Journal of insurance medicine (New York, N.Y.)最新文献

Introduction.—: Prostate cancer is one of the most common cancers, with an approximate global annual incidence of 1.5 million men and nearly 400,000 deaths. Treatment options include surgical resection, radiotherapy, and high-intensity focused ultrasounds, often combined with hormone deprivation therapy. Insurability of prostate cancer patients is evaluated based on tumor severity using the AJCC and TNM classifications, along with PSA levels and Gleason Scores. To control the risk, life insurers use medical selection, albeit many individuals may be excluded from coverage. Regulations, such as France's "Right to Be Forgotten," allow standard rate acceptance for certain prostate cancer survivors under specific conditions.

Methods.—: By matching patient data from the SEER database with mortality tables, we established a Cox survival prostate cancer model for patients sharing similar long-term survival risk and compared it with that of the general population.

Results.—: By investigating risks in populations of various age ranges, we defined groups with variable survival risk. To distinguish insurable from uninsurable, we have defined a so-called "acceptance corridor," which delimits the boundary within the expected normal range of survival for a group of age and the highest acceptable premium. This corridor is delimited with an upper boundary depicted where the risk is equal to the standard population and a lower boundary where the risk of death is higher than that of the normal population or where the risk overpasses the maximum acceptable premium of 250%.

Conclusion.—: In this paper, we have revisited the risk of individuals with a history of prostate cancer and have provided estimates of risk belonging within an acceptance corridor of insurability, broadening options for standard rate. This method may be further used to evaluate the impacts of regulatory guidelines, rules, and regulations, such as the right to be forgotten, to cancer patient populations.

Some underwriting departments believe hiring a board-certified specialist from a clinical background will improve their life underwriting, expectancy estimations, and profitability. This is not a panacea for solving adverse underwriting expectations. The need is a potential red flag indicating internal underwriting deficiencies. The specialist comes with their own limitations, the most prominent being the lack of any experience in insurance medicine and risk selection. You will be depending on the least experienced medical director to correct your problems. Likely, one or more internal underwriting practices could be the root cause of the unfavorable results.

Liver steatosis is now the politically correct term for excessive fat in the liver (fatty liver). Its incidence and prevalence, in lockstep with diabetes and obesity, continue to climb to over 2 billion persons worldwide. It is the most common cause of chronic liver disease and the leading cause of liver-related morbidity and mortality. This treatise, resulting from a selection of PubMed literature of relevant steatosis studies since the nomenclature change in 2023, will include the change in the names for the steatotic liver entities, documenting the contribution of metabolic dysfunctions (obesity, diabetes, hypertension, and dyslipidemias) to the pathology of insulin resistance and alcohol in the evolution of these liver diseases. The various modalities for measuring the degree of fat, fibrosis, and cirrhotic scarring of the liver will be discussed, followed by a review of the mortality implications of the subcategories of liver steatosis, including intrahepatic cirrhosis and malignancy, extrahepatic malignancies, and cardiovascular disease. Finally, a review of treatments to address these entities will be briefly reviewed.

Leukemia is a broad term for a heterogenous group of hematologic malignancies that arise from the abnormal proliferation of leukocytes. It occurs most often in adults older than 55, but also is the most common cancer in children younger than 15, and accounts for more than 25% of cancer deaths in this age group. In this United States long term retrospective population-based analysis of 143,713 microscopically confirmed leukemia cases, mortality and survival study, 1975-2022, data is derived from the NCI Surveillance, Epidemiology and End-Results Programs, SEER*Stat software versions 8.4.5 and SEER*Stat 9.0.40.0, and, SEER Registry - Incidence - SEER Research Data, 8 Registries, Nov 2024 Sub (1975-2022). This comparative cohort entry time-period analysis is intended to provide age-adjusted epidemiologic, demographic, short and long-term survival and mortality data for convenient reference by all physicians, scientists, insurance underwriters, and others interested in cancer mortality follow-up.

Objectives.—: This study seeks to quantify the mortality effect of high levels of body mass index (BMI) on life insurance applicants and participants in the National Health and Nutrition Examination Survey (NHANES) in univariate models and in successive models controlling for BMI-related diseases and conditions.

Background.—: It is well established that a high BMI is associated with increased all-cause and cardiovascular mortality; however, the quantitative effect of controlling for related diseases and conditions is not well understood.

Methods.—: Data were collected from over 7 million life insurance applicants submitting samples to Clinical Reference Laboratories (CRL) and 23,486 NHANES participants with available BMI and mortality status. Cox models were utilized, treating BMI as both a continuous predictor and as a categorical variable within various age and sex groups. Six Cox models were constructed in each age-sex-data group: a univariate model controlled only for age, then 5 more successively controlling for disease status (hypertension, diabetes, and heart disease), liver function tests, blood pressure/renal function, and finally hemoglobin A1c.

Results.—: Overall, the effect of high BMI on mortality hazard was highest in the univariate model, and lower with successively controlled models. In the life insurance data, the residual effect of BMI in the final models was still significant above a BMI of about 35. In the NHANES data, the effect remained significant only above a BMI of about 40. In the continuous models, the hazard of BMI was persistently significant for both sexes in the CRL models, only for men in the final NHANES model.

Conclusion.—: Based on this study, the effect of high BMI on mortality is significantly blunted when accounting for diseases and conditions that are associated with high BMI.

