Is Occupation as Air Transport Pilot a Stroke Risk?
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1 Dr Kevin Tan Is Occupation as Air Transport Pilot a Stroke Risk? A Case-Control Study
2 Why this question?
3 Why? Shift & Night Work Sleep Restriction Air Transport Pilot Occupation? Ischaemic Stroke 4% increased stroke risk for every 5 years of night shift in nurses Ischaemic Stroke Meta analysis (n=559,252): HR 1.15 (95% CI, ) for short sleep Ischaemic Stroke Brown et al. Rotating Night Shift Work and the Risk of Ischemic Stroke. American Journal of Epidemiology Vyas et al. Shift work and vascular events: systematic review and meta analysis. British Medical Journal Leng Y, et al. Sleep duration and risk of fatal and nonfatal stroke: a prospective study and meta analysis. Neurology 2015.
4 Aim of Study Air Transport Pilot Stroke Cases vs Unexposed All Australian Civilian Aviation Pilots and Air Traffic Controllers Control Cases Air Transport Pilot vs Unexposed Hypothesis: Odds of long haul Air Transport Pilot occupation exposure versus non-exposed in stroke cases different to control cases? (α = 0.05)
5 Method
6 Ischaemic Stroke Cases & Controls Ischaemic Stroke or TIA Stroke Cases First Event Diagnosis by Neurologist All Australian Civilian Aviation Pilots and Air Traffic Controllers Control Cases Random Selection No matching or restriction 4:1
7 The Exposed Air Transport Pilot Occupied in Medium to Long Haul Work Air Transport Pilot Licencing Maximum Take-Off Weight (Fixed Wing) > 15,000 kg Flight Hours Accumulated > 5000 hours Multicrew command Stated Employer a Medium to Long Haul Carrier
8 The Unexposed Private/recreational pilots (Class 2) Commercial pilots (Class 1, non ATP) Air traffic controllers (Class 3) Limited exposure to shift & night work and trans meridian travel compared to Air Transport Pilots?
9 Confounder Management Complete data on significant* ischaemic stroke risk factors was collected for each subject *Age, sex, *hypertension, *current smoking, *diabetes, *other cardiac/vascular disorders, BMI. Multivariable logistic regression modelling to adjust for confounding by these risk factors
10 Results?
11 Sampling Characteristics Records: 1985 to 2017 Total subjects years to 88 years age 376 Controls 88 Stroke & TIA 60 Stroke Median age of 42 years in both groups 28 TIA (30%) Mostly male (94.4%)
12 Raw Numbers Occupational Exposure Air Transport Pilot = 11 (12%) Stroke = 88 Unexposed = 77 (88%) Commercial Pilot = 14 (18%) Private Pilot = 59 (77%) Air Traffic Controller = 4 (5%) Controls = 376 Air Transport Pilot = 24 (6%) Unexposed = 352 (94%) Commercial Pilot = 112 (32%) Private Pilot = 234 (66%) Air Traffic Controller = 6 (2%)
13 Explanatory Factors (Unadjusted)
14 Unadjusted Primary Association & Qualitative Confounder Relationships Unadjusted Odds Ratio of Air Transport Pilot Exposure and Stroke Pooled Odds Ratio (Mantel Haenzsel) 2.09 (95% CI: 0.98, 4.46; p = 0.068) Age < 50 Age > 50 Age Normal BP BP > 140/90 or Treated BP BP > 140/90 or Treated BP BMI < 30 BMI > 30 BMI > *Comorbid cardiac and vascular disease, gender, diabetes, and smoking not amendable to stratified analysis due to small number drop out in some strata.
15 Primary Outcome Air Transport Pilot Occupation OR = 2.09, p = OR = 2.09 p = OR = 2.51, p = OR = 2.81 OR = 2.81, p p = =
16 Discussion
17 2.8 fold Increased Risk of Stroke in Air Transport Pilot Occupation?
18 Weaknesses of this Study Modest Ischaemic Stroke Case Numbers Differential Case Selection in the Exposed Group (potential) Residual Confounding (potential)
19 Replicate or do better studies?
20 Potential Implications? What is the difference between Air Transport Pilots and other Civilian Aviation Participants? Circadian disruption / sleep disruption? Prolonged hypobaric environment? Cosmic radiation? Possible aeromedical safety risk implications?
21 Dr Kevin Tan Is Occupation as Air Transport Pilot a Stroke Risk? Yes it could be
22 Acknowledgements Dr Eugen Mattes, FAFOEM Dr Michael Drane, PMO CASA Dr Aparna Rao, CASA ASAM Dr Derchieh Hung, Statistician CSL Dr Craig White, FAFOEM
23 Dr Kevin Tan Is Occupation as Air Transport Pilot a Stroke Risk? Yes it could be
24
25 Differential selection of stroke cases wrt ATP status SOURCE POPULATION Air Transport Pilots who developed stroke vs Other Pilots / ATCs who developed stroke Some may not apply for re-certification
26 Exploratory Factors (Unadjusted)
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