Mortality of medical practitioners in Japan: social class and the "healthy worker effect"

To assess patterns of mortality in Japanese medical practitioners, we compared the mortality of male physicians in a Japanese prefecture with that of eight major working populations, the nonworking population, and the general population of all Japan and of the prefecture. Standardized mortality ratios were calculated. All-causes mortality in medical practitioners aged 25-64 years was significantly higher than that of administrative and managing workers (standardized mortality ratio [SMR] = 228); it was significantly lower than that of the nonworking population (SMR = 23). Physicians were found to have higher cause-specific mortality for pneumonia and bronchitis and for ischemic heart disease than the total working population. These findings suggest that the previously reported low mortality of physicians reflects principally their high socioeconomic status; within the professional class, the mortality of medical practitioners compares unfavorably with that of other persons.