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PubMed2005

Sarcoidosis: a review.

Sarcoidosis is a systemic inflammatory disorder characterized by non-caseating granulomas found in the lung, lymphatic systems, and potentially in a host of other tissues and organs. Despite intriguing hints of infectious or environmental etiology, causation remains a mystery. The diagnosis, therefore, requires demonstration of granulomatous inflammation in more than one organ and exclusion of any of the known causes of granulomatous disease or local sarcoid reaction. Clinicians and underwriters alike frequently forget the latter requirement. For this reason, the other causes of granulomatous inflammation will be included in this treatise. Although the vast majority of applicants with sarcoidosis exhibit limited or remitting disease, the remaining applicants represent increased risk of both morbidity and mortality. This paper reviews the relevant clinical, radiographic, and laboratory findings that may help identify those applicants with increased or prohibitive risk for life or disability insurance.

Adult↗
PubMed1998

Life transitions and health insurance coverage of the near elderly.

OBJECTIVES: This study addresses three issues. (1) What are demographic wealth, employment, and health characteristics of near-elderly persons losing or acquiring health insurance coverage? Specifically, (2) what are the effects of life transitions, including changes in employment status, health, and marital status? (3) To what extent do public policies protect such persons against coverage loss, including various state policies recently implemented to increase access to insurance? METHODS: The authors used the 1992 and 1994 waves of the Health and Retirement Study to analyze coverage among adults aged 51 to 64 years. RESULTS: One in five near-elderly persons experienced a change in insurance coverage from 1992 to 1994. Yet, there was no significant change in the mix of coverage as those losing one form of coverage were replaced by others acquiring similar coverage. CONCLUSIONS: Individuals whose health deteriorated significantly were not more likely than others to suffer a subsequent loss of coverage, due to substitution of retiree or individual coverage for those losing private coverage and acquisition of Medicaid and Medicare coverage for one in five uninsured. State policies to increase access to private health insurance generally did not prevent individuals from losing coverage or allow the uninsured to gain coverage. Major determinants of the probability of being insured were education, employment status of person and spouse, and work disability status. Other measures of health and functional status did not affect the probability of being insured, but had important impacts on the probability of having public coverage, conditional on being insured.

Death↗
PubMed2000

Age pattern of mortality in eight breeds of insured dogs in Sweden.

The objective of this study was to use several methods to describe the age patterns for risk of death in selected breeds of dogs insured for life in a Swedish animal-insurance company in 1996. Data on eight breeds were analyzed for age at death (including euthanasia). If dogs left the insurance for reasons other than death, they were regarded as censored. Dogs were only insured up to 10 years of age. Four analytical approaches were used. First, descriptive statistics of age distributions (e.g. breed-specific median ages at death, breed- and age-specific mortality risks) were computed. Second, age-specific estimates of survival were calculated using the formula: survival=(1-risk(age<1 year))(1-risk(age 1<2 year))... (1-risk(age 9<1 0 year)). Third, Cox regression (proportional-hazards model) was used to estimate survival and hazard functions. Finally, hierarchically coded Poisson regression was used to determine age-specific cut-points in the risk of death. The hazards from Cox and the incidence-density rates from the hierarchically coded models were transformed to estimates of risk: risk=1-exp¿-(hazard)¿ or 1-exp¿-(incidence-density rate)¿. The breeds studied were Beagle, Bernese mountain dog, Boxer, Cavalier King Charles spaniel, Drever, German shepherd dog, Mongrel and Poodle, together representing over 50000 dogs each year. The yearly breed-specific mortality risk varied between 1.7% (Poodle) and 6.5% (Bernese mountain dog). In all breeds, the risk of death increased with age but the pattern varied by breed. The probability of survival at 5 years of age varied between 94% (Cavalier King Charles spaniel and Poodle) and 83% (Bernese mountain dog, Drever, German shepherd dog) and the survival at 10 years between 83% (Poodle) and 30% (Bernese mountain dog). The survival estimates from Cox and those derived using the combined-risk formula were similar. The cut-point risk estimates provided a simplified picture of when the risk of death changed significantly compared to previous age categories. As anticipated, breeds differed widely in survival up to 10 years of age and there were marked differences in age patterns of mortality. The implications of these findings should be considered in multivariable analyses, where the confounding effect of age is often controlled for using a single age variable common to several breeds.

Age Distribution↗