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, unless there is established clinical evidence,
satisfactory to the Federal Air Surgeon, of recovery, including
sustained total abstinence from alcohol for not less than the
preceding 2 years. “Alcoholism” means a condition in which a
person's intake of alcohol is great enough to damage physical ,
health or personal or social functioning, or when alcohol has
become a prerequisite to normal functioning.
4. Drug dependence. ‘
5. Epilepsy.
6. A disturbance of consciousness without satisfactory medical
explanation of the cause.
7. Myocardial infarction.
8. Angina pectoris.
9. Coronary heart disease that has required treatment or, if untreated,
that has been symptomatic or clinically significant.
10. 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 special issuance is granted after
extensive medical review by FAA and consultant specialists. The primary
considerations in such cases are history, findings, prognosis, and potential
risk of sudden or insidious incapacitation. It is appropriate to note,
however, that when airmen with disqualifying conditions are issued medical i
certificates it is with special medical and operational restrictions that i
allow for control of risk.

Automated medical record files maintained by the Aeromedical
Certification Branch provided the source data for the study. The files
utilized contained 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 5
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. This study includes airmen certified during 1986 and 1987.

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


RATES PER 1,000 AIRMEN

61.1
EYE | 61.8

65.9

LEGEND

ilillll| 1ST CLASS

|NE 2ND CLASS

13.8
Ml SRD CLASS ENT it 13.7
6.4
| 3.6
RESPIRATORY [ff 3.2
3.2
CARDIOVASCULAR 70.6
69.8
79.9
ABDOMINAL {l 50.0 |
(GL, G.U., ETC.) 64.2
{Il 23.0
NEUROPSYCHIATRIC 19.6
21.6
BONES AND JOINTS Wilh ico
17.1
MUSCLES [ ‘2
2.0
MISCELLANEOUS | 518
(ENDOCRINOPATHIES, 48.9

DRUGS, ETC.) 54.1

Figure 1. Disease Prevalence Among Active Airmen by Class of Medical Certificate, 1988.


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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 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 population 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

Diseases of the cardiovascular system are the 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 I,
the prevalence of hypertension is only a fraction of that which would be
expected in an unscreened population. The low prevalence of hypertension in
this population is due to higher than usual upper limit cutoffs for assignment
of a hypertensive diagnosis among airmen (170/100 for applicants for second-
and third-class certification, and only slightly more stringent for class one
applicants). Medications acceptable to the FAA for treatment of hypertension
include all diuretics, all Food and Drug Administration approved
beta-adrenergic blockers including combination agents, ACE inhibitors, calcium
slow channel blocking agents, and combinations thereof.

Heart murmurs including functional or physiologic murmurs, account for
over 16 percent of all heart conditions observed to exist among active airmen.

Reference to Tables I and II indicates that eye diseases are the next
most prevalent medical problems among active airmen (excluding lens
correction). While representing a potential threat to air safety if not
recognized and treated by adequate correction, most eye pathology is
relatively innocuous. Of these 685,552 active airmen as of January 1, 1988
some 48 percent (326,757) required lens correction for some visual
deficiency. Of this total, 21,650 are known contact lens wearers.
Additionally, 3,984 airmen are certified to fly with blindness or absence of
an eye (which includes visual acuity worse that 20/200 uncorrected in either
eye). Serious incapacitation during flight is possible should corrective
lenses become dislocated and temporarily unavailable during a critical phase
or flight. Therefore, considerable research effort has been and will continue

to be devoted to this important aspect of potentially health-related pilot
dysfunction.

Prevalence of abdominal diseases is third in total body system
importance. Specfic diseases making major contributions include current
hernias, history of kidney stones, and uncomplicated ulcers.

Major body system prevalence rates for neuropsychiatric and bone and
joint diseases are next highest at 21.2 and 16.6 per 1,000 airmen
respectively. 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 to the total for the major body system.


The “miscellaneous” category of disease includes endocrinopathies, skin
diseases, drug usage by type, allergies, tropical diseases, and general
systemic conditions. Nearly 30 percent of all disease observed in this
category was “hay fever.” Other major contributors to this category included
antihistamine drug usage, asthma, diabetes controlled by diet, and
hypothyroidism.

The ten most prevalent diseases observed among active airmen are
presented in Table I. Diseases found to increase with age include
hypertension, kidney stones, hernia, history of neoplasm, uncomplicated ulcer
and arthritis. Diseases demonstrating a trend of decrease with age included
contact lens use, hay fever, and asthma. Heart murmurs were most common among
young and older ages with lower pevalence among the middle ages.

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

Overall, disease is slightly more prevalent among third-class (general
aviation) airmen than among class one and two airmen (professional pilots)
(see Figure 1). Since the professional pilot undergoes a more thorough and
vigid 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. Possibly 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 population or segments thereof are generally similar with
respect to major body systems presenting the highest prevalence rates; i.e.,
cardiovascular, eye, and abdominal (1-3). 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 and would be greater in a given population at
successive measurements for nonlethal diseases. The second consideration with
tegard to increased prevalence rates surely has to do with the fact that
medical requirements have been cautiously relaxed over recent years to allow
airmen to continue flying with various medical problems not previously
acceptable. A possible additional factor having to do with the increase in
prevalence seen in this study has to do with a rather dramatic decrease in the
airman population. It seems likely that the residual population are more
“hard core" aviators, many of whom may have accumulated pathology over the
years and are thus still represented in the numerator while the denominator
has decreased significantly...

Large and statistically significant increases in age-specific
cardiovascular pathology were observed in comparing this study with the 1984
study. This difference is largely attributable to an increased number of
hypertensives in the population resulting from a relaxation of allowable
medications and combinations, and more liberal certification of airmen with
cardiovascular disease during recent years.

Sizable increases in age-specific rates for abdominal pathologies were
also observed in this study over the previous study. No single explanation,
however, accounts for this latter observation other than that speculated
earlier.


FAA-Am-84-2

AIAM-89/2 Prevalence of Disease
* Aviation Medici I i
Pas tone 20st” = Among Active

a Civil Airmen

02

Charles F. Booze, ur., Ph.D.

Civil Aeromedical Institute
Office of Aviation Medicine
Federal Aviation Administration
Oklahoma City, OK 73125

October 1988

Final Report

This document is available to the public
through the National Technical Information
Service, Springfield, Virginia 22161

©

US.Department of Transportation
Federal Aviation Administration

ERAU. LIBRARY



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 problems associated
with accurate reporting of symptoms and history by pilots.

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

Eye disease is the next most common problem among pilots with some 48
percent of all airmen requiring lens correction for some visual deficiency.

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 cautious relaxation of medical
standards where possible when not resulting in a compromise of air safety.

The difference in prevalence of disease among general aviation pilots
compared to professional pilots is much less than in previous studies and
certainly reflects a more liberal certification policy by FAA in recent
years. However, in view of the trend away from airline medical departments,
and the preventive medical benefits of such departments, possibly we are
seeing the result of diminished preventive efforts.


RATES PER 1,000 AIRMEN

LEGEND EYE 63.8
44.4
MI i988
ENT 9.9
IM 1984 é
RESPIRATORY 3.3
2.9
CARDIOVASCULAR 75.3
59.4
ABDOMINAL 63.4
(GL, G.U., ETC.) 40.2
NEUROPSYCHIATRIC 21.2
14.1
BONES AND JOINTS 16.6
12.1
MUSCLES 1.8
18
MISCELLANEOUS 52.2
(ENDOCRINOPATHIES, 43.1

DRUGS, ETC.)

Figure 2. Comparison of Disease Prevalence Among Airmen by Body System, 1988 Verses 1984


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PREVALENCE OF DISEASE AMONG
ACTIVE CIVIL 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, 1988, 685,552 active
airmen were medically certified. Federal Aviation Regulations require that
physical examinations 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 research results to verify or
incriminate current medical criteria in the furtherance of aviation safety and
better service to the airman. It has been the policy of the FAA to medically
certify for a variety of flying privileges, individuals who also have medical
deficiency or disease, provided it can be determined that such action does not
compromise air safety.

This descriptive epidemiologic study presents the period prevalence of
pathology among active airmen for years 1986 and 1987 by age, class of medical
certificate, major body system, and other selected pathologies of interest
within the major body systems. The study updates previous studies of a
similar nature with respect to current prevalence of disease among airmen.

METHODS

Physical examinations to detect medical conditions which could
incapacitate a pilot or otherwise adversely affect pilot performance are given
by some 6,799 designated aviation medical examiners (AME's), most of whom are
physicians in private practice. Military applicants receive their
examinations at 410 designated military facilities. Reports of these
examinations from throughout the world are forwarded to the Aeromedical
Certification Branch in Oklahoma City.


NOTICE

This document is disseminated under the sponsorship of the U.S.
Department of Transportation in the interest of information exchange. The
United States Government assumes no liability for the contents or use thereof.


Technical Report Documentation Page

1, Report No. 2. Government Accession No. 3. Recipient's Catalog No.

DOT/FAA/AM- 89/2

4. Tithe and Subtitle 5. Report Date
OCTOBER 1988
PREVALENCE OF DISEASE AMONG ACTIVE CIVIL AIRMEN 6. Performing Organization Code

[8. Performing Organization Report No.

7. Author! s)

Charles F, Booze, Jr Ph.D

9. Performing Organization Name and Address 70. Work Unit No. (TRAIS)
FAA CIvil Aeromedical Institute Te Sian

ract or Grant No.
P.O. Box 25082 ” Contract or Grant No.

Oklahoma City, Oklahoma 73125
13. Type of Report and Period Covered

12. Sponsoring Agency Name ond Address
Office of Aviation Medicine

Federal Aviation Administration

800 Independence Avenue, S.W. 14. Sponsoring Agency Code
Washington, D.C. 20591 AAM-330

15. Supplementary Notes

16. Abstract

It has been the policy of the Federal Aviation Administration to medically
certify, for a variety of flying privileges, individuals who have a medical
deficiency or disease, provided it can be determined that such action does
not compromise air safety.

This descriptive epidemiologic study presents the point prevalence of
pathology among 685,552 active airmen as of January 1, 1988, by major
body system. The study also presents other selected pathologies of
interest within the major body system.

Cardiovascular, eye, and abdominal pathologies represent the most prevalent
medical conditions among active airmen (7.5%, 6.4% and 6.3% respectively).
Hypertension is the most frequently occurring cardiovascular condition.

Prevalence of pathology among active civil airmen, while still considerably
less than among the general population, is increasing due to recent emphasis
on relaxation of regulatory requirements when consistent with safety.

V7. Key Words 18. Distribution Statement
Prevalence Document is available to the public
Disease through the National Technical
Active airmen Information Service, Springfield, VA
22161.
19. Security Clossif. (of this report) 20. Security Clossif, (of this page) 21. No, of Pages | 22, Price
UNCLASSIFIED UNCLASSIFIED 10

Form DOT F 1700.7 ~72) Reproduction of completed page authorized


REFERENCES

Booze, C., 1973, Prevalence and incidence of disease among airmen
medically certified during 1965. FAA Office of Aviation Medicine
Report No. AM-73-8.

Booze, C., 1979. Morbidity experience of air traffic control personnel -
1967-77. Aviation, Space, and Environmental Medicine, 59(1):1-8.

Booze, C., 1981. Prevalence of selected pathology among currently
certified active airmen. FAA Office of Aviation Medicine Report
No. AM-81-9

HU.S. Government Printing Office : 1989 - 617-000/88632