All-Cause Mortality for Life Insurance Applicants with a History of Prostate Cancer

Objective. – To determine the all-cause mortality of life insurance applicants diagnosed with prostate cancer currently or at some time in the past. Background. – Prostate cancer is common and a frequent cause of cancer death. Both the frequency of prostate cancer in men and its propensity for causing premature mortality require insurance company medical directors and underwriters to have a good understanding of prostate cancer-related mortality trends, patterns, and outcomes in the insured population. Methodology. – Life insurance applicants with reported prostate cancer were extracted from data covering United States residents between November 2007 and November 2014. Information about these applicants was matched to the Social Security Death Master (SSDMF) file for deaths occurring from 2007 to 2011 and to another commercially available death source file (Other Death Source, ODS) for deaths occurring from 2007 to 2014 to determine vital status. Actual to Expected (A/E) mortality ratios were calculated using the Society of Actuaries 2015 Valuation Basic Table (2015VBT), select and ultimate table (age last birthday) and the 2013 US population as expected mortality ratios. All expected bases were not smoker distinct. Results. – The study covered applicants between the ages of 45 and 75 and had approximately 405,000 person-years of exposure. Older aged applicants had a lower mortality ratio than those who were younger. Applicants 45 to 54 had the highest mortality ratios in the first year after diagnosis which steadily decreased in years 6 to 10 with an increase in the mortality ratio for those over 10 years from diagnosis. Relative mortality rate was close to unity for those with localized cancer across all age groups. The mortality ratio was 2 to 4 times greater for those with cancer in 1 positive node, and much greater with 3 positive nodes. For each time-from-diagnosis category, the relative mortality ratios compared to age were highest in the 45–54 age group. The A/E mortality ratios based on the 2015VBT were consistently 3 to 4 times that of the mortality ratios based on the 2013 US population. Conclusion. – The mortality patterns of insurance applicants with prostate cancer were similar to that observed in individuals with prostate cancer in the general population. Applicant age, time to diagnosis and cancer severity were the most significant variables to predict mortality.

Download Full-text

All-Cause Mortality for Life Insurance Applicants with the Presence of Bundle Branch Block

Journal of Insurance Medicine ◽

10.17849/insm-48-1-1-12.1 ◽

2019 ◽

Vol 48 (1) ◽

pp. 36-47

Author(s):

Stephen A Freitas ◽

Ross MacKenzie ◽

David N Wylde ◽

Jason Von Bergen ◽

J. Carl Holowaty ◽

...

Keyword(s):

Right Bundle Branch Block ◽

Life Insurance ◽

Confidence Bands ◽

Comorbid Condition ◽

Bundle Branch Block ◽

All Cause Mortality ◽

Cardiac Condition ◽

Mortality Ratio ◽

Long Term Prognosis ◽

Expected Mortality

Objective.—To determine the all-cause mortality of life insurance applicants who have a bundle branch block. Background.—Bundle branch block is an electrocardiographic pattern that has variable prognostic implications. Research studies have shown that both left and right bundle branch block are associated with increased mortality among cases that have heart disease. In the general population and life insurance applicant population, the prevalence of bundle branch block is relatively low, and its effects on long-term prognosis are not as well established. Methodology.—Life insurance applicants with reported bundle branch block were extracted from data covering United States residents between October 2009 and October 2016. Information about these applicants was matched to the Social Security Death Master (SSDMF) file for deaths occurring from 2009 to 2012 and to another commercially available death source file (Other Death Source, ODS) for deaths occurring from 2009 to 2016 to determine vital status. Actual to expected (A/E) mortality ratios were calculated using the Society of Actuaries 2015 Valuation Basic Table (2015VBT), select and ultimate table (age last birthday). All expected bases were not smoker distinct. Confidence bands around these mortality ratios were calculated. The variables of interest were applicant age, gender, location of the bundle branch block, and the presence of cardiac or cardiovascular conditions. Results.—There were 258,529.85 person-years exposure for applicants with bundle branch block. Of the applicants, 57.2% had right bundle branch block. Of person-years exposure, 11.5% had a cardiac condition along with the bundle branch block, and 4.4% had an underlying cardiovascular condition. Female mortality ratios were higher than those for males, but due to the low number of deaths, this difference was not significant. Left bundle branch block mortality ratios (1.01) were 1.4 times higher than those with right (0.74). Those applicants with a cardiac condition along with their bundle branch block had between 1.6 to 1.8 times the mortality ratio depending on the bundle branch block location, and those with a cardiovascular condition had between 1.5 to 1.7 times the mortality ratio over those applicants with just bundle branch block alone. Conclusion.—The presence of bundle branch block in an insurance applicant may be associated with increased all-cause mortality. In this study, life insurance applicants overall had a mortality slightly lower than the expected mortality based on the 2015 VBT. However, applicants with bundle branch block and a cardiac or cardiovascular comorbid condition had a significantly higher mortality ratio.

