Morbidity among airline pilots: the AMAS experience. Aviation Medicine Advisory Service

Various cohort studies, military databases, and Federal Aviation Administration databases have characterized morbidity and disability in pilots. However, an overriding limitation of these studies is acquiring complete and accurate medical information from pilots with a profession, hobby, or aircraft investment to protect (6). The unique role of Aviation Medicine Advisory Service (AMAS) as pure pilot advocate with guaranteed patient confidentiality eliminates the aviator's need to conceal medical problems. Therefore, analyses of cases reported to AMAS might provide additional insight regarding the true prevalence of morbidity in airline pilots.

All AMAS cases of airline pilots and flight engineers from January 1996 through November 1999 were reviewed (n = 20,522). During that time, AMAS provided consultation to approximately 51 U.S. and Canadian airlines. Diagnoses were stratified by decades ranging from 20 to 69 yr of age.

Notably, the five conditions most frequently inquired about at AMAS were similar to the major causes of long term disability found in a cohort of Air Canada pilots (5). Cardiovascular conditions accounted for almost 25% of the inquiries. However, the relative percentage especially in the older population was less than that reported previously. Interestingly, orthopedic and musculoskeletal cases (10-11%) rated second only to cardiovascular cases.

These findings are limited by the inability to draw an exact reference population at risk, the use of proportional measures for description and the inherent difficulty in attempting to utilize an administrative index as an epidemiological tool. Further study addressing the impact of aviator nondisclosure of medical problems on the reported prevalence of disease among U.S. airline pilots may help target preventive efforts in the future.