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PubMed2005

How to prepare a life expectancy report for an attorney in a tort case.

The purpose of this methodology article is to describe a suitable format for a legally acceptable report on the life expectancy of the principal in a tort case that is being advocated or defended by an attorney. Life insurance medical directors and underwriters are clearly skilled and experienced in mortality risk classification for life insurance. However, the judicial system is accustomed to measuring excess mortality only in terms of reduced life expectancy. The analyst preparing the report must convert the excess mortality into a figure for reduced life expectancy and compare this with the life expectancy of persons matched by age, sex and race in the latest Decennial US Life Tables. This process is different from the life insurance underwriting process. A life table projected to age 109 must be constructed as an essential part of the report, and the entire process must be presented clearly and convincingly. There are good reasons why the excess death rate (EDR) should be used as the index of excess mortality in constructing the life table, in preference to the mortality ratio (MR), which is used most of the time in life insurance risk classification. All of these considerations are discussed in this article, which is based on a sample of 40 cases handled by the author, a retired life insurance medical director.

Adolescent↗
PubMed1994

The impact of hospice services on the quality of life of primary caregivers.

PURPOSE/OBJECTIVES: To evaluate the effects of hospice services on the quality of life of primary caregivers and to evaluate the validity and reliability of a new tool. DESIGN: Exploratory, descriptive. SETTING: A nonprofit hospice in Florida; clients are cared for primarily in the home. SAMPLE: 68 adult primary caregivers of 68 patients with cancer enrolled in hospice care and 62 noncaregiving adults. METHODS: Subjects were recruited on admission to hospice and completed the Caregiver Quality of Life Index (CQLI) and the Hospice Quality of Life Index (HQLI) on admission and during week four of hospice care. MAIN RESEARCH VARIABLES: Caregivers' assessment of their own physical, social, financial, and emotional quality of life; patients' assessment of their physical, psychological, spiritual, social, and financial well-being. FINDINGS: No significant differences were found in caregiver quality-of-life scores from admission to week four, and no correlations existed between quality-of-life scores and age or education. A significant positive correlation was found between the caregivers' quality of life and their estimate of the patients' quality of life. Evidence exists that the CQLI is valid and reliable. CONCLUSIONS: Caregivers of terminally ill people with cancer can maintain their quality of life during the first month of hospice care. The caregiver's perception of the patient's quality of life may affect the caregiver's quality of life. IMPLICATIONS FOR NURSING PRACTICE: When offering support to primary caregivers, the hospice team should include the four domains (physical, emotional, social, and financial) and should focus on the interrelatedness of the patient's and caregiver's quality of life.

Adult↗
PubMed1998

Life control and health.

This paper describes the life control and its development, concentrating on relationship between life control and health. The main goal is to review the life control and health among Northern Finnish women and men. Life control and its connections with health and life situation make up the theoretical basis of the work. The definition of life control is based on Antonovsky's theory of a sense of coherence. The concept of life control here includes the following subconcepts: comprehensibility (how understandable are the internal and external environments), manageability (ability to influence one's life course at work and in one's whole life), meaningfulness (one's experiences of the meaning of the present or future events) and life satisfaction and human relationships. Future studies need to explain factors affecting the abilities of individuals to control their lives and reach sensible decisions regarding their health and lives overall. New ways of strengthening life control among those who have become marginalized in relation to society need to be identified. A model of factors relating to life control and relationships between such factors could be constructed.

Adult↗
PubMed2006

Ancestral telomere shortening: a countdown that will increase mean life span?

Like cells, all mammals have a limited life span. Among cells there are a few exceptions (e.g., immortal cells), among mammals not, even if some of them live longer. Many in vitro and in vivo studies support the consensus that telomere length is strongly correlated with life span. At the somatic cellular level, long telomeres have been associated with longer life span. A different situation can be seen in immortal cells, such as cancer, germ and stem cells, where telomeres are maintained by telomerase, a specialized reverse transcriptase that is involved in synthesis of telomeres. Irrespective of telomere length, if telomerase is active, telomeres can be maintained at a sufficient length to ensure cell survival. To the contrary, telomeres shorten progressively with each cell division and when a critical telomere length (Hayflick limit) is reached, the cells undergo senescence and subsequently apoptosis. In mammals, those with the longest telomeres (e.g., mice) have the shortest life span. Furthermore, the shorter the mean telomere length, the longer the mean life span, as observed in humans (10-14 kpb) and bowhead-whales (undetermined telomere length), which have the longest mean life span among mammals. Over the past centuries, human average life span has increased. The hypothesis presented here suggests that this continual increase in the mean life span could be due to a decrease of mean telomere length over the last hundreds years. Actually, the life span is not directly influenced by length of telomeres, but rather by telomere length - dependent gene expression pattern. According to Greider, "rather than average telomere length, it is the shortest telomere length that makes the biggest difference to a cell". In the context of fast-growing global elderly population due to increase in life expectancy, it also seem to be an age related increase in cancer incidence. Nevertheless, extending healthy life span could depend on how good cells achieve, during the prenatal period and few years after birth, the equilibrium between telomere length and telomerase activity, as seen in germ cells. After all, I suggest that decrease in mean telomere length might result in, on the one hand, an increased life span and, on the other, a higher risk of tumorigenesis.

