Technical Report Documentation Page 

1. Report No. 2. Government Accession No. 

FAA-AM-84- 8 

4. Title and Subtitle 

HEALTH EXAMINATION FINDINGS AMONG ACTIVE CIVIL AIRMEN 

7. Author's) 

Charles F. Booze, Jr. 

9. Performing Organization Name and Address 

FAA Civil Aeromedical Institute 

P.O. Box 25082 

Oklahoma City, Oklahoma 73125 

12. Sponsoring Agency Name and Address 

Off ice of Aviation Medicine 

Federal Aviation Administration 

800 Independence Avenue, S.W. 

Washington, D.C. 20591 

3. Rectpient's Catolog No. 

-~ 

5. Report Date 

____.____ 

August 1984 

6. Performing Orgonlrotbon Code 

8. Performing Organization Report No. 

10. Work Unlt No. (TRAIS) 

- 

11. Contract or Grant No. 

-___ 

13. Type of Report and Perlod Covered 

14. Sponsoring Agency Code 

16. Abstract 

- 

It has been the policy of the Federal Aviation Administration to medically certify 

individuals, for a variety of flying privileges, who have a 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, 1984, 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. 

Cardiovascular, eye, and abdominal pathologies represent the most prevalent medical 

conditions among active airmen (5.9%, 4.4%, and 4.0% respectively). HypertenSiOTl 

is the most frequently occurring cardiovascular condition. Of particular interest 

is the current certification of 263 airmen who have undergone coronary artery bypass. 

Some 324,986 active airmen (45%) require correction for some visual deficiency. Of 

this total, 20,355 are contact lens wearers. History of kidney stones is the most 

common genitourinary/abdominal finding. 

Prevalence of pathology among active civil airmen, while still considerably less 

than among the general population, is increasing due to current and past emphasis 

on relaxation of regulatory requirements when consistent with safety. 

17. Key Words 18. Distribution Statement 

Health Examination Findings 

Act ive Airmen 

Document is available to the public: 

through the National Technical 

Information Service, Springfield, 

Virginia 22161 

I 

19. Security Classif. (of this repart) 20. Security Classif. (of this page) 21. No. of Pages 22. Prlce 

____ 

Unclassified Unclassified 10 

____ 

Form DOT F 1700.7 (8-72) Reproduction of completed page authorized 
Acknowledgment 

Appreciation is extended to Ms. Shirley Dark, Mrs. Leslie Downey, 

and Mrs. Clara Staggs for their assistance 'in the review and 

preparation of this study. 
HEALTH EXAMINATION FINDINGS 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, 1984, 715,858 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 1nstitut:e 

(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, 1984, 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 som'e 

7,696 designated aviation medical examiners (AME's), most of whom are 

physicians in private practice. Military applicants receive their 

examinations at 536 designated military facilities. Reports of these 

examinations from throughout the world are forwarded to the Aeromedical 

Certification Branch in Oklahoma City. 

1 
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. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

9. 

10. 

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

A psychosis. 

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. 

Drug dependence. 

Epilepsy. 

A disturbance of consciousness without satisfactory medical explanation of the cause. 

Myocardial infarction. 

Angina pectoris. 

Coronary heart disease that has required treatment or, if untreated, 

that has been symptomatic or clinically significant. 

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 nedical review by FAA and consultant specialists. The primary 

considerations in such cases are history, prognosis, and potential risk of 

sudden or insidious 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 Certification 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 acquisition 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 

2 
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 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 

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 11, 

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). More severely hypertensive airman applicants are also 

excluded from this population due to the type or dosage of medication required 

for control. Diuretics and some beta-blockers in low dosage are currently 

allowed for hypertension control. Clearly, this excludes many hypertensive 

applicants requiring larger doses or combinations of drugs for effective 

control. 

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 I1 indicates that eye diseases are the next 

most prevalent medical problems among active airmen (excluding lens 

correction). While representing a serious threat to air safety if not 

recognized and treated by adequate correction, most eye pathology is 

relatively innocuous. Of the 715,858 active airmen as of January 1, 1984, 

some 45 percent (324,986) required lens correction for some visual 

deficiency. Of this total, 20,355 are known contact lens wearers. 

Additionally, 4,437 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. 

Prevalence of abdominal diseases is third in total body system importance. Specific 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 approximately equal at 14.1 and 12.1 per 1,000 airmen 

respectively. Within these systems no single disease entity makes a contrlbution significant enough to deserve separate mention. Both major body systems 

contain 30 to 40 distinct disease categories, with each making minor contri'butions totaling the approximate 12-14 per 1,000 rate for the major body system. 

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The "miscellaneous" category of disease includes endocrinopathies, skin 

diseases, drug usage by type, allergies, tropical diseases, and general systemic conditions. Nearly one-third 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 11. Diseases found to increase with age include hypertension, 

kidney stones, hernia, blindness or absence of an eye, history of neoplasm, 

and uncomplicated ulcer. Diseases demonstrating a trend of decrease with age 

included contact ].ens use, hay fever, and asthma. Heart murmurs were most 

common among young and older ages with lower prevalence among the middle 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 classes one and two airmen (professional pilots) 

(see Figure 1). 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. 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 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. 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 population since 

the previous study. It seems likely that the residual population are more 

"hard core" aviators, many of whom may have accumulated pathology over the 

years. Large and statistically significant increases in age-specific cardio- vascular pathology were observed in comparing this study with the 1980 study. 

This difference is largely attributable to an increased number of hypertensives in the population resulting from a relaxation of allowable medications and combinations. 

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. 

6 
Eye 

ENT 

Respiratory 

Card iovascu lar 

Abdominal (GI., G.U., etc.) 

Neuropsychiatric 

Bones and Joints 

Rates per 1,000 Airmen 

.3 

60.8 

6 3.5 

Muscles 

Miscellaneous 

0 3rd Class 

38.6 

41.8 

(Endocrinopathies, Drugs, etc.) 43.9 

Figure 1. Disease prevalence among active airmen by 

system and class of medical certificate, 1984. 

7 
E NT 

Respiratory 

Cardiovascular 

Abdominal (G. I.*G.U., etc.) 

Neuropsychiatric 

Bones and Joints 

Muscles 

Rates per 1,000 Airmen 

# 

1-1 11.4 

p :: 0 1980 0 1984 

Miscellaneous 

(Endocrinopathies, Br ugs, etc.) 

Figure 2. Comparison of disease prevalence among airmen 

by body system, 1980 versus 1984. 

8 
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 associatied 

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 45 

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 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 with 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. With the trend 

away from airline medical departments, possibly some increased vigilance in 

examination of professional pilots will be necessary. 

9 
REFERENCES 

1. Booze, C., 1973. Prevalence and incidence of disease among airmen 

medically certified during 1965. FAA Office of Aviation Medicine 

Report No. AM-73-8. 

2. Booze, C., 1979. Morbidity experience of air traffic control personnel-- 

1967-77. Aviation, Space, and Environmental Medicine, 59(19:1-8. 

3. Booze, C., 1981. Prevalence of selected pathology among currently 

certified active airmen. FAA Office of Aviation Medicine Report 

NO. AM-81-9. 

10