FAA Office of Aerospace Medicine
Civil Aerospace Medical Institute

Report No: DOT/FAA/AM-22/03

Title and Subtitle: Assessing Mortality Between the BasicMed Population and Third-Class Medically Certificated Pilots

Report Date: March 2022

Authors: Norris, A., Skaggs, V., Chidester, T.

Abstract: Because airmen seeking third-class medical certification and those declaring intention to fly under BasicMed differ in degree of medical observation and review, mortality and incapacitation differences are relevant to assess safety. In support of the Congressional requirement to review the efficacy and safety of BasicMed, we investigated differences in mortality between BasicMed and third-class medical certificate pilots. Methods. We conducted a retrospective cohort study among pilot populations from May 2017 through December 2019. All BasicMed pilots within the first year of implementation were included in the study, and a random sample of third-class medical certificate holders was observed as a comparison group. Both groups were followed through December 2019. We collected mortality data from the U.S. Centers for Disease Control and Prevention for both groups and used Cox proportional hazards regression for data analyses, adjusting for age and Special Issuance (SI).

Results. A total of 29,248 BasicMed pilots were included in the study, and the same number of third-class airmen were randomly selected from the active third-class airmen population as the comparison group. Generally, BasicMed pilots had a lower risk of dying in nonmedically related deaths than the third-class group. When restricting the outcome to medically related deaths, BasicMed pilots had an overall age- and SI-adjusted 53% higher mortality risk than the third-class group. After adjustment for age and SI status, the mortality risk from suddenly incapacitating causes was three times higher among BasicMed airmen than third-class airmen. Further, risk of cancer-related deaths was two times higher among BasicMed airmen.

Summary. The mortality data are generally unfavorable to BasicMed, likely because the BasicMed population is significantly older and more likely to have required an SI. However, the mortality risk remains elevated even when controlling for both age and SI. Absent Federal Aviation Administration oversight, mitigation of elevated risk of incapacitation and death is dependent upon the airman seeking regular medical care for their conditions.

Key Words: Pilot Medical Certification, BasicMed Population, Pilot Medical Conditions, Mortality

No. of Pages: 16