Aged↗
PubMed1999

Relationship among mental stress-induced ischemia and ischemia during daily life and during exercise: the Psychophysiologic Investigations of Myocardial Ischemia (PIMI) study.

OBJECTIVES: The purposes of this database study were to determine: 1) the relationship between mental stress-induced ischemia and ischemia during daily life and during exercise; 2) whether patients who exhibited daily life ischemia experienced greater hemodynamic and catecholamine responses to mental or physical stress than patients who did not exhibit daily life ischemia, and 3) whether patients who experienced daily life ischemia could be identified on the basis of laboratory-induced ischemia using mental or exercise stress testing. BACKGROUND: The relationships between mental stress-induced ischemia in the laboratory and ischemia during daily life and during exercise are unclear. METHODS: One hundred ninety-six stable patients with documented coronary disease and a positive exercise test underwent mental stress testing and bicycle exercise testing. Radionuclide ventriculography and electrocardiographic (ECG) monitoring were performed during the mental stress and bicycle tests. Patients underwent 48 h of ambulatory ECG monitoring. Hemodynamic and catecholamine responses were obtained during mental stress and bicycle tests. RESULTS: Ischemia (reversible left ventricular dysfunction or ST segment depression > or = 1 mm) developed in 106 of 183 patients (58%) during the mental stress test. There were no significant differences in clinical characteristics of patients with, compared with those without, mental stress-induced ischemia. Patients with mental stress ischemia more often had daily life ischemia than patients without mental stress ischemia, but their exercise tests were similar. Patients with daily life ischemia had higher ejection fraction and cardiac output, and lower systemic vascular resistance during mental stress than patients without daily life ischemia. Blood pressure and catecholamine levels at rest and during the mental stress tests were not different in patients with, compared with those without, daily life ischemia. Patients with daily life ischemia had a higher ejection fraction at rest and at peak bicycle exercise compared with patients without daily life ischemia, but there were no other differences in peak hemodynamic or catecholamine responses to exercise. The presence of ST segment depression during routine daily activities was best predicted by ST segment depression during mental or bicycle exercise stress, although ST segment depression was rare during mental stress. CONCLUSIONS: Patients with daily life ischemia exhibit a heightened generalized response to mental stress. ST segment depression in response to mental or exercise stress is more predictive of ST segment depression during routine daily activities than other laboratory-based ischemic markers. Therapeutic management strategies might therefore focus on patients with these physiologic responses to stress and on whether lessening such responses reduces ischemia.

Activities of Daily Living↗
PubMed2001

End-of-life care in the intensive care unit: can we do better?

Everywhere we turn these days, it seems that we are confronted with a new study that reports the dissatisfaction expressed by families with the quality of care received by their loved ones who have died while in the intensive care unit. It is difficult for caregivers to accept this information, which is now commonly reported both in published studies and in the lay press. As clinicians, most of us believe that we truly care about our patients and are trying, as best we can, to act in their best interest. No caregiver wants to hear that he or she does not do a good job when caring for dying patients and their families. It is ironic that clinicians recognize and accept the need for continuing education. Yet many clinicians resent the suggestion that the skills required for end-of-life care might be viewed in the same manner, as a lifelong learning process. It is unusual for physicians to identify end-of-life-care as an area of competency that can be improved or updated. Perhaps this is why end-of-life-care has been so difficult to teach to clinicians in training. Although many medical schools offer courses on the ethics of death and dying, formal training in end-of-life care skills is not routinely given in most postgraduate training programs. Learning these skills is a matter of on-the-job training for most caregivers. Not only have we been unable to measure any beneficial impact from education initiatives for end-of-life care, we have yet to identify clear indicators for end-of-life care. For caregivers, enhancing end-of-life skills may be a matter of improved listening skills, attention to the proper environment for end-of-life discussions, and a willingness to facilitate end-of-life decision-making. Encouraging caregivers to view end-of-life skills as a lifelong educational process, identifying core competencies in end-of-life care, and training clinicians in these skills are the challenges for the future. The quality of care our patients receive at the end of life will depend on our ability to answer these difficult questions.