Download Full-text

All-Cause Mortality for Life Insurance Applicants with a History of Breast Cancer

Journal of Insurance Medicine ◽

10.17849/insm-47-01-6-22.1 ◽

2017 ◽

Vol 47 (1) ◽

pp. 6-22 ◽

Cited By ~ 1

Author(s):

Stephen A Freitas ◽

Ross MacKenzie ◽

David N Wylde ◽

Bradley T Roudebush ◽

Richard L Bergstrom ◽

...

Keyword(s):

Breast Cancer ◽

United States ◽

Life Insurance ◽

Smoking Status ◽

Fold Increase ◽

The United States ◽

Age Group ◽

Relative Mortality ◽

All Cause Mortality ◽

Mortality Ratio

Breast cancer is the most commonly diagnosed cancer worldwide. Breast cancer is also the second leading cause of cancer death among women in the United States after lung cancer with over 40,000 breast cancer deaths occurring each year. The purpose of this research was to determine the all-cause mortality of applicants diagnosed with breast cancer currently or at some time in the past. Life insurance applicants with reported breast cancer were extracted from data covering United States residents between November 2007 and November 2014. Information about these applicants was matched to the Social Security Death Master (SSDMF) file for deaths occurring from 2007 to 2011 and to another commercially available death source file (Other Death Source, ODS) for deaths occurring from 2007 to 2014 to determine vital status. If there was a death from the other death source, then the SSDMF was searched to verify the death. The study had approximately 561,000 person-years of exposure. Actual-to-expected (A/E) mortality ratios were calculated using the Society of Actuaries 2008 Valuation Basic Table (2008VBT), select and ultimate table (age last birthday) and the 2010 US population as expected mortality ratios. Since the A/Es presented in this paper were known to be an underestimate due to the exclusion of the recent SSDMF deaths, comparative analysis of the mortality ratios was done. Since there was no smoking status information in this study, all expected bases were not smoker distinct. Overall, the 35-44 age group had 6.3 times the relative mortality ratio than those in the 65-75 age group. The relative mortality ratio for the 35-44 age group applicants, when cancer severity was accounted for in combination with 3 or more nodes of cancer involvement, was 29.3 times that when compared to those in the 65-75 age group having localized cancer, where no nodes are involved. The 35-44 age group applicants who were diagnosed with cancer within the last year had over 10-fold increase in relative mortality ratios compared to the 65-75 age group, who were over 10 years from diagnosis. Taking the severity of cancer along with time from diagnosis showed over a 12 times relative mortality ratio between the low rate of over 10 years from diagnosis and localized involvement to those diagnosed within the last year having 3 or more nodes with cancer. Applicant age, time since diagnosis and cancer severity were the most significant variables to predict the relative mortality ratios.

Download Full-text

Estimation of Excess Mortality and Years of Life Lost to COVID-19 in Norway and Sweden between March and November 2020

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18083913 ◽

2021 ◽

Vol 18 (8) ◽

pp. 3913

Author(s):

Martin Rypdal ◽

Kristoffer Rypdal ◽

Ola Løvsletten ◽

Sigrunn Holbek Sørbye ◽

Elinor Ytterstad ◽

...

Keyword(s):

