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The substantial decrease in abdominal pathology between the 1965 and
1980 prevalence studies is largely due to the fact that only current hernia
conditions were included in the present study, and less importantly due to
a decrease in the prevalence of uncomplicated ulcers from 1965 to 1980.

SUMMARY

Health findings in the active airman population are generally consistent
with those that might be expected in the general U.S. population, except
scaled to reflect lower prevalence due to prescreening and other problems
associated with accurate reporting of symptoms and history by pilots.

Eye disease is the most common problem among pilots with some 42 percent
of all airmen requiring lens correction for some visual deficiency.

Cardiovascular diseases are next in frequency of occurrence among
active airmen. As expected, hypertension is the greatest contributor to
cardiovascular disease prevalence.

Abdominal disease prevalence is third in total body system importance,
Major contributors to the category include current hernia conditions,
history of kidney stones, and uncomplicated ulcers.

Overall, disease prevalence is greater among currently certified
airmen than among previous groups studied, This increase in prevalence is
probably a reflection of more liberal standards more than any other single
factor. Through the years the trend has been toward relaxation of medical
standards where possible when not resulting in a compromise of air safety.

The greater prevalence of disease observed among general aviation
pilots compared to professional pilots likely reflects the impact of
stricter standards and examination for professional pilots with some
greater masking of disease and history among the professional pilots
suspected.

Further civil aviation research priorities should consider common
medical problems of airmen in an effort to elucidate possible health and
flight environment interactions which could result in safety hazards.


Major body system prevalence rates for neuropsychiatric and bone and
joint diseases are approximately equal at 11.5 per 1,000 airmen. Within
these systems no single disease entity makes a contribution significant
enough to deserve separate mention. Both major body systems contain 30 to
40 distinct disease categories, with each making minor contributions totaling
the approximate 11.5 per 1,000 rate for themajor body system.

The "miscellaneous" category of disease includes endocrinopathies, skin
diseases, drug usage by type, allergies, tropical diseases, and general
systemic conditions, Nearly half of all disease observed in this category
was “hay fever." Other major contributors to this category included anti-
histamine drug usage, asthma, and diabetes controlled by diet.

The most prevalent diseases observed among active airmen are presented
in Table II, Diseases found to increase with age include hypertension,
hernia, blindness or absence of an eye, defective hearing, history of neo-
plasm, limitation of motion, peripheral vascular disease, arthritis, and
diabetes controlled by diet. Diseases demonstrating a trend of decrease
with age included contact lens use, hay fever, asthma, and disturbance of
consciousness. Heart murmurs were most common among young and older ages
with lower prevalence among the middle ages. History of kidney stones and
prevalence of uncomplicated ulcers appear to increase with age through the
middle ages and decrease among older ages.

These age/disease findings are consistent with expectation except for
the decreasing prevalence of hay fever with age, which may be due to
underreporting.

Disease is most prevalent among third class (general aviation) airmen
and least prevalent among class one airmen (professional pilots). Since
the professional pilot undergoes a more thorough and rigid examination and
is subjected to stricter standards by the FAA as well as employers, one
must assume that these results reflect the effects of more thorough early
screening out of problem medical cases which results in less subsequent
disease among the remaining group, or that medical history (which would
lead to disease detection) is being masked to a greater extent among the
professional category pilots. Certainly the incentive is great, both
monetary and otherwise, for the latter hypothesis.

The prevalence findings of this study and previous research efforts
involving the airman pupulation or segments thereof are generally similar
with respect to major body systems presenting the highest prevalence rates;
i.e., eye, cardiovascular, and abdominal (1,2). However, as seen in
Figure 2, prevalence rates are higher than those in previous studies for
most major body systems partially due to the fact that prevalence, by
definition, is an accumulation of disease at a point in time and would be
greater in a given population at successive measurements for nonlethal
diseases. The second consideration with regard to increased prevalence rates
surely has to do with the fact that medical requirements have been relaxed
over recent years to allow airmen to continue flying with various medical
problems not previously acceptable.


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Rates per 1,000 Airmen

Eve 19.4
y 77, SLA SILL. Zn 48.9
7.5
ENT a 7.2
4.0
Respiratory 2.3
14.9
Cardiovascular 36.6
Abdominal 7] 57.0
(G.1.,G.U,, etc.) LZ 26.5
Neuropsychlatric nin
B id Joint 14-5
ones and Joints 1.4
Muscles J ne
Miscellaneous 15.3
(Endocrinopathies, 40.8

Drugs, etc.)

19652) 1980

Fig. 2. Comparison of disease prevalence among airmen by
by body system, 1965 versus 1980.



