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Disparities in mortality among doctors in Taiwan: a 17-year follow-up study of 37 545 doctors
  1. Tung-Fu Shang1,
  2. Pau-Chung Chen2,
  3. Jung-Der Wang2,3
  1. 1Bureau of International Cooperation, Department of Health, Executive Yuan, Taipei City, Taiwan
  2. 2Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei City, Taiwan
  3. 3Department of Public Health, National Cheng Kung University College of Medicine and Hospital, Tainan, Taiwan
  1. Correspondence to Dr Jung-Der Wang; jdwang121{at}


Objectives The authors used cohort data from the registry of all doctors in Taiwan to determine if the effect of health disparities exists after control of potential confounding by different occupational exposures in different specialties.

Design Retrospective cohort study, 1990–2006.

Settings The Taiwan Medical Association.

Participants A total of 37 545 doctors from the registry of the doctor file maintained by the Taiwan Medical Association. The registry has been required by the governmental regulation for verification of credentials of all practicing doctors.

Main outcome measures Cause-specific standardised mortality ratios for surgeons and anaesthesiologists were compared with those of the internists. The Cox proportional hazard model was constructed to explore multiple risk factors for mortality, including specialties, age, gender, geographic region of practices, regional health resources, ages of beginning practices and years of beginning practice.

Results The all-cause-specific standardised mortality ratios for surgeons and anaesthesiologists were marginally elevated at 1.15 (95% CI 0.98 to 1.34) and 1.62 (95% CI 0.93 to 2.64), respectively. The Cox regression model showed that the anaesthesiologists had the highest HR of 1.97, seconded by surgeons at 1.23. Localities with the doctor-to-population ratio lower than 1:500 were associated with an increased HR of doctor mortality.

Conclusions The doctor-to-population ratio and the region of practice may influence doctor's mortality. Increasing number of doctors and/or improving the practice environment may be helpful in reducing the health disparities in regions with poor resources.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Shang T-F, Chen P-C, Wang J-D. Disparities in mortality among doctors in Taiwan: a 17-year follow-up study of 37 545 doctors. BMJ Open 2012;2:e000382. doi:10.1136/bmjopen-2011-000382

  • Contributors T-FS has acquired the data set, designed the study together with J-DW (the corresponding author), conducted the analysis under the full supervision and discussion with P-CC and J-DW, written the first draft and all three participated in the revision of the later drafts until the final one. T-FS has access to all the data in the study and takes responsibility for the integrity of the data. Together with all co-authors, we shall be responsible for the accuracy of the data analysis and interpretation of the results.

  • Funding The study was partially supported by a grant from the National Science Council of the Executive Yuan, Taiwan (No. NSC 99-2628-B-006-036-MY3). The sponsors had no role in the study design, data collection, data analyses, the interpretation of data, the writing of the report or the decision to submit the article for publication.

  • Competing interests None.

  • Ethics approval The ethics review board of our institute (Institute of Occupational Medicine and Industrial Hygiene College of Public Health, National Taiwan University, Taiwan) approved the protocol before the commencement of this study.

  • Data sharing statement We are willing to share our data in an open repository.

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