Excess Mortality ◽

Age Groups ◽

Years Of Life Lost ◽

Regressive Model ◽

Epidemic Period ◽

All Cause Mortality ◽

Auto Regressive ◽

Expected Mortality ◽

Auto Regressive Model ◽

Excess Deaths

We estimate the weekly excess all-cause mortality in Norway and Sweden, the years of life lost (YLL) attributed to COVID-19 in Sweden, and the significance of mortality displacement. We computed the expected mortality by taking into account the declining trend and the seasonality in mortality in the two countries over the past 20 years. From the excess mortality in Sweden in 2019/20, we estimated the YLL attributed to COVID-19 using the life expectancy in different age groups. We adjusted this estimate for possible displacement using an auto-regressive model for the year-to-year variations in excess mortality. We found that excess all-cause mortality over the epidemic year, July 2019 to July 2020, was 517 (95%CI = (12, 1074)) in Norway and 4329 [3331, 5325] in Sweden. There were 255 COVID-19 related deaths reported in Norway, and 5741 in Sweden, that year. During the epidemic period of 11 March–11 November, there were 6247 reported COVID-19 deaths and 5517 (4701, 6330) excess deaths in Sweden. We estimated that the number of YLL attributed to COVID-19 in Sweden was 45,850 [13,915, 80,276] without adjusting for mortality displacement and 43,073 (12,160, 85,451) after adjusting for the displacement accounted for by the auto-regressive model. In conclusion, we find good agreement between officially recorded COVID-19 related deaths and all-cause excess deaths in both countries during the first epidemic wave and no significant mortality displacement that can explain those deaths.

Download Full-text

All-Cause Mortality for Life Insurance Applicants with a Family History of Coronary Artery Disease Before 60

Journal of Insurance Medicine ◽

10.17849/insm-47-03-159-171.1 ◽

2018 ◽

Vol 47 (3) ◽

pp. 159-171

Author(s):

Stephen A. Freitas ◽

Ross MacKenzie ◽

David N. Wylde ◽

Jason Von Bergen ◽

J. Carl Holowaty ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Family History ◽

Life Insurance ◽

Family Members ◽

Comorbid Condition ◽

All Cause Mortality ◽

Mortality Ratio ◽

History Of ◽

Artery Disease

Objective.—To determine the all-cause mortality of life insurance applicants having a family history of coronary artery disease (CAD) before age 60. Background.—Epidemiological studies have shown that a family history of premature CAD is an independent risk factor for CAD events. The strength of the association between family history and CAD is greatest with earlier age of presentation of CAD in the family member and when multiple family members are affected. Despite earlier insurance studies on this relationship, there is sparse current data on the association between family history of CAD and all-cause mortality in life insurance applicants. Methodology.—Life insurance applicants with reported family history of Coronary Artery Disease (CAD) were extracted from data covering United States residents between October 2009 and October 2016. Information about these applicants was matched to the Social Security Death Master (SSDMF) file for deaths occurring from 2009 to 2012 and to another commercially available death source file (Other Death Source, ODS) for deaths occurring from 2009 to 2016 to determine vital status. Actual to Expected (A/E) mortality ratios were calculated using the Society of Actuaries 2015 Valuation Basic Table (2015VBT), select and ultimate table (age last birthday). All expected bases were not smoker distinct. Confidence bands around these mortality ratios were calculated. The variables of interest were applicant age, gender, number of family members with CAD before age 60, and the presence of cardiac or cardiovascular conditions. Results.—Overall, the mortality of applicants with family members with a history of CAD before age 60 was slightly lower than expected mortality based on the 2015 VBT. Applicants with a cardiac or cardiovascular comorbid condition had a significantly higher mortality ratio. For applicants aged 25-54 and 65-75 with cardiac comorbid conditions, the mortality ratio was 2 times that of those without a cardiac comorbid condition. For those aged 55-64 with cardiovascular comorbid conditions, the mortality ratio was 2.9 times that of those without a cardiovascular comorbid condition. Females had a slightly higher mortality ratio for all age groups, number of family members with CAD before age 60, and cardiovascular conditions. Conclusion.—A family history of CAD before the age of 60 in an insurance applicant may be associated with increased all-cause mortality. Overall in this study, life insurance applicants had a mortality slightly lower than the expected mortality based on the 2015 VBT. However, applicants with a positive family history and a cardiac or cardiovascular comorbid condition had a significantly higher mortality ratio.

Download Full-text

All-Cause Mortality for Diabetics or Individuals with Hyperglycemia Applying for Life Insurance

Journal of Insurance Medicine ◽

10.17849/0743-6661-46.1.2 ◽

2016 ◽

Vol 46 (1) ◽

pp. 2-12 ◽

Cited By ~ 2

Author(s):

Stephen A. Freitas ◽

Ross MacKenzie ◽

David N. Wylde ◽

Bradley T. Roudebush ◽

Richard L. Bergstrom ◽

...