Technical Report Documentation Page

1, Report No, 2. Government Accession No. 3. Recipient's Catalog Ne.
FAA-AM-81~9
4. Title and Subtitle 5. Report Date
PREVALENCE OF SELECTED PATHOLOGY AMONG CURRENTLY April 1961
CERTIFIED ACTIVE AIRMEN 6. Performing Organization Code
8. Performing Organization Report No.
7. Author! s)
F. Booze, Jr
9. Performing Orgenization Name and Address 10. Work Unit No. (TRAIS)
FAA Civil Aeromedical Institute
P.O. Box 25082 TI. Contract or Grant No.

Oklahoma City, Oklahoma 73125

13. Type of Report ond Period Covered

12. Sponsoring Agency Name and Address
Office of Aviation Medicine
Federal Aviation Administration
800 Independence Avenue, S.W. 14. Sponsoring Agency Code

Washington, D.C. 20591
15, Supplementary Notes

16. Abstract

It has been the policy of the Federal Aviation Administration to medically certify
individuals, for a variety of flying privileges, who also have medical deficiency
or disease, provided it can be determined that such action does not compromise
air safety, During recent years, for example, standards have been relaxed with
respect to contact lens use and medication allowed for control of hypertension.

This descriptive epidemiologic study presents the point prevalence of pathology
among active airmen as of January 1, 1980, by major body system and for other
selected pathologies of interest within the major body systems. Data were
obtained from active computer files maintained by the Aeromedical Certification
Branch of the Civil Aeromedical Institute in connection with the certification
program. Some 350,701 (42%) active airmen require correction for some visual
deficiency. Of this total, 20,058 are contact lens wearers. After eye pathology,
cardiovascular and abdominal pathology represent the most prevalent medical
conditions among active airmen (3.7% and 2.6% respectively).

Overall, disease prevalence is greater among currently certified airmen than
among previous groups studied. This increase in prevalence is probably a
reflection of more liberal standards more than any other single factor.

17. Key Words 18. Distribution Statement
Airman Certification (Medical) ~ Document is available to the public
Disease, Prevalence and Incidence through the National Technical

Information Service, Springfield,
Virginia 22161

19. Security Classif. (of this report) 2%. Security Classif. (of this page) 21. No. of Pages | 22. Price

Unclassified Unclassified 10

Form DOT F 1700.7 (8-72)

Reproduction of completed page authorized


REFERENCES

Booze, C., 1973.
medically certified during 1965.
Report No. AM-73-8.

Booze, C., 1979.
1967-77.

Prevalence and incidence of disease among airmen

FAA Office of Aviation Medicine

Morbidity experience of air traffic control personnel -
Aviation, Space, and Environmental Medicine, 50(1):1-8.

PAA Prevalence of selected
AM patholo among certi-
= ‘ied active airmen.

81-9

FAA Prevalence of selected

AM pathology among

81-9 « currently certified

active airmen.
DATE af ISSUEP TO :
a —s

Kobo! 5. (bgpety

Paes O3/--B33

SS 28

- i Kewur x Vy

10

%& U. 8, GOVERNMENT PRINTING OFFICE ; 1981 342-428/ 1207


| Rates per 1,000 Airmen
y
34.6
46.6
Eye Li C44 22222. 54.0

ENT

Respiratory

Cardiovascular

Abdominai ees] 7.1
(G.1., G.U., ete.) 375
9.0
Neuropsychiatric 11.8
12.6
7.5 @ ist Class
Bones and Joints 12-0 0 2nd class

0.8 3rd Class
Muscles H
Miscellaneous
( Endocrinopathies,
Drugs, etc.)

6 37.7
47.1

Fig. 1. Disease prevalence among active airmen by body system

and class of medical certificate.


are likely to be denied medical certification and would not become eligible
for study. These data do, however, indicate the relative importance of
various diseases among airmen, even though conservative in some instances,
and provide insight concerning potential health problem interaction with
the aviation environment. Since general literature prevalence data are
limited with respect to some of the diseases reported on in this study,
some further benefit is expected in that regard.

RESULTS AND DISCUSSION

Reference to TablesI and II indicates that eye diseases are the most
prevalent medical problems among active airmen. While representing a serious
threat to air safety if not recognized and treated by adequate correction,
most eye pathology is relatively innocuous. Of the 827,592 active airmen as
of January 1,.1980, some 42 percent (350,701) required lens correction for
some visual deficiency, Of this total, 20,058 are contact lens wearers.
Additionally, 5,156 airmen are certified to fly with blindness or absence
of an eye (which includes visual acuity worse than 20/200 uncorrected in
either eye). Serious incapacitation during flight is possible should
corrective lenses become dislocated and temporarily unavailable during a
critical phase of flight, Considerable research effort has been and will
continue to be devoted to this important area of potentially health-related
pilot dysfunction,

Diseases of the cardiovascular system are the next most frequently
observed diseases among active airmen. As expected, hypertension is the
greatest contributor to the total prevalence rate. However, as may be seen
in Table Il, the prevalence of hypertension is only a fraction of that which
would be expected in an unscreened population. The low prevalence of hyper-
tension in this population is due to higher than usual upper limit cutoffs
for assignment of a hypertensive diagnosis among airmen (170/100 for appli-
cants for second- and third-class certification, and only slightly more
stringent for class one applicants). More severe hypertensive airman appli-
cants are also excluded from this population due to the type or dosage of
medication required for control, Mild diuretics without other derivatives
and some beta-blockers in low dosage are currently allowed for hypertension
control, Clearly this excludes many hypertensive applicants requiring
larger doses or combination of drugs for effective control.