Chronic myeloid leukemia (CML) is a myeloproliferative disorder in which there is a neoplastic proliferation of mature granulocytes. The cancer results from a reciprocal translocation of the breakpoint cluster region (BCR) on chromosome 22 and the ABL1 gene region on chromosome 9 - t (9;22). The result is an abnormal fusion gene on chromosome 22 known as the Philadelphia chromosome. It represents 15% to 20% of all leukemias in the United States with an estimated incidence rate of 1 to 2 cases per 100,000. About 50% of affected individuals are asymptomatic. Diagnosis depends on demonstrating the presence of the Philadelphia chromosome. CML occurs in 3 phases. The most common is the chronic phase characterized by an indolent course and <15% blast cells in the myeloid space. The remaining advanced phases are the accelerated (15%-30% blasts) and the blast phase (>30% blasts). Without treatment, progression is slow but relentless to the advanced stages and occurs over 3 to 5 years. Survival is markedly reduced once these latter stages are reached. The recognition that the BCR-ABL1 fusion gene was a key driver of the disease process led to the development of tyrosine kinase inhibitor (TKI) drugs that targeted the genetic basis for the cancer. The first of these was imatinib, which was released in 2001. Since then both second and third generations of the drug class have been approved. These medications have been demonstrated to reduce the ratio of abnormal to normal BCR:ABL1 transcripts. They are most effective if used in the chronic phase. The degree of this molecular response has been demonstrated to correlate with limitation of progression of disease and improvement, often marked, of survival. Most individuals who respond well require lifelong use of the medication. However, a subset of the responders may achieve treatment-free remission (TFR) without ongoing therapy. For those individuals who are in the advanced state of the disease, do not respond to the TKI drugs or cannot tolerate them, allogeneic hematopoietic stem cell transplantation (SCT) is an alternative therapy that can achieve long-term survival in some cases.

Background.—: Previously we have shown that, in theory, a prediction algorithm that incorporates methylation sensitive digital PCR (MSdPCR) assessments of smoking and drinking could predict mortality. But the potential impact of these findings was speculative because limitations of the generalizability and available data from the study cohort.

Objective.—: To directly demonstrate the potential financial impact of using an epigenetic mortality index to assess potential applicants based off actual MSdPCR and survival data from a nationally representative cohort.

Methods.—: Using actual MSdPCR and survival data from our recent study of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, we modeled the survival and financial impact of a 55-year-old male smoker at the 25th, 50th and 75th percentile of Alcohol T Score (ATS) values.

Results.—: The likelihood of survival to maturation of 20 years was 86.2%, 80.8% and 74.4%. Using a simplified financial modeling of a 20-year term policy with $500K face value, insuring a client at the 25th percentile, would result in an average of $38,749 and $85,833 more in average net revenue than insuring the individuals at the 50th and 75th percentile.

Conclusions.—: Epigenetic survival indices can make financially impactful predictions. Real life pilots of this technology in the underwriting space are in order.

Mental health disorders are harder to evaluate for life insurance because their diagnoses can be subjective. To make fair decisions, insurance medical directors use research from trusted sources to calculate risk based on survival data. This article reviews a study conducted on patients in the UK with a diagnosis of attention-deficit and hyperactivity disorder (ADHD).

In the United States, ovarian cancer is the second most common form of gynecologic cancer and the second leading cause of gynecologic cancer death. It is a heterogeneous disease with many different types and subtypes. The most common variety (70%-80%) is the high-grade serous epithelial tumor. A positive family history and/or the presence of susceptibility genes (BRCA1, BRCA2, and mismatch repair genes) increase the risk for developing the disease. Due to the lack of effective screening tools, even in those with known increased risk, most ovarian cancers are diagnosed at advanced stages. Diagnosis and accurate staging usually require tissue sampling and extensive debulking surgery performed by a surgeon who specializes in gynecologic oncology. Combination chemotherapy, before or after surgery, or as primary treatment for advanced disease is commonly needed. Mortality rates vary by stage, grade, and type of tumor. For the most common histotypes, due to the presence of advanced disease at presentation in most individuals, overall death rates remain high. Survival is better with some of the less common subtypes including sex cord stromal, germ cell and borderline epithelial ovarian tumors.

Objective.—: To compare the alcohol biomarkers phosphatidylethanol (PEth) and carbohydrate-deficient transferrin (CDT) in a convenience sample of life insurance applicants.

Background.—: PEth is a direct measure of alcohol consumption, which may have some advantages in the detection of problematic alcohol use when compared to CDT.

Methods.—: A total of 619 life insurance applicants were tested for both PEth and CDT. Linear models were constructed to assess the relationship between these two markers and other laboratory values. Classification and regression tree (CART) models were also constructed to identify clusters of individuals with high levels of either marker.

Results.—: The correlation between PEth and CDT was 0.52. PEth was positive in 23% of the sample at a threshold of 200 ng/ml, while CDT was positive in 11% at a threshold of 1.5%. CART models showed that GGT and AST were the most important predictors of PEth positivity, while HDL and AST were the most important predictors of CDT positivity.

Conclusion.—: PEth may be a more sensitive marker of alcohol intake than CDT, and may be useful as a reflex test from other laboratory values in both the clinical and life insurance setting.