Keyword(s):

Life Insurance ◽

Smoking Status ◽

Full Cohort ◽

Source File ◽

Vital Status ◽

The Social ◽

The Us ◽

Mortality Ratio ◽

Expected Mortality ◽

Death Cases

Diabetics and individuals with lab results consistent with a diagnosis of diabetes or hyperglycemia were extracted from data covering US residents who applied for life insurance between January 2007 and January 2014. Information about these applicants was matched to the Social Security Death Master File (SSDMF) and another commercially available death source file to determine vital status. Due to the inconsistencies of reporting within the death files, there were two cohorts of death cases, one including the imputed year of birth (full cohort of deaths), and the second where the date of birth was known (reduced cohort of deaths). The study had approximately 8.5 million person-years of exposure. Actual to expected (A/E) mortality ratios were calculated using the Society of Actuaries 2008 Valuation Basic Table (2008VBT) select table, age last birthday and the 2010 US population as expected mortality rates. With the 2008VBT as an expected basis, the overall A/E mortality ratio was 3.15 for the full cohort of deaths and 2.56 for the reduced cohort of deaths. Using the US population as the expected basis, the overall A/E mortality ratio was 0.98 for the full cohort of deaths and 0.79 for the reduced cohort. Since there was no smoking status information in this study, all expected bases were not smoker distinct. A/E mortality ratios varied by disease treatment category and were considerably higher in individuals using insulin. A/E mortality ratios decreased with increasing age and took on a J-shaped distribution with increasing BMI (Body Mass Index). The lowest mortality ratios were observed for overweight and obese individuals. The A/E mortality ratio based on the 2008VBT decreased with the increase in applicant duration, which was defined as the time since initial life insurance application.

Download Full-text

Prostate Cancer Screening in Men of African Descent: 15-year Results of the Tobago Prostate Cancer Survey

West Indian Medical Journal ◽

10.7727/wimj.2016.312 ◽

2018 ◽

pp. 334-343

Author(s):

AL Patrick ◽

JB Nelson ◽

JL Weissfeld ◽

R Dhir ◽

RJ Phillips ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Screening ◽

Prostate Cancer Screening ◽

African Descent ◽

Specific Antigen ◽

Age Groups ◽

Radical Retropubic Prostatectomy ◽

Survival Curves ◽

All Cause Mortality

Objective: To compare all-cause-mortality in screening-detected prostate cancer cases versus non-cases after a median 12.2-year follow-up. Methods: In this prospective, population-based study of 3089 Afro-Caribbean men aged 40–79 years in Tobago, Trinidad and Tobago, West Indies, all men were screened for prostate cancer (serum prostate specific antigen and/or digital rectal exam) one to three times between 1997 and 2007 and followed for mortality to 2012. Among 502 men diagnosed with prostate cancer, 81 younger men underwent radical retropubic prostatectomy. Minimal treatment was available for older men. Survival curves compared all-cause-mortality in cases versus non-cases within 10-year age groups at first screening. Results: There were 350 all-cause-deaths over 34 089 person-years of follow-up. All-cause-survival curves in men aged 60 years or above at first screening did not diverge between cases and non-cases until after 10–12 years of follow-up (p > 0.36). In contrast, among men first screened at age 50–59 years, survival was lower in cases, with survival curves diverging at seven years (p = 0.003). Survival in men aged 50–59 years who underwent prostatectomy was similar to survival in non-cases (p = 0.63). Conclusion: Among men aged 60 years or above, the absence of excess all-cause-mortality among screening-detected prostate cancer cases provides argument against the utility of routine prostate cancer screening in this older population of African descent. However, the significantly poorer survival in men aged 50–59 years with screening-detected prostate cancer, compared with screened men without prostate cancer, along with the potential for prostate cancer treatment to improve survival, supports the continuation of prostate cancer screening in this age group, pending further research to assess the risks and benefits.

Download Full-text

Estimation of Years of Life Lost by Sweden's Relaxed COVID-19 Mitigation Strategy

10.21203/rs.3.rs-125934/v1 ◽

2020 ◽

Author(s):

Martin Rypdal ◽

Kristoffer Rypdal ◽

Ola Løvsletten ◽

Sigrunn Sørbye ◽

Elinor Ytterstad ◽

...

