Evidence Matters

To What Extent Did COVID-19 Contribute to Physician Mortality in the US?

BACKGROUND AND PURPOSE:

COVID-19 has resulted in over 1 million excess deaths, but little is known about excess deaths among physicians
Kiang et al. (JAMA Internal Medicine, 2023) calculated excess deaths among US physicians from March 2020 through December 2021

Excess mortality analysis
- AMA Masterfile and corresponding Deceased Physician File
Data source
- Deaths of physicians aged 45 to 84 years
Exposures
- Pre-pandemic: 2016 through early 2020
- Pandemic: 2020 through 2021
Study design
- Models were used to estimate monthly mortality pre-pandemic, accounting for within-year seasonality and long-term trends
- A counterfactual model was used to estimate expected deaths during the pandemic
- Excess deaths were calculated as the difference between observed and expected deaths, per 100,000 person-years
Primary outcome
- Excess mortality among US physicians during the COVID-19 pandemic

Physician deaths during the pandemic: 4511
Excess deaths: 43 per 100,000 person years (95% CI, 33 to 53)
There was a strong age gradient among active physicians providing direct patient care
- Youngest group of physicians: 10 per 100,000 person-years (95% CI, 3 to 17)
- Oldest group of physicians: 182 per 100,000 person-years (95% CI, 98 to 267)
Within all age groups, physicians had substantially lower excess mortality than the general population
- Nonactive physicians had the highest excess deaths: 140 per 100,000 person-years (95% CI, 100 to 181)
- This was still substantially lower than the excess mortality rate of the general public: 294 per 100,000 person-years (95% CI, 292 to 296)
Excess deaths peaked in December 2020 and then had a rapid monotonic decrease in 2021
There was no statistically significant excess mortality after April 2021

Excess mortality among US physicians during the COVID-19 pandemic was 622 deaths
There were no excess physician deaths after April 2021
Physicians experienced less excess mortality than the general public across all age groups
The group of physicians that experienced the highest level of increased mortality was older physicians providing direct patient care