Heart murmurs, including functional or physiologic murmurs, account
for over 20 percent of all heart diseases observed to exist among active
airmen,

Prevalence of abdominal diseases is third in total body system impor-
tance, Specific disesases making major contributions include current
hernias, history of kidney stones, and uncomplicated ulcers,


Federal Aviation Regulations, Part 67, specify that a medical certificate
will be denied if an applicant has an established medical history or clinical
diagnosis of any of the following conditions.

1. <A personality disorder that is severe enough to have repeatedly
manifested itself by overt acts.

2. A psychosis.

3, Alcoholism.

4. Drug dependence.

5. Epilepsy.

6. Disturbance of consciousness without satisfactory medical explanation
of the cause.

7. Myocardial infarction,

8. Angina pectoris or other evidence of coronary disease.

9. Diabetes mellitus, requiring insulin or other hypoglycemic drug
for control,

However, certification is possible despite the existence of one of the
above disqualifying medical conditions if exemption from the regulations is
granted after extensive medical review by FAA and consultant specialists.
The primary considerations in such exemption cases are history, prognosis,
and potential risk of sudden incapacitation. It is appropriate to note,
however, that airmen with disqualifying conditions are issued medical
certificates with special medical and operational restrictions that allow
for control of risk.

Automated medical record files maintained by the Aeromedical Certifi-
cation Branch provided the source data for the study, The files utilized
contain only the most recent application for medical certification from an
airman within the past 3 years. Pathology detected by previous medical
examinations is brought forward to the current automated medical file in
order to maintain as complete a history as possible. While this file
contains records for a total of 3 years, a medically certified airman is
considered "active" for a maximum of 24 calendar months following his or
her most recent FAA medical examination; i.e., regardless of the class of
medical certificate originally issued, it is valid for third class airman
purposes for a period of time up to 24 calendar months unless otherwise
limited or recalled by the FAA,

Prevalence data were automatically produced from the automated files
described above. Prevalence data in this population are expected to be
somewhat conservative since problems have been experienced in the acqui-

- sition of complete and accurate histories from pilots with a job, hobby,
or aircraft investment to protect,

Prevalence data are obviously a function of incidence and duration of
diseases; therefore, one would not expect the more immediately lethal
diseases to be represented to the same extent as less serious diseases of
longer duration, Additionally, airmen with more serious health problems


PREVALENCE OF SELECTED PATHOLOGY
AMONG CURRENTLY CERTIFIED ACTIVE AIRMEN

INTRODUCTION

The Federal Aviation Administration (FAA) and its predecessors have
been charged with the responsibility for medical certification of all
United States and some international civil airmen since 1927. Each airman
must hold a current medical certificate of the appropriate class to
validate any pilot certificates he or she may possess. As of January 1, 1980,
an unprecedented 827,592 active airmen were medically certified. Federal
Aviation Regulations require that physical examinations must be performed
at 6-month intervals for air transport pilots, annually for other commercial
pilots, and at 2-year intervals for private pilots.

The Aeromedical Certification Branch of the Civil Aeromedical Institute
(CAMI), located in Oklahoma City, Oklahoma, is the central screening facility
and repository within the FAA for collection, processing, adjudication,
investigation, and analyses of medical data generated by the aeromedical
certification and related regulatory programs.

Medical certification criteria have changed dramatically in favor of
the_airman during recent years as a result of the evolution of aviation
medicine and increased efforts in the area of aeromedical research. A
primary function of CAMI is to identify and provide substantive data in
support of current medical criteria in the furtherance of aviation safety
as well as provide a better service to the airman. It has been the policy
of the FAA to medically certify individuals, for a variety of flying
privileges, who also have medical deficiency or disease, provided it can
be determined that such action does not compromise air safety. During
recent years, for example, standards have been relaxed with respect to
contact lens use and medication allowed for control of hypertension.

This descriptive epidemiologic study presents the point prevalence of
pathology among active airmen as of January 1, 1980, by age, class of medical
certificate, major body system, and other selected pathologies of interest
within the major body systems.

METHODS

Physical examinations to detect medical conditions which could incapaci-
tate or otherwise adversely affect pilot performance are given by some 7,716
designated aviation medical examiners (AMEs), most of whom are physicians
in private practice. Military applicants receive their examinations at 489
designated military facilities. Reports of these examinations from through-
out the world are forwarded to the Aeromedical Certification Branch in
Oklahoma City.