Corresponding author’s e-mail: dongfu@ms4.hinet

1. Determinants of Mortality among Physicians in Taiwan Tung-Fu Shang , Jung-Der Wang The specific potential hazards in medical work include stress, radiation, anesthetic gases or agents and other biologically hazardous blood or body fluids are concerned in many studies. Due to the adverse effects of such occupational exposures, several studies have described higher death rates in certain specialties. In the present study, we used the cohort data from the registry of the physician file maintained by the Taiwan Medical Association to identify predictors of mortality among physicians in Taiwan. Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health Background and Purpose Table 1. Characteristics of Taiwan physicians Included in the study from 1990 to 2006. Table 2. Cox regression model of factors associated with mortality rates among Taiwan physicians from 1990 to 2006. Materials and Methods 37,545 physicians who once registered in the database of TMA during January 1990 to December 2006 were enrolled for analysis. A multivariate mortality rate analysis was performed by the Cox’s proportional hazards regression which took survival and years of practice as the dependent variables, while factors like their specialties, gender, geographic region of practices, regional health resources, ages of initial practices, and years of initial practice were used as independent variables. Results During the above period, 1686 deaths were observed, with 1642 of the 32,713 male physicians and 44 of 4822 female physicians. There were 18,664 (49.7%) internists (4,571surgeons, 12.2%; 2,883 pediatricians, 7.7%). 18,046 (48.1%) and 15,632 (41.6%) physicians had practiced in the north region and high medical resource area, respectively (Table 1). The Cox regression analysis (Table 2) identified significant predictors for mortality included: working in the south region (HR 1.36 ), the east region (HR 1.59); the poor, low, medium medical resource area (HR 1.19, HR1.29, HR1.26 respectively) ; starting practice in older age, after the year of the implementation of NHIP (HR 5.53,HR 4.67 respectively); otolaryngologists (HR 0.68), ophthalmologists (HR 0.60), pediatricians (HR 0.69) and psychiatrists (HR 0.60).No significant difference was found between both genders in the mortality rate of Taiwan physician from 1990 to 2006.Except for pediatricians (HR 0.56), there were no significant differences in the mortality rates among different specialties when limited to physicians who practice in high medical resource area. aP<0.05 bP<0.01 cP<0.001 *Model 1 was conducted on all physicians in Taiwan. †Model 2 was conducted on only physicians in high medical resource area where is a municipal city with physician-population ratio ≧ 0.0015 and presence of medical center. Conclusions Baseline characteristics associated with increased death rate among Taiwan physicians include geographic region of practices, regional health resources, ages of initial practices, and years of initial practice. These results will be useful in planning and securing health human resources in Taiwan and many other countries which are with similar health care systems. Corresponding author’s e-mail: dongfu@ms4.hinet.net OMIH