to 64 years, excess deaths among those active physicians providing direct care, active physicians providing indirect care, and non-active physicians were 81, 13, and 11, respectively. The corresponding deaths among physicians aged between 65 and 74 years were 108, -8.0, and 91, respectively, and the corresponding excess deaths among those aged between 75 and 84 years were 85, 10, and 228, respectively.
Across ages, excess deaths among all active US physicians administering direct care to patients, among active physicians providing indirect patient care, and among non-active physicians were 285, 24, and 361, respectively. The corresponding values for the total number of COVID-19-associated deaths were 1805, 225, and 2481, respectively. The total number of deaths was the highest among non-active physicians aged between 45 years and 84 years (n=2,481), and lowest among active physicians not providing care to patients directly, aged between 45 years and 64 years (n=39).
Overall, the study findings highlighted excess mortality among US physicians during the COVID-19 pandemic and showed that healthcare strategies and policies implemented to prevent excessive mortality among US physicians are critical components of excess death mitigation in the general public.
The research letter had a few limitations. Anonymized physician mortality and COVID-19-associated changes in the workforce, such as the retirement of physicians at a younger age, could have led to mortality underestimations. In the initial COVID-19 wave, US-residing physicians had excessive deaths with elevated work stress and associated burnout. During resurges of the COVID-19 pandemic, the conditions could increase the hospital burden and cause excessive mortality among US residents.