Attitude of Health Personnel↗
PubMed1994

Relationships between sire genetic evaluations for conformation and functional herd life of daughters.

Linear and nonlinear relationships between functional herd life and conformation traits were investigated by regression of functional herd life of 63,602 Quebec Holstein cows on the estimated transmitting abilities of their sires for conformation traits. Relationships with functional herd life were obtained by inclusion in regression models of covariants for the deviations of cows in production of milk and fat. Individual conformation traits had low to moderate genetic relationships with functional herd life. Relationships were strongest for traits associated with udder conformation and feet and legs, and relationships were stronger for registered than for grade herds. Nonlinear relationships were present for some traits. Indexes to predict estimated transmitting ability of sires for functional herd life, based on combinations of estimated transmitting abilities of sires for conformation traits, explained .3 to .8% of phenotypic variation in functional herd life, which, for a heritability of functional herd life of .08, amounts to 15 to 40% of genetic variation in functional herd life. For registered herds, unlike grade herds, composite traits provided significant information on functional herd life and linear conformation traits. Correlations between indexes of conformation traits to predict estimated transmitting abilities of sires for functional herd life for registered versus grade herds were low to moderate. Selection for functional herd life based on conformation traits is possible but has moderate efficiency because of low to moderate relationships between conformation traits and functional herd life.

Animals↗
PubMed1998

Genetic evaluation for herd life in Canada.

Methods were developed for the national genetic evaluation of herd life for Canadian Holstein sires. The genetic evaluations incorporate information from survival (direct herd life) and information from conformation traits that are related to herd life (indirect herd life) after adjustment for production in first lactation to remove the effect of culling for production. Direct genetic evaluations for herd life were based on survival in each of the first three lactations, which was analyzed using a multiple-trait animal model. Sire evaluations thus obtained for survival in each of the first three lactations were combined based on their economic weights into an overall sire evaluation for direct herd life. Sire evaluations for indirect herd life were based on an index of sire evaluations for mammary system, feet and legs, rump, and capacity. A multiple-trait sire model based on multiple-trait across country evaluation methodology was used to combine direct and indirect genetic evaluations for herd life into an overall genetic evaluation for herd life. Sire evaluations for herd life were expressed in estimated transmitting ability as the number of lactations and represent expected differences among daughters in functional herd life (number of lactations); the average functional herd life was set equal to three lactations. Estimated transmitting abilities were normally distributed and ranged from 2.31 to 3.43 lactations.

Animals↗
PubMed1999

Genetic analysis of herd life in Quebec Holsteins using Weibull models.

Survival analysis methodologies were used to study herd life in Canadian Holstein cows. Herd life was defined as true herd life or the length of time between first calving and censoring. True herd life adjusted for 305-d milk production was defined as functional herd life. Lifetime record (censored or completed) were from 331,147 Holstein cows registered in the Programme d'Analyse des Troupeaux Laitiers du Québec (PATLQ) that calved for the first time between March 1, 1981 and March 31, 1995. The Weibull (proportional hazards) model used to analyze true herd life and functional herd life contained a Weibull baseline hazard function and the time-dependent effects of year of first calving, lactation number by stage of lactation, annual change in herd size and herd-year (random), and the time-independent effects of the milk recording option (supervised or not) and age at first calving. The model for functional herd life included also the time-dependent effect of herd-year-parity class of 305-d milk production. Genetic differences between sires with regard to the hazard function of their daughters was clearly demonstrated. The hazard rate followed a different pattern in later lactations, particularly in the first 240 d in milk. Older age at first calving was found to be associated with higher risks of culling. Changes in herd size had a small impact on the hazard function of animals. The hazard decreased as production of the cow increased. Heritability in the log scale was 0.09 for true herd life and 0.08 for functional herd life, but when heritability was expressed on the original scale, the estimates for the two traits were 0.19 and 0.15, respectively. The difference in the median survival between a bull with an estimated transmitting ability of 0.6 and another bull with an estimated transmitting ability of 1.3 was 690 d or 1.7 lactations. Rank correlations between the official estimated transmitting abilities for true herd life and functional herd life and those obtained in this study were 0.62 and 0.66, respectively.

Aging↗
PubMed1999

How Fast Can the Racial Gap in Life Expectancy Between Whites and Blacks Be Eliminated?

BACKGROUND: The racial gap in life expectancy between whites and blacks fluctuated from 7.6 to 5.7 years from 1970-1996, but the causes of this gap and the years required to eliminate it remain unclear. This paper analyzes the leading causes of death and how they contribute to the racial gap in life expectancy, and estimates the number of years required to eliminate this gap. METHODS: Standard abridged life table methods and life table partitioning techniques were used to estimate the total and the cause-specific racial gap in life expectancy. Cause-specific mortality rates by age, sex, and race in the United States from 1970-1996 were obtained from the Centers for Disease Control and Prevention. The predictions of years needed to eliminate the racial gap in life expectancy are based on international and domestic trends in life expectancy improvement. RESULTS: The racial gap in life expectancy declined before 1982, increased from 1982 to 1989, and slowly declined after 1989. In 1996, about 54% and 62% of the racial gap was attributable to cancer, heart disease, homicide, and HIV for females and males, respectively. If blacks could experience substantial improvement in life expectancy, the current racial gap in life expectancy could be eliminated in about 40 years. CONCLUSIONS: The goal of eliminating the racial gap in life expectancy is a critical national priority. Differences in life expectancy are the result of multiple health and socioeconomic determinants, which will require multiple intervention strategies. The time it will take to reduce the overall gap will depend on the speed of reduction of the leading cause-specific mortality differences, which will require intensified efforts in both prevention and treatment.

Journal Article↗
PubMed1988

Quality of life: does measurement help?

'Quality of life' is a very frequently applied concept nowadays. One may doubt whether everyone has the same connotation in mind while using this expression and why 'quality of life' attracts so much attention. Is the idea a very old one or is it a new and noble value? It is argued here that changes such as in the number of aged people and of chronically disabled people, combined with spectacular developments in medical technology and with a rise in knowledge and assertivity, created an increased awareness of 'quality of life' and its interaction with medicine. Moreover, limitations to budgets and technological developments trigger an interest in new arguments. 'Quality of life' plays an increasing role in all sorts of medical decisions, be it in policy decisions or in individual clinical decisions, be it formally assessed or implicitly weighted. A number of examples is briefly described to illustrate the very broad and diffuse use of quality of life as a criterion. Subsequently we have tried to operationalize the concept on 4 levels: macro, meso, personal and physical. The macro level applies to the meaning of life in a society; assessments of quality of life play a role, for instance, in discussions on euthanasia and in political decisions on medical investments. Examples of the meso level are the hospital, with its internal processes and its ties to the rest of the world, but also the patient in his social environment. On the personal level the individual's frames of reference on health, illness, future, pain and hope - both of the patient and the doctor - are being considered. It is argued that legitimation of important decisions, investments and interventions requires measurement of quality of life in an objective way and on different levels. Quantifying quality, however, appears hardly feasible. Therefore 'quality of life' is frequently measured at the fourth level only, the level of physical activities. Confining measurement to the measurable induces the question of whether it really is 'quality of life' that is being quantified. Still, results from such measurements can be of help in decision making. Who decides in clinical situations and in what way should 'quality of life' be involved in decision making? In one solution, perhaps the old fashioned one, the doctor takes all responsibility, possibly from a paternalistic ideal. Conversely, should the doctor behave in a completely non-directive way, full autonomy is given to the patient.(ABSTRACT TRUNCATED AT 400 WORDS)

Decision Making↗
PubMed2005

Patients' and healthcare providers' understandings of life-sustaining treatment: are perceptions of goals shared or divergent?

In this cross-sectional qualitative study, researchers performed in-depth, semistructured interviews with 30 pairs of patients and their primary care providers in an outpatient clinic of a large, urban Veterans Affairs (VA) medical center in the United States. During audiotaped interviews to assess their understanding of advance directive concepts, participants were asked what "life-sustaining treatment" means to them and why they think of it in the way they do. The findings indicate that patients and providers in the United States tend to view and discuss life-sustaining treatment in terms of four goals for end-of-life care: (1) extending the length of life, (2) improving the quality of life, (3) maintaining or improving specific biological functions, and (4) assisting the body for a temporary period of time. Patients thought providers were more concerned with extending the length of life than with quality-based outcomes, and patients often discussed life-sustaining treatment as acceptable means for short-term but not long-term use. Many providers indicated that they struggle with conflicting quality-based and physiologic care goals. The findings highlight the importance of eliciting patient preferences not only for specific types of treatment, such as cardiopulmonary resuscitation, but also for end-of-life care goals or desired health-related outcomes, such as maximizing the quantity of life. The findings also suggest that advance directives and patient-provider discussions that focus on acceptable health states and valued life activities may be better suited to patients' end-of-life care goals than those that focus on specific medical interventions.

Adult↗
PubMed2003

Regional differences in healthy life expectancy in The Netherlands.

BACKGROUND: Healthy life expectancy has mainly been studied at the level of healthcare systems rather than at regional level within healthcare systems. In this article, healthy life expectancy at birth and at 65 years of age for men and women in the Netherlands has been described, and factors related to these regional variations have been explored. METHODS: Ecological study of 27 healthcare regions (hospital catchment areas). Life expectancy and healthy life expectancy were calculated using 1995 mortality data and pooled health interview survey data (1992-1997) from Statistics Netherlands. RESULTS: Healthy life expectancy shows a regional pattern, slightly different from that found in life expectancy and self-reported health. The regional distribution of male and female healthy life expectancy is different, especially at 65 years. Healthy life expectancy of women aged 65 years is independent of their total life expectancy. Social conditions and lifestyle differences between regions are negatively associated with healthy life expectancy in Dutch regions. Healthcare supply variables show no clear relationship. CONCLUSION: Although the Netherlands is a small, homogeneous country, substantial differences were found in healthy life expectancy.

Aged↗
PubMed2002

Quality of life and its correlates in a community population in a Japanese rural area.

Correlations of three aspects of quality of life (QOL) (health perception, life satisfaction, and self-confidence) with personality traits and early experiences were examined. Quality of life aspects were examined using 220 inhabitants in a rural community in Japan. Health perception was better among men than among women. Life satisfaction and self-confidence were better in people aged 55 or over than in those under 55. Among the current predictor variables, the Eysenck Personality Questionnaire neuroticism score was correlated with poor life satisfaction in the younger women; the extraversion score with the older women's health perception, the older men's life satisfaction, and the women's self-confidence; and the psychoticism score with the older men's life satisfaction. Among early life predictors, self-confidence was lower among those older men who had reported early parental loss. Childhood paternal overprotection was correlated with poor health perception in younger people and with good health perception in older women. Some negative life events experienced during childhood were correlated with poorer QOL measures in some subgroups, while positive life experiences were correlated with the older women's life satisfaction. These findings suggest that the three aspects of the QOL are discrete in their psychosocial correlates and that interventions on health education and care should take into account individual's psychosocial attributes.

Adult↗
PubMed2004

Is social participation associated with quality of life of older adults with physical disabilities?

PURPOSE: To explore the relationships between subjective quality of life and social participation of older adults with physical disabilities. METHOD: A cross-sectional design was used with a convenience sample of 46 people aged 60 to 90 living in the community. Subjective quality of life was estimated with the Quality of Life Index and social participation with the Assessment of Life Habits. RESULTS: Only a weak relationship was found between total scores of quality of life and social participation. Interpersonal relationships, responsibilities, fitness and recreation were the categories of social participation most associated with quality of life. Social roles were more associated with quality of life than daily activities. Finally, satisfaction with the accomplishment of life habits was also more associated with quality of life than the performance itself. CONCLUSIONS: The importance of social participation in regard to the quality of life of older persons with physical disabilities living in the community is partially supported by these findings. Other studies are needed to clarify how social participation influences quality of life in this population.

Aged↗
PubMed2000

Lack of improvement of life expectancy at advanced ages in The Netherlands.

BACKGROUND: Several countries have reported an increase in life expectancy at advanced ages. This paper analyses recent changes in life expectancy at age 60 and 85 in The Netherlands, a low mortality country with reliable mortality data. METHODS: We used data on the population and the number of deaths by age, sex and underlying cause of death for 1970-1994. Life expectancy at age 60 and 85 was estimated using standard life-table techniques. The contribution of different ages and causes of death to the change in life expectancy during the 1970s (1970/74-1980/84) and the 1980s (1980/84-1990/94) were estimated with a decomposition technique developed by Arