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PubMed1990

Body weight and longevity: insurance experience in Japan.

Adverse effects of obesity on health and longevity are widely known in clinical medicine. The author reports here the result of a study on the relationship of body weight and longevity based on the data obtained by the life insurance cohort study in which he participated. The result is summarized below: 1. Mortality by body weight assumed a U-shaped curve with the nadir near the average weight for both men and women. 2. Because the mortality for some causes went upward toward right or reverse with the shift from underweight to overweight, the curve for all-cause mortality became U-shaped. 3. The relationship between hospitalization ratio and body weight showed substantially the same trend although the cause for hospitalization varied. 4. The body weight showing the lowest mortality was slightly heavier than the average body weight in Japan, which was different from North America. 5. Based on Metropolitan Life's principle of lowest mortality, we published Meiji Life's height and weight tables in order to set the standard body weight for the Japanese today.

Body Weight↗
PubMed2000

An assessment of the wealth holdings of recent widows.

OBJECTIVES: This study examines the wealth holdings of recent widows, how they compare to those of married couple households, and the potential to use this wealth to augment the incomes of widowed women. METHODS: Data from the Survey of Income and Program Participation are used to investigate the amount and composition of wealth held by four different groups: always married women, about-to-be-widowed women, recent widows, and long-standing widows. Regression analyses assess the impact of group membership on wealth holding controlling for other sociodemographic factors, and annuity calculations assess the potential for wealth to augment income. RESULTS: About-to-be widowed women have fewer assets than intact couples, and there is a further decline in assets at the time of the husbands' deaths and in the ensuing period. Estimates of the annuity value of widows' wealth show that its liquidation would do little to improve the economic situation of the poorest widows. DISCUSSION: These findings parallel what is known about income changes that surround the death of a spouse. They also point to the need for additional research on the relationship between wealth holdings and mortality as well as the roles that health care costs, life insurance, and bequests may play in altering widows' wealth.

Aged↗
PubMed1983

Recent supreme court antitrust rulings in health care.

Three recent U.S. Supreme Court antitrust rulings that influence the health-care delivery system are examined. Historically four defenses protected the health-care system from antitrust law. They are the learned-profession exemption, the fact that health-care systems have little effect on interstate commerce, the state-action defense, and the business-of-insurance exemption under the McCarran-Ferguson Act. These defenses and Supreme Court cases that have weakened or eliminated them are described. The cases are Arizona v. Maricopa County Medical Society, Union Labor Life Insurance Co. v. Pireno, and Blue Shield of Virginia v. McCready. Health-care providers will be subject to increased antitrust scrutiny as a result of these cases.

Arizona↗
PubMed1997

[Ethical problems in molecular genetics and their reflection in clinical medicine].

There are at least two groups of issues connected with an impact of a realization of the "Human Genome Project": a) philosophical; b) ethical, which can be divided into four groups: 1) the influence of DNA technologies on everyday applications of bioethical principles; 2) ethical aspects of genetic diversity; 3) ethical aspects of genetic screening; 4) somatic and germ-cell gene therapy; Unlike essential philosophical issues practical realization of issues in question can be largely expressed as only revitalization of old ones and concerns: the principle of justice-equal access and priorities; protection of reproductive choices; disclosure to patients and to relatives at genetic risk (disclosure and exclusion tests); prenatal diagnosis for "mild to moderate" diseases with and without genetic indication-commercialization; insurance policy; non-directive and directive genetic counseling. Maybe there are regional and other differences, but in practice, the main ethical issues are likely to involve screening for genetic risk of common diseases of adult life e.g. hypertension, diabetes, gout, dyslipoproteinemia, genes for premature atherosclerosis, etc. because of the possible direct impact on a patient, an implication for life-insurance, employers and commercial exploitation.

Ethics, Medical↗
PubMedDate not supplied

BC appellate court dismisses insurance appeal.

As reported in the last issue of the Newsletter, in September 1997 a British Columbia trial court had dismissed a "wrongful dismissal" claim by the estate of a gay man who died of AIDS against his former employer for damages arising out of his termination, including the loss of his life insurance coverage. The man's estate appealed that decision to the BC Court of Appeal. The Canadian AIDS Society and the BC Persons with AIDS Society were denied leave to intervene before the appellate court to make submissions. The case was heard in October 1999 by the British Columbia Court of Appeal. In December 1999, the Court released its judgment dismissing the appeal.

Acquired Immunodeficiency Syndrome↗
PubMed2002

[Survival of children born with cerebral palsy. Children born 1971-1986].

