Comparison of Cardiovascular Risk Factors and Outcomes Among Practicing Physicians vs the General Population in Ontario, Canada | Cardiology | JAMA Network Open | JAMA Network
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    Original Investigation
    November 22, 2019

    Comparison of Cardiovascular Risk Factors and Outcomes Among Practicing Physicians vs the General Population in Ontario, Canada

    Author Affiliations
    • 1ICES, Toronto, Ontario, Canada
    • 2Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
    • 3Department of Medicine, University of Toronto, Toronto, Ontario, Canada
    • 4Bruyère Research Institute, Ottawa, Ontario, Canada
    • 5Departmentof Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
    • 6Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor
    • 7Women’s College Hospital, Toronto, Ontario, Canada
    • 8School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
    JAMA Netw Open. 2019;2(11):e1915983. doi:10.1001/jamanetworkopen.2019.15983
    Key Points español 中文 (chinese)

    Question  How do cardiovascular health outcomes of physicians compare with those of the general population?

    Findings  This cohort study of 17 071 practicing physicians and 5 306 038 members of the general population in Ontario found that physicians used fewer guideline-recommended preventive services and had lower rates of cardiac risk factors. At 8 years’ follow-up, physicians had a substantially lower risk of adverse outcomes than the general population, even after adjusting for differences in risk factors and health services.

    Meaning  Ontario physicians have better cardiovascular outcomes than the general population, and the difference in outcomes between physicians and nonphysicians was not fully explained by traditional cardiac risk factors.


    Importance  Although cardiovascular disease is the leading cause of death in most developed countries, little is known about current physicians’ cardiovascular health and outcomes.

    Objective  To compare cardiac risk factor burden, health services use, and major cardiovascular event incidence between physicians and the general population.

    Design, Setting, and Participants  This cohort study used data from practicing physicians and nonphysicians without cardiovascular disease aged 40 to 75 years in Ontario, Canada. Cohorts were assembled beginning January 1, 2008, and were followed up to December 31, 2015. Data analysis was performed between November 2017 and September 2019.

    Exposure  Being a practicing physician.

    Main Outcomes and Measures  The primary outcome was 8-year incidence of a major cardiovascular event (ie, cardiovascular death or hospitalization for myocardial infarction, stroke, heart failure, or coronary revascularization). Secondary outcomes included health services used, such as physician assessments and guideline-recommended tests.

    Results  The cohort comprised 17 071 physicians (mean [SD] age, 53.3 [8.8] years; 11 963 [70.1%] men) and 5 306 038 nonphysicians (mean [SD] age, 53.7 [9.5] years; 2 556 044 [48.2%] men). Physicians had significantly lower baseline rates of hypertension (16.9% vs 29.6%), diabetes (5.0% vs 11.3%), and smoking (13.1% vs 21.6%), while having better cholesterol profiles (total cholesterol levels >240 mg/dL, 13.3% vs 16.5%; low-density lipoprotein cholesterol >130 mg/dL, 33.2% vs 36.8%); age- and sex-adjusted differences were even larger. Physicians also had lower rates of periodic health examinations (58.9% [95% CI, 57.5%-60.4%] vs 67.9% [95% CI, 67.8%-67.9%]), hyperlipidemia screening (76.3% [95% CI, 74.7%-78.0%] vs 83.8% [95% CI, 83.7%-83.9%]), and diabetes screening (79.0% [95% CI, 77.3%-80.8%] vs 85.3% [95% CI, 85.2%-85.4%]), but higher rates of cardiologist consultations (25.2% [95% CI, 24.2%-26.3%] vs 19.5% [95% CI, 19.4%-19.5%]). The 8-year age- and sex-standardized primary outcome incidence was 4.4 major cardiovascular events per 1000 person-years for physicians and 7.1 major cardiovascular events per 1000 person-years for the general population. After adjusting for age, sex, socioeconomic status, and cardiac risks and comorbidities, physicians had a 22% lower hazard (hazard ratio, 0.78; 95% CI, 0.72-0.85) of experiencing the primary outcome compared with the general population.

    Conclusions and Relevance  Practicing physicians in Ontario had fewer cardiovascular risk factors, underwent less preventive testing, and were less likely to experience major adverse cardiovascular outcomes than the general population.