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Do Physicians Have Lower Risk of Severe Sepsis and Associated Mortality? A Matched Cohort Study*

Shen, Hsiu-Nien MD1,2; Lu, Chin-Li MS2,3; Li, Chung-Yi PhD2,4

doi: 10.1097/CCM.0000000000000033
Clinical Investigations

Objectives: Physicians generally have higher disease awareness and easier access to medical care, which may help them reduce risk of developing severe sepsis and associated mortality when they suffer from acute infection. However, the opposite situation may occur due to the presence of potential barriers to healthcare in physicians. We aim to examine the risk of severe sepsis and associated mortality in physicians.

Design: A matched cohort study.

Setting: Registry of medical professionals and inpatient and outpatient claims data from Taiwan’s National Health Insurance Research Database.

Subjects: Physicians (n = 29,697) in Taiwan and a group of persons who were demographically and socioeconomically matched (1:1 ratio) and without any medical education and background. All subjects were followed from the index date (January 1, 2000) to the occurrence of endpoint, withdrawal, or December 31, 2008, whichever date came first.

Interventions: None.

Measurements and Main Results: Primary outcome was development of severe sepsis. Secondary outcome was 90-day mortality following severe sepsis. The overall incidence density of severe sepsis was lower in physicians than in controls (3.25 vs 3.90 per 1,000 person-years, p < 0.001). According to the Cox regression model, severe sepsis develops in physicians 24% less likely than controls after baseline covariates were adjusted (adjusted hazard ratio, 0.76; 95% CI, 0.68–0.85). The 90-day mortality rates were similar between physicians and controls with severe sepsis (46.5% vs 45.7%, p = 0.72). However, after controlling for the baseline and additional covariates, the risk of death was significantly lower in physicians than in controls (adjusted hazard ratio, 0.82; 95% CI, 0.71–0.95).

Conclusions: These findings support the hypothesis that physicians are less likely than controls to develop or die of severe sepsis, implying that medical knowledge, higher disease awareness, and easier healthcare access in physicians may help reduce their risk of severe sepsis and associated mortality.

1Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.

2Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

3Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan.

4Department of Public Health, China Medical University, Taichung, Taiwan.

* See also p. 981.

This study was done in Chi Mei Medical Center.

Dr. Shen received grant support, support for travel, and support for article research from the Chi Mei Medical Center (CMFHR10182). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins