Pub Date : 2020-04-30DOI: 10.17849/insm-48-2-1-12.1
Steven J Rigatti, Robert Stout
Objectives.- To quantify the effect of physical activity on the mortality rates of healthy individuals in a population sample, after controlling for other sources of mortality risk. Background.- The widespread availability of activity monitors has spurred life insurance companies to consider incorporating such data into their underwriting practices. Studies have shown that sedentary lifestyles are associated with poor health outcomes and higher risks of death. The aim of this paper is to investigate how well certain measures of activity predict mortality when controlled for other known predictors of mortality including a multivariate laboratory based risk score. Methods.- Data were obtained from the National Health and Nutrition Examination Survey (NHANES) for the years 1999 through 2014. Laboratory and biometric data were scored for mortality risk using a previously developed proprietary algorithm (CRL SmartScore). Data on activity were obtained from the NHANES questionnaires pertaining to activity. In a second analysis, data were obtained from pedometers worn for 1 week by NHANES participants (years 2003-2004, and 2005-2006 only). Before analysis, cases were selected based on commonly used life insurance underwriting criteria to remove from consideration those who have major health issues, which would ordinarily preclude an offer of life insurance. Results.-In fully-adjusted Cox model which included survey-based MET*hours per day as a 3-level categorical variable, the moderate and minimal levels of activity were associated with hazard ratios of 1.15 (95% CI: 1.04-1.28) and 1.38 (95% CI: 1.23-1.56), respectively, when compared to the highest level of activity. When treated as a continuous variable, the fully adjusted model the HR for MET*hours per day was 0.91 (95% CI: 0.87-0.95). In fully adjusted models using pedometer data, the percentage of wear time spent sedentary was associated with mortality (HR: 1.19, 95% CI: 1.09-1.31), while average counts per minute were negatively associated with mortality (HR: 0.82, CI: 0.75-0.90). Conclusions.-It is clear from these results that high proportions of sedentary time are associated with increased mortality, whether the sedentary time is quantified via questionnaire or pedometer. Because both laboratory scores and activity levels remain significant in Cox models where both are included, these factors are largely independent, indicating that they are measuring distinct influences on the risk of mortality.
{"title":"Activity Level as a Mortality Predictor in a Population Sample after Typical Underwriting Exclusions and Laboratory Scoring.","authors":"Steven J Rigatti, Robert Stout","doi":"10.17849/insm-48-2-1-12.1","DOIUrl":"10.17849/insm-48-2-1-12.1","url":null,"abstract":"<p><p><b>Objectives.-</b> To quantify the effect of physical activity on the mortality rates of healthy individuals in a population sample, after controlling for other sources of mortality risk. <b>Background.-</b> The widespread availability of activity monitors has spurred life insurance companies to consider incorporating such data into their underwriting practices. Studies have shown that sedentary lifestyles are associated with poor health outcomes and higher risks of death. The aim of this paper is to investigate how well certain measures of activity predict mortality when controlled for other known predictors of mortality including a multivariate laboratory based risk score. <b>Methods.-</b> Data were obtained from the National Health and Nutrition Examination Survey (NHANES) for the years 1999 through 2014. Laboratory and biometric data were scored for mortality risk using a previously developed proprietary algorithm (CRL SmartScore). Data on activity were obtained from the NHANES questionnaires pertaining to activity. In a second analysis, data were obtained from pedometers worn for 1 week by NHANES participants (years 2003-2004, and 2005-2006 only). Before analysis, cases were selected based on commonly used life insurance underwriting criteria to remove from consideration those who have major health issues, which would ordinarily preclude an offer of life insurance. <b>Results.-</b>In fully-adjusted Cox model which included survey-based MET*hours per day as a 3-level categorical variable, the moderate and minimal levels of activity were associated with hazard ratios of 1.15 (95% CI: 1.04-1.28) and 1.38 (95% CI: 1.23-1.56), respectively, when compared to the highest level of activity. When treated as a continuous variable, the fully adjusted model the HR for MET*hours per day was 0.91 (95% CI: 0.87-0.95). In fully adjusted models using pedometer data, the percentage of wear time spent sedentary was associated with mortality (HR: 1.19, 95% CI: 1.09-1.31), while average counts per minute were negatively associated with mortality (HR: 0.82, CI: 0.75-0.90). <b>Conclusions.-</b>It is clear from these results that high proportions of sedentary time are associated with increased mortality, whether the sedentary time is quantified via questionnaire or pedometer. Because both laboratory scores and activity levels remain significant in Cox models where both are included, these factors are largely independent, indicating that they are measuring distinct influences on the risk of mortality.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":" ","pages":"124 – 135"},"PeriodicalIF":0.0,"publicationDate":"2020-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37887984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"What's in a name?","authors":"N. Roberts","doi":"10.1201/b17764-12","DOIUrl":"https://doi.org/10.1201/b17764-12","url":null,"abstract":"","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"32 2 1","pages":"61-2"},"PeriodicalIF":0.0,"publicationDate":"2020-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46417168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-02-05DOI: 10.17849/insm-48-2-1-1.1
David S Williams
Hepatic adenomas are rare, usually benign tumors of the liver with a small risk for bleeding and malignant transformation.
肝腺瘤很少见，通常是肝脏的良性肿瘤，出血和恶变的风险较小。
{"title":"Hepatic Adenoma.","authors":"David S Williams","doi":"10.17849/insm-48-2-1-1.1","DOIUrl":"10.17849/insm-48-2-1-1.1","url":null,"abstract":"<p><p>Hepatic adenomas are rare, usually benign tumors of the liver with a small risk for bleeding and malignant transformation.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":" ","pages":"165 – 167"},"PeriodicalIF":0.0,"publicationDate":"2020-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37613055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.17849/insm-48-2-113-123.1
A. Milano
Objective.— To update trends in incidence, prevalence, short- and long-term survival and mortality of esophageal cancer using the statistical database of SEER*Stat 8.3.4 for diagnosis years 1973-2014 employing multiple case selection variables. Methods.— A retrospective, population-based study using nationally representative data from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program to evaluate 83,658 cases of esophageal cancer for diagnosis years 1973-2014 comparing multiple variables of age, sex, race, stage, grade, cohort entry time-period, disease duration, and, two histologic oncotypes. Relative survival statistics were analyzed in two cohorts: 1973-1994 and 1995-2014. Survival statistics were derived from: SEER*Stat Database: Incidence – SEER 9 Regs Research Data, November 2016 Submission (1973-2014) Released April 2017 (Ref. 9). Case frequency and incidence data, derived from the SEER program, were used to design the table format and number of pages for this report. Results.— In a total of 83,658 cases of esophageal cancer in the United States for diagnosis years 1973-2014, multiple variables of age, sex, race, stage, grade, cohort entry time-period, disease duration, and, two histologic oncotypes were compared. Mean age in males was 66.5 years, females 70.1 years, both male and female 67.2 years. Greater than 85% of incidence cases occurred between ages 55-85+ years with the zenith in males at 65-69 years (59.4%) and 70-74 years (60.5%) in females. The overall annual US death rate from 1975-2014 has slightly increased from 3.69 to 3.99 per 100,000 per year, and excess mortality remains exceedingly high. Of the 83,658 invasive cases, 82.6% were clinically staged and 79.4% were histologically graded. Conclusions.— Relative frequency, incidence and time-trends, and the clinical, demographic and secular variables of age, sex, race, stage, grade, cohort-entry time-periods, and predominant clinical oncotypes were comparatively analyzed to provide a comprehensive medical-actuarial assessment of esophageal cancer survival and mortality in the 1973-2014 time-frame.
{"title":"20-Year Comparative Survival and Mortality of Cancer of the Esophagus by Age, Sex, Race, Stage, Grade, Cohort Entry Time-Period, Disease Duration & Selected ICD-O-3 Oncologic Phenotypes: A Systematic Review of 83,658 Cases for Diagnosis Years 1973-2014: (SEER*Stat 8.3.4)","authors":"A. Milano","doi":"10.17849/insm-48-2-113-123.1","DOIUrl":"https://doi.org/10.17849/insm-48-2-113-123.1","url":null,"abstract":"Objective.— To update trends in incidence, prevalence, short- and long-term survival and mortality of esophageal cancer using the statistical database of SEER*Stat 8.3.4 for diagnosis years 1973-2014 employing multiple case selection variables.\u0000 Methods.— A retrospective, population-based study using nationally representative data from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program to evaluate 83,658 cases of esophageal cancer for diagnosis years 1973-2014 comparing multiple variables of age, sex, race, stage, grade, cohort entry time-period, disease duration, and, two histologic oncotypes. Relative survival statistics were analyzed in two cohorts: 1973-1994 and 1995-2014. Survival statistics were derived from: SEER*Stat Database: Incidence – SEER 9 Regs Research Data, November 2016 Submission (1973-2014) <Katrina/Rita Population Adjustment> Released April 2017 (Ref. 9). Case frequency and incidence data, derived from the SEER program, were used to design the table format and number of pages for this report.\u0000 Results.— In a total of 83,658 cases of esophageal cancer in the United States for diagnosis years 1973-2014, multiple variables of age, sex, race, stage, grade, cohort entry time-period, disease duration, and, two histologic oncotypes were compared. Mean age in males was 66.5 years, females 70.1 years, both male and female 67.2 years. Greater than 85% of incidence cases occurred between ages 55-85+ years with the zenith in males at 65-69 years (59.4%) and 70-74 years (60.5%) in females. The overall annual US death rate from 1975-2014 has slightly increased from 3.69 to 3.99 per 100,000 per year, and excess mortality remains exceedingly high. Of the 83,658 invasive cases, 82.6% were clinically staged and 79.4% were histologically graded.\u0000 Conclusions.— Relative frequency, incidence and time-trends, and the clinical, demographic and secular variables of age, sex, race, stage, grade, cohort-entry time-periods, and predominant clinical oncotypes were comparatively analyzed to provide a comprehensive medical-actuarial assessment of esophageal cancer survival and mortality in the 1973-2014 time-frame.","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43261896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.17849/insm-48-2-1-11.1
K. Moodley, C. Cancelliere, R. Power, Pierre Côté
Background.— In the Ontario automobile insurance system, claims adjusters decide whether to approve, partially approve or deny funding for clinical interventions submitted by healthcare practitione...
{"title":"Evidence-based Claims Adjudication of Traffic Injury Claims in Ontario: Shifting the Focus from Cost to Care","authors":"K. Moodley, C. Cancelliere, R. Power, Pierre Côté","doi":"10.17849/insm-48-2-1-11.1","DOIUrl":"https://doi.org/10.17849/insm-48-2-1-11.1","url":null,"abstract":"Background.— In the Ontario automobile insurance system, claims adjusters decide whether to approve, partially approve or deny funding for clinical interventions submitted by healthcare practitione...","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"48 1","pages":"154-164"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67475740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.17849/INSM-48-2-136-143.1
Ahmed Okba
Objectives.—To assess mortality and survival analysis for patients with hairy cell leukemia, taking into consideration the effect of new therapies. Background.—Hairy cell leukemia (HCL) is a chroni...
{"title":"Hairy Cell Leukemia – A Mortality Analysis","authors":"Ahmed Okba","doi":"10.17849/INSM-48-2-136-143.1","DOIUrl":"https://doi.org/10.17849/INSM-48-2-136-143.1","url":null,"abstract":"Objectives.—To assess mortality and survival analysis for patients with hairy cell leukemia, taking into consideration the effect of new therapies. Background.—Hairy cell leukemia (HCL) is a chroni...","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"48 1","pages":"136-143"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67475800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.17849/INSM-48-2-144-148.1
Alacia J Tarpley
Medical directors of life and disability companies need to be aware of CRISPR technology and how it has beneficial and potential detrimental impacts to our industry. Clustered Interspaced Short Pal...
{"title":"CRISPR Technology Cracking into Creation","authors":"Alacia J Tarpley","doi":"10.17849/INSM-48-2-144-148.1","DOIUrl":"https://doi.org/10.17849/INSM-48-2-144-148.1","url":null,"abstract":"Medical directors of life and disability companies need to be aware of CRISPR technology and how it has beneficial and potential detrimental impacts to our industry. Clustered Interspaced Short Pal...","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"48 1","pages":"144-148"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67475811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-11-20DOI: 10.17849/insm-48-1-1-1.1
R. Philibert, Shelly Miller, A. Noel, Kelsey Dawes, E. Papworth, Donald W. Black, S. Beach, J. Long, J. Mills, Meeshanthini V Dogan
Background.-Heavy alcohol consumption (HAC) is a shared concern of the forensic, medical and insurance underwriting communities. Unfortunately, there is a relative lack of clinically employable tools for detecting HAC and monitoring treatment response. Building on the results of 3 genome wide methylation studies, we have previously shown in a small group of samples that methylation sensitive digital PCR assays (MSdPCR) have the potential to accurately classify individuals with respect to HAC in a small set of individuals. Objective.-We now expand on those earlier findings using data and biomaterials from 143 participants with current HAC and 200 abstinent controls. Results.-We show that a set of 4 digital PCR assays that have a receiver operating characteristic (ROC) area under the curve (AUC) of 0.96 for detecting those with HAC. After a mean of 21 days of inpatient enforced abstinence, methylation status at one of these markers, cg04987734, began to revert to baseline values. Re-examination of methylation data from our smaller 2014 study with respect to this locus demonstrated a similarly significant reversion pattern at cg04987734 in association with treatment enforced abstinence. Conclusions.-We conclude that clinically implementable dPCR tools can sensitively detect the presence of HAC and that they show promise for monitoring alcohol treatment results. These dPCR tools could be useful to clinicians and researchers in monitoring those enrolled in substance use disorder treatment, employee wellness programs and insurance underwriting.
{"title":"A Four Marker Digital PCR Toolkit for Detecting Heavy Alcohol Consumption and the Effectiveness of Its Treatment.","authors":"R. Philibert, Shelly Miller, A. Noel, Kelsey Dawes, E. Papworth, Donald W. Black, S. Beach, J. Long, J. Mills, Meeshanthini V Dogan","doi":"10.17849/insm-48-1-1-1.1","DOIUrl":"https://doi.org/10.17849/insm-48-1-1-1.1","url":null,"abstract":"Background.-Heavy alcohol consumption (HAC) is a shared concern of the forensic, medical and insurance underwriting communities. Unfortunately, there is a relative lack of clinically employable tools for detecting HAC and monitoring treatment response. Building on the results of 3 genome wide methylation studies, we have previously shown in a small group of samples that methylation sensitive digital PCR assays (MSdPCR) have the potential to accurately classify individuals with respect to HAC in a small set of individuals. Objective.-We now expand on those earlier findings using data and biomaterials from 143 participants with current HAC and 200 abstinent controls. Results.-We show that a set of 4 digital PCR assays that have a receiver operating characteristic (ROC) area under the curve (AUC) of 0.96 for detecting those with HAC. After a mean of 21 days of inpatient enforced abstinence, methylation status at one of these markers, cg04987734, began to revert to baseline values. Re-examination of methylation data from our smaller 2014 study with respect to this locus demonstrated a similarly significant reversion pattern at cg04987734 in association with treatment enforced abstinence. Conclusions.-We conclude that clinically implementable dPCR tools can sensitively detect the presence of HAC and that they show promise for monitoring alcohol treatment results. These dPCR tools could be useful to clinicians and researchers in monitoring those enrolled in substance use disorder treatment, employee wellness programs and insurance underwriting.","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45033035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Generally Speaking","authors":"","doi":"10.2307/j.ctvgs0bvb.9","DOIUrl":"https://doi.org/10.2307/j.ctvgs0bvb.9","url":null,"abstract":"","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68842501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-01-01DOI: 10.17849/insm-48-1-1-8.1
Timothy J. Meagher
Liquid biopsies hold great promise for the diagnosis and treatment of cancer. Earlier recognition of recurrent and metastatic disease and better treatment choices based on liquid biopsies seem achievable in the near future. However, earlier cancer diagnosis, the most heralded application, will remain the most challenging. The impact of liquid biopsies on life insurance will be positive. The impact on critical illness insurance will be more nuanced. It will depend on 2 factors: the success of liquid biopsies as cancer screening tests and the ability of an insurer to use "genetic information" during risk selection. In jurisdictions where use is prohibited, critical illness insurance, as presently designed, may not be sustainable.
{"title":"Liquid Biopsies and Critical Illness Insurance: Uncomfortable Bedfellows?","authors":"Timothy J. Meagher","doi":"10.17849/insm-48-1-1-8.1","DOIUrl":"https://doi.org/10.17849/insm-48-1-1-8.1","url":null,"abstract":"Liquid biopsies hold great promise for the diagnosis and treatment of cancer. Earlier recognition of recurrent and metastatic disease and better treatment choices based on liquid biopsies seem achievable in the near future. However, earlier cancer diagnosis, the most heralded application, will remain the most challenging. The impact of liquid biopsies on life insurance will be positive. The impact on critical illness insurance will be more nuanced. It will depend on 2 factors: the success of liquid biopsies as cancer screening tests and the ability of an insurer to use \"genetic information\" during risk selection. In jurisdictions where use is prohibited, critical illness insurance, as presently designed, may not be sustainable.","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49328384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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