INTRODUCTION: Since 1967, children with cerebral palsy in Eastern Denmark have been registered in the Danish Cerebral Palsy Registry. We wanted to investigate the survival of Danish patients with cerebral palsy and examine different factors that influence on survival. We also compared the survival rate with that of the background population. MATERIAL AND METHODS: All patients in the Cerebral Palsy Register, born between 1971 and 1986, were included in our study cohort. We examined the influence of the following factors on the survival of persons with cerebral palsy: sex, epilepsy, type of cerebral palsy, mental retardation, functional disability, birth year, and birth weight. Each factor was tested with Cox regression. RESULTS: Seventy-seven of the 1093 persons included (7%), died before September 1997. Our study showed that survival was associated with the type of cerebral palsy, epilepsy, mental retardation, and the degree of functional disability. Surprisingly, birth year and birth weight had no influence on survival. Persons with cerebral palsy had a lower survival rate than the background population. However, there was no significant difference between cerebral palsy persons with walking abilities, and the background population. DISCUSSION: Compared to earlier studies, the survival rate seems to have improved. The Danish cerebral palsy patients had a survival as good as, and maybe even better, than that of cerebral palsy patients from other countries. Persons with low functional disabilities had a survival rate comparable to that of the background population, a finding that may be relevant in regard to life insurance.

Adolescent↗
PubMedDate not supplied

Heart disease as a cause of death in insured Swedish dogs younger than 10 years of age.

BACKGROUND: Population-based information on disease occurrence is paramount in clinical decision making and in designing preventative measures, but such information is scarce. HYPOTHESIS: The risk of cardiac death is higher in certain breeds and mortality varies by age and sex. DOGS: Dogs that were life insured by an animal insurance company between 1995 and 2002. METHODS: The mortality pattern for heart disease in insured dogs up to 10 years of age was studied. The influences of sex, age, breed, month, and geographic location were investigated by means of incidence rates, proportions, and survival proportions. Cox proportional hazards regression was used to model time to heart disease. RESULTS: 405,376 dogs contributed to a denominator of 1,431,933 dog-years at risk (DYAR) and 3,049 dogs had been assigned a cardiac-related diagnosis as cause of death. The cardiac-related mortality for dogs <10 years of age, was 21.3 deaths per 10,000 DYAR. This mortality in males and females was 27.3 deaths and 15.4 deaths per 10,000 DYAR, respectively. Twelve of 54 breeds had a point estimate above the overall rate. The 3 breeds with the highest point estimates were: Irish Wolfhounds, Cavalier King Charles Spaniels, and Great Danes (rates of 356, 247, and 179 deaths per 10,000 DYAR, respectively). CONCLUSIONS AND CLINICAL IMPORTANCE: Breed, age, and sex affect cardiac mortality in certain breeds of dogs, but no effects of month and geographic location were identified. These findings can assist clinicians in establishing diagnoses, and can assist breeders in defining priorities for preventative measures.

Age Factors↗
PubMed1986

The lifetime risks and costs of nursing home use among the elderly.

In this paper, we estimate the risk of an individual of entering a nursing home throughout the aging process. We then estimate the expected lifetime costs of nursing home use both for an individual and for society as a whole. The model is based on double-decrement life-table analysis. Data are taken from a 1977 survey of 4,400 Medicare beneficiaries. At age 65, the upper bound for the lifetime risk of entering a nursing home is 43.1%. The risk of entering a nursing home increases with age until around age 80. At about age 85, the risk begins to decline significantly. At almost all ages, the lifetime risk of entry for females is twice that of males. The expected lifetime costs of nursing home care across all ages are between $10,500 and $13,600. These costs are distributed very unequally. Only 13% of the elderly account for 90% of all nursing home expenditures. Given current life expectancy, the expected annual cost per person over age 65 is between $532 and $760. In the year 2000, the expected annual average costs of nursing home care per elderly person will range from $450 to $650. The decline in the average annual cost per person reflects shifts in the age structure and increased life expectancy. These figures need not represent an unmanageable burden on society's resources. Figures presented here help establish the feasibility and desirability of long-term care risk-sharing arrangements among the elderly, like long-term care insurance, life care communities, and other models.

Actuarial Analysis↗
PubMed2001

The first mortality follow-up study: the 1841 Report of William Farr (physician) on the mortality of lunatics.

BACKGROUND: In the 1830s in England, there was a great cultural interest in the collection and publishing of all kinds of statistics. The Council of the Statistical Society of London (founded in 1834) commissioned one of its Fellows, Dr William Farr, to investigate and prepare a report on the mortality of patients in the county asylums, with the mortality in a large number of proprietary houses that were licensed to care for patients with mental illness (then called lunatics) ordered for confinement because of their mental condition. Committees of Parliament had investigated the condition of the mentally ill confined to the asylums and taken measures in an attempt to improve their treatment and to correct abuses. RESULTS: Farr collected data from Hanwell, the Middlesex County asylum opened in 1831, and other asylums on annual admissions, resident patients, deaths, discharges, derived years of residence (exposure to risk), and annual mortality rates by duration and as an aggregate. He used similar data from a recent report on a large number of licensed houses. For the best estimate of comparative mortality, an assumed age distribution by sex and rates from the English Life Table No. 1 (constructed by Farr for 1841). CONCLUSION: Farr demonstrated that annual mortality rates were higher at durations 0-1.5 years than at durations 1.5-7.5 years, higher in men than in women, higher in paupers than in other patients, higher in licensed houses than in the Hanwell Asylum, and higher in the 4 large licensed houses than in a collection of smaller ones. COMMENT: A brief sketch of Farr's life is given as a memorial tribute to his pioneer work in vital statistics, life table methodology, public health, and life insurance medicine.

Adolescent↗
PubMed1980

The incidence and causes of death in a follow-up study of individuals with haemoglobin AS and AA.

A cohort of 574 black Adults (mean age 47 years with a range of 28-73 years) with sickle cell trait (haemoglobin AS) which had been age and sex matched with 1148 controls (haemoglobin AA) was monitored for 7 years. We found no evidence of excess mortality or differential causes of mortality between cases and controls. There were no case deaths related to kidney disease, splenic infarcts, or pregnancy. Reports in the literature have been inconsistent with regard to the health effects of sickle cell trait. These findings suggest that discrimination against trait carriers in terms of life insurance premiums and some job opportunities are unjustified.

Adolescent↗
PubMed2000

Parentage testing on blood crusts from firearms projectiles by DNA typing settles and insurance fraud case.

We describe a case of a fraudulent insurance claim. The family of an adult white male (DLF) notified the police of their son's disappearance. After a few weeks, a corpse that presented characteristics similar to those of the DLF was found in advanced stages of decay and was identified by the family as being DLF. The family then filed a claim for the life insurance that DLF had taken out just before he disappeared. Suspicions were raised about the identification of the corpse, because it had been done only visually, and because the insurance policy had been taken out just prior to DLF's disappearance. The insurance company requested a postmortem examination for identification. As the corpse had been cremated immediately after identification by the family, the biological material that was encrusted on the two projectiles removed from the body was used for analysis. The blood crusts provided enough genomic DNA for us to carry out PCR base typing of HLA-DQA1, D1S80, HUMCSF1PO, HUMTPOX, HUMTH01, D3S1744, D12S1090, D18S849, and amelogenin. Results from all loci typing from the corpse presumed to be that of DLF were then compared with that of his alleged biological parents, revealing genetic incompatibility.

Adult↗
PubMed1985

Economic security, 1935-85.

The economic well-being of both working and retired persons has improved significantly since the Social Security Act was passed in 1935. More people are employed now than at any time since then, despite declining employment among the aged and more years of school attendance among the young. The ratio of non-workers to workers--a broad measure of dependency--is lower now than at any time since the 1930's. Social security has grown and matured to become a strong foundation of retirement income, and other work-related employee benefits have grown in tandem with social security. Employer contributions for social insurance and related employee benefits have grown from being about a 1-percent supplement to aggregate wages and salaries in 1929 to nearly 20 percent today. Social security and Medicare account for just over a fourth of employer contributions, while other public and private retirement systems represent just over another fourth. The balance of benefits for active workers includes group health and life insurance, unemployment insurance, workers' compensation, temporary disability insurance, and related benefits. Pay for holidays, vacations, and sick leave is estimated to have increased from less than 1 percent of aggregate pay in 1929 to about 10 percent today. The improved economic status of the aged has been documented by a series of surveys beginning in 1941-42 and carried out from time to time until 1972 and biennially since 1976. The earlier surveys were supplemented with estimates from record data and tables from the Bureau of the Census. The income of the aged as a whole has grown by about 75 percent over the past 2 decades after taking inflation into account. The income of the aged as a whole grew faster than that of the nonaged in the 1970's and early 1980's when real social security benefits increased faster than inflation and wages lagged behind it. New beneficiaries in 1982 were in better health and were more likely to retire because they wanted to than was true of their counterparts in the early 1940's. Not only have benefits continued to be the main component of income of the aged as total incomes have grown, but also benefits have become much larger in relation to average earnings than used to be the case. Retired workers are much more likely now than in the early 1940's to have other pensions or income from assets to supplement benefits.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1996

Quality of life in breast cancer patients before and after autologous bone marrow transplantation.

The purpose of this study was to compare pre- and posttreatment quality of life (QOL) in breast cancer patients undergoing high-dose chemotherapy with autologous bone marrow transplantation (ABMT). Fifty-two female breast cancer patients were assessed on overall QOL, mood status, and social support before transplantation. After ABMT, 24 patients were assessed on the same measures as well as a measure of depressive symptoms and specific concerns identified in a structured interview. Mean pre- and post-transplant scores on the quality of life measure, mood scores and social support were not significantly different. Eight patients (33%) reported depressive symptoms post-transplantation. In the structured interview, a percentage of patients reported concerns in the following areas: job or work situation (25%); finances (42%); general physical health (50%); general frame of mind (25%); appearance (33%); health or life insurance (37%); personal or intimate physical relations (33%); planning for the future (38%). QOL and mood following ABMT improved slightly and compares favorably with breast cancer patients treated with conventional treatment. However, approximately 30% of patients had problems with sexuality, fatigue and depressive symptoms and may need follow-up psychosocial care in these areas. ABMT may pose no more threat to quality of life than conventional chemotherapy.

Adult↗
PubMed2006

[Carbohydrate-deficient transferrin as the marker of alcohol abuse].

The quantity of usual alcohol consumption is a fact that can be determined from the anamnesis of patients. In many cases patients do not inform their doctors in detail, in some cases they want to keep it a secret. The diagnosis of alcohol abuse based on objective data is a necessary requirement in clinical, insurance, as well as in forensic medicine. Among the different biomarkers of chronic alcohol abuse, carbohydrate-deficient transferrin is recognized world wide as the most reliable indicator. The authors review the pathomechanism of carbohydrate-deficient transferrin in the human organism, the methods for its measurement and its role in the diagnostic procedures of alcohol induced clinical diseases, as well as its decisive role for life insurance and in forensic medicine.

Alcohol Drinking↗
PubMed1989

Utilization management in the small group insurance market.

Small businesses are the most rapidly growing segment of the economy, providing one half of all jobs in the United States. The health insurance industry must address issues which are unique to this market. The health insurance product for small businesses must have simple administration for the owners and easy access to quality medical care for the employees. Small businesses have been adversely affected by the high cost of health care. Numerous studies have shown that a major factor contributing to the high cost of health care is inappropriate and unnecessary utilization of health care. Until recently, techniques of utilization management have been difficult to adapt to the small group market. The Celtic Life Insurance Company has been using a managed care fee for service arrangement for the past three years. Celtic has been able to tailor a program for small businesses and maintain complete administrative coordination, instead of contracting with a private utilization review company. Our program maintains freedom of choice of providers and easy access to health care, without limiting access to specialists. Cost containment features have assisted insureds in selecting appropriate health care, in the appropriate setting while not interfering with the doctor-patient relationship.

Economic Competition↗
PubMed2002

Disease-related difficulties and satisfaction with level of knowledge in adults with mild or complex congenital heart disease.

OBJECTIVES: To evaluate difficulties in daily life, and satisfaction with level of knowledge about their disease, in patients with congenital cardiac disease in order to improve counselling. METHODS: A self-administered questionnaire was completed by 80 patients with mild, and 76 with complex, congenital cardiac disease. They were aged from 17 to 32 years. RESULTS: Even patients with only mild malformations experienced difficulties related to their disease, but being found in only 11%, these were significantly less than those uncovered in 87% of those with complex disease (p < 0.001). Those patients with complex malformations frequently felt restricted in choices because of their disease in areas such as sport (59%), employment (51%), and education (34%). Other difficulties reported were: paying a higher premium for life insurance (29%), having to give up on a sport (28%), and being excluded from a job (18%). Depending on the item, between one-fifth and two-thirds of participants reported gaps in knowledge, most frequently for "causes of congenital cardiac disease", "future consequences", and "family planning". For 53% of those with mild anomalies, and 93% of severely affected patients, the cardiologist is the most important source of information. CONCLUSIONS: A minority of adults with mild, and a majority of those with complex congenital cardiac disease report difficulties in daily life. A substantial number of these patients feel that they have an inadequate level of knowledge about their disease. Our results suggest the need for a specific programme of counselling.

Activities of Daily Living↗
PubMed2005

Forecasting Spanish natural life expectancy.

Knowledge of trends in life expectancy is of major importance for policy planning. It is also a key indicator for assessing future development of life insurance products, substantiality of existing retirement schemes, and long-term care for the elderly. This article examines the feasibility of decomposing age-gender-specific accidental and natural mortality rates. We study this decomposition by using the Lee and Carter model. In particular, we fit the Poisson log-bilinear version of this model proposed by Wilmoth and Brouhns et al. to historical (1975-1998) Spanish mortality rates. In addition, by using the model introduced by Wilmoth and Valkonen we analyze mortality-gender differentials for accidental and natural rates. We present aggregated life expectancy forecasts compared with those constructed using nondecomposed mortality rates.

Aged↗