—Since physicians, partly because of their economic status, are more likely than the general US population to own and use private aircraft,1,2 their higher risk of death from aircraft accidents is not surprising (LLU, 38 deaths, standardized mortality ratio [SMR] = 1318; USC, 7 deaths, SMR = 360). As Dr Doram's letter underscores, what we could not account for in our study is why the risk of fatal aircraft accidents was three times higher for LLU physicians than for USC physicians (mortality ratio was 2.98 [95% confidence interval, 1.27 to 6.96]. We tested several hypotheses to elucidate this difference.
The international service hypothesis.
—Since LLU physicians provide service to the worldwide network of Seventh-day Adventist medical facilities, we tested the possibility that the increased risk of aircraft accidents might be attributed to the frequent use of private aircraft in their assignments. We found, however, that 88% of the aircraft