Unsafe sax: cohort study of the impact of too much sax on the mortality of famous jazz musicians

British Medical Journal, Dec 18, 1999 by Sanjay Kinra, Mona Okasha

It is widely accepted that poor breathing technique on any wind instrument breaks up the shape and flow of a solo. To overcome this problem, woodwind instrument players--especially saxophonists--often use circular breathing techniques (fig 1) to produce seamless air streams, inhaling through the nose while simultaneously inflating the cheeks and neck with air. This is a demanding and possibly dangerous exercise.[1] Despite anecdotal reports of death by cerebrovascular causes,[2 3] there has been no formal study looking at mortality in these musicians.

[Figure 1 ILLUSTRATION OMITTED]

Subjects, methods, and results

Two compendiums of jazz with information on famous jazz musicians were used as the source of the cohort.[2 3] Information retrieved included dates of birth and death (where relevant), nationality (American or otherwise), number and type of main instrument played (voice, brass, woodwind, percussion, keyboards, string), saxophone (played or not), social class (number of hit albums), social cohesion (number of band members), and having control over life situations (being band leader). Association between the variables and mortality was examined by Cox proportional hazards models using Stata version 5. Year of birth was divided into fifths to control for secular trends.

In total, 813 musicians born between 1 January 1882 and 30 June 1974 were identified, providing 49 360 person years to the analysis. Of these, 349 (43%) died during the follow up period (to 15 February 1998, the most recent date of book publication). Saxophone players were more at risk of death than other musicians (fig 2). Other variables that were significantly associated with mortality risk were US nationality, playing more than one instrument, and being bandleader (table). Of the instrument groups, only brass and woodwind were associated with significantly higher mortality (compared with vocalists).

[Figure 2 ILLUSTRATION OMITTED]

Relative mortality in 813 musicians born between 1882 and 1974

                                           No of     No of
Explanatory variable                      subjects   deaths

Play saxophone (yes)                        230       136
Play more than one instrument (yes)         367       134
Nationality (American)                      550       292
Control over life situations (yes)          231        83
Social class([dagger]) (higher)             633       262
Social cohesion([dagger]) (greater)         633       262
Main instrument group([double dagger]):
  Vocalist                                   54        18
  Brass                                     161        80
  Woodwind                                  219       109
  Percussion                                113        39
  Keyboard                                  138        59
  String                                    128        44

                                             Crude hazard
Explanatory variable                        ratio (95% Cl)

Play saxophone (yes)                      1.84 (1.48 to 2.28)
Play more than one instrument (yes)       0.76 (0.61 to 0.94)
Nationality (American)                    1.90 (1.43 to 2.53)
Control over life situations (yes)        0.64 (0.50 to 0.83)
Social class([dagger]) (higher)           1.00 (0.99 to 1.02)
Social cohesion([dagger]) (greater)       1.01 (0.99 to 1.03)
Main instrument group([double dagger]):
  Vocalist                                1.00
  Brass                                   1.53 (0.91 to 2.54)
  Woodwind                                1.70 (1.03 to 2.80)
  Percussion                              1.12 (0.63 to 1.94)
  Keyboard                                1.56 (0.92 to 2.65)
  String                                  1.34 (0.77 to 2.32)

                                            Adjusted hazard
Explanatory variable                       ratio(*) (95% Cl)

Play saxophone (yes)                      2.47 (1.89 to 3.24)
Play more than one instrument (yes)       0.53 (0.40 to 0.70)
Nationality (American)                    1.79 (1.29 to 2.50)
Control over life situations (yes)        0.71 (0.55 to 0.92)
Social class([dagger]) (higher)           1.00 (0.98 to 1.02)
Social cohesion([dagger]) (greater)       1.01 (0.98 to 1.04)
Main instrument group([double dagger]):
  Vocalist                                1.00
  Brass                                   2.03 (1.11 to 3.72)
  Woodwind                                2.09 (1.15 to 3.78)
  Percussion                              1.33 (0.70 to 2.53)
  Keyboard                                1.59 (0.94 to 2.71)
  String                                  1.69 (0.90 to 3.18)

(*) Adjusted for other remaining variables in table.

([dagger]) Used as continuous variable; all others used as binary variables (yes/no).

([double dagger]) Other instrument groups compared with vocalist as baseline.

Comment

Among famous jazz musicians, playing saxophone is a major health hazard. Other factors associated with higher mortality include, to a smaller extent, playing other woodwind instruments or being of US nationality. Playing more than one instrument or being a bandleader has a protective influence.