Keyword(s):

Excess Mortality ◽

Age Groups ◽

Years Of Life Lost ◽

Life Years ◽

Epidemic Period ◽

All Cause Mortality ◽

Auto Regressive ◽

Life Years Lost ◽

Expected Mortality ◽

Auto Regressive Model

Abstract Objective: To estimate the weekly excess all-cause mortality in Norway and Sweden, and to estimate the years of life lost (YLL) attributed to COVID-19 in Sweden and the significance of mortality displacement. Methods: We found expected mortality by taking the declining trend and the seasonality in mortality into account. From the excess mortality in Sweden in 2019/20, we estimated the YLL attributed to COVID-19 using the life expectancy in different age groups. We adjusted this estimate for possible displacement using an auto-regressive model for the year-to-year variations in excess mortality. Results: We found that excess all-cause mortality over the epidemic year (July to July) 2019/20 was 517 (95%CI -12, 1074) in Norway and 4329 (3331, 5325) in Sweden. There were reported 255 COVID-19 related deaths in Norway, and 5741 in Sweden, that year. During the epidemic period March 11 – November 11, there were 6247 reported COVID-19 deaths and 5517 (4701, 6330) excess deaths in Sweden. The estimated number of life-years lost attributed to the more relaxed Swedish strategy was 45850 (13915, 80276) without adjusting for mortality displacement and 43073 (12160, 85451) after adjusting for possible displacement.

Download Full-text

Premature Mortality of Gastrointestinal Cancer in Iran: Trends and Projections for 2001–2030

10.21203/rs.2.13926/v4 ◽

2020 ◽

Author(s):

Fatemeh Khosravi Shadmani ◽

Farshad Farzadfar ◽

Moein Yoosefi ◽

Kamyar Mansori ◽

Reza Khosravi Shadman ◽

...

Keyword(s):

Mortality Rate ◽

Age Groups ◽

Premature Mortality ◽

Mortality Rates ◽

Mortality Trends ◽

Control Plan ◽

Liver Cancers ◽

Colon And Rectum ◽

Gi Cancers ◽

Overall Mortality

Abstract Background: The present study was conducted to determine the trend and projection of premature mortality from gastrointestinal cancers (GI cancers) at national and subnational levels in Iran.Methods: Employing the data obtained from Iranian Death Registry System (DRS) and population data from census, the mortality rates of GI cancers was calculated among 30-70 age groups. The trends of esophageal, colon and rectum, gallbladder, pancreases, stomach, and liver cancer premature mortalities were estimated and projected at the national and subnational levels from 2001 to 2030. Then, Spatio-temporal model was used to project spatial and temporal correlations. Results: The overall mortality rate of GI cancers was higher in males than in females, indicating 6.1, 3.9 and 3.9 percent per 100000 individuals among males in 2001, 2015 and 2030 respectively and 3.8, 3.1 and 3.7 per 100000 individuals among females in the same time-frame. The overall mortality rate of GI cancers in males was decreasing until 2015 and will remain stationary into 2030; however, the rate will be increasing among females in both time-frames. Also, there was a considerable variation in the mortality trends of different cancers. Pancreatic, gallbladder, and liver cancers were shown to have an increasing trend while a drop was observed in the mortality rates of stomach, colon and rectum, and esophageal cancers. Conclusion: Variation of GI cancers patterns and trends around the country indicated that a more comprehensive control plan is needed to include the predicted variations.

Download Full-text

Premature Mortality of Gastrointestinal Cancer in Iran: Trends and Projections for 2001–2030

10.21203/rs.2.13926/v3 ◽

2020 ◽

Author(s):

Fatemeh Khosravi Shadmani ◽

Farshad Farzadfar ◽

Moein Yoosefi ◽

Kamyar Mansori ◽

Reza Khosravi Shadman ◽

...

Keyword(s):

Mortality Rate ◽

Age Groups ◽

Premature Mortality ◽

Mortality Rates ◽

Mortality Trends ◽

Control Plan ◽

Liver Cancers ◽

Colon And Rectum ◽

Gi Cancers ◽

Overall Mortality

Download Full-text

Tuesday Evening

PMLA ◽

10.1017/s0030812900130524 ◽

1935 ◽

Vol 50 (4) ◽

pp. 1357-1357

Keyword(s):

Life Insurance ◽

Insurance Company ◽

Life Insurance Company ◽

Local Committee ◽

Tuesday Evening

On Tuesday evening the members of the Association, and attending members of their families, were entertained with a buffet supper at the Queen City Club at 7:30 p.m. at the invitation of Messrs. Joseph S. Graydon, John J. Rowe, and other Cincinnati friends of the Association. Following this supper an entertainment arranged by the Local Committee was presented in the Hall of the Western and Southern Life Insurance Company. Attendance: about 900.

Download Full-text