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

This report summarizes the incidence, relative frequency distributions and survival & mortality by age, sex, stage and grade, of adult invasive primary cancers of the lip in two entrant time-periods as recorded in the SEER Program of the National Cancer Institute for diagnosis years 1973-2014 (SEER Stat 8.3.5). While the occurrence rates and frequency are low in the United States, they are exceptionally important from a clinical and surgical standpoint because of the morphological and functional changes involved.

Objective: -Explore the impact of proactive outreach to a health plan population during COVID-19 pandemic in New Mexico.

Background: -By March 2020, the 2019 novel coronavirus (COVID-19) was a global pandemic, circulating in more than 114 countries. As more information about virus transmission, symptoms, and comorbidities were reported over time, recommendations for reducing the spread of the virus within communities was provided by leading health organizations like the Centers for Disease Control and Prevention (CDC).

Methods: -Criteria were developed to identify health plan members most at risk for virus complications. Once members were identified, a health plan representative contacted each member to inquire about member needs, questions, and provide them with resources. Members were then tracked for COVID-19 testing results and vaccination status.

Results: -Overall, 50,000+ members received an outreach call (during 8-month timeframe), and 26,000 calls were tracked for member outcomes. Over 50% of the outreach calls were answered by the health plan member. Of the members who were called, 1186 (4.4%) tested positive for COVID-19. Health plan members that could not be reached represented 55% of the positive cases. A chi-square test of the two populations (reached vs unable to reach) showed a significant difference in COVID-19 positive test results (N = 26,663, X2(1) = 16.33, P<0.01).

Conclusions: -Community outreach was related to lower rates of COVID-19. Community connection is important, especially in tumultuous times, and proactive outreach to the community provides an opportunity for information sharing and community bonding.

This article summarizes the mortality associated with asthma and was created from a presentation given at the 130th AAIM Annual Meeting.

Detecting undisclosed methamphetamine and heroin abuse is a challenge for life underwriters and medical directors. A common clinical assumption is that if substance abusers experience liver damage, it will be indicated by elevated serum transaminases. The following case suggests that assumption may not be true for heavy substance abusers who consume no or minimal alcohol. This report describes a 44-year-old male with long-term use of inhaled combined methamphetamine and heroin ("speedballs") and minimal alcohol use, whose transaminases remained normal while episodes of acute liver failure and transient hepatic encephalopathy from hyperammonemia were observed. In this case, a fatal motor vehicle accident occurred following the sudden onset of hepatic encephalopathy hours after consuming a "speedball." Normal transaminases may not be proof of a normal healthy liver among methamphetamine and heroin abusers.

Critical illness insurance was introduced 40 years ago. Medical directors continue to be challenged and frustrated with the complexities that critical illness claims offer. This article provides insights into the continued issues and possible solutions.

This article summarizes the morbidity and mortality associated with COPD and was created from a presentation given at the 130th AAIM Annual Meeting. The author reviews what most medical directors already know about COPD, but with particular attention paid to the Pulmonary Function Tests dealing with spirometry. Underwriters and medical directors need to understand the three basic measurements of spirometry (FVC, FEV1, and FEF25-75), as well as the significance of the FEV1/FVC ratio, in establishing an applicant as having an obstructive or restrictive impairment.

Objectives: -Determine the relationship between liver function test (LFT) results (GGT, alkaline phosphatase, AST, ALT and albumin) and all-cause mortality in life insurance applicants.

Method: -By use of the Social Security Master Death File, mortality was examined in 15,272,955 insurance applicants for whom blood samples were submitted to the Clinical Reference Laboratory. There were 268,593 deaths observed in this study population, after an average follow-up time of 10.9 years. Results were stratified by sex and by age less/greater than 60, creating 4 groups. Liver function test values were grouped using percentiles of their distribution within these age/ sex groups - so as to update the results generated in prior publications. Additional models were fit using different exclusions and percentile groups within single year age groups. Also, LFTs were treated as continuous variables and included in Cox models with age and smoking status.

Results: -Using the risk of the middle 50% of the population by distribution as a reference, relative mortality observed for GGT and alkaline phosphatase was linear with a steep slope from very low to high values. AST showed a J-shaped association with mortality. ALT showed a low-magnitude inverse correlation with mortality. Albumin demonstrated a higher-magnitude inverse correlation with mortality, especially at values below the median. The overall risk associated with LFTs was durable over at least 10 years of follow-up.

Conclusion: -Liver function tests show a strong and durable correlation to mortality in a large group of insurance applicants. The durability over time suggests that even older values of LFTs found in medical records could be of use in mortality risk prediction.

This article summarizes the results of a retrospective population-based cohort study using the statistical database of SEER*Stat 8.3.54 (produced 3/5/2018 for diagnosis years 1973-2014) to assess, determine, compare, and summarize the occurrence, long-term survival, and mortality indices of 218,066 patients with oral cavity and pharynx cancers by age, sex, race, stage, grade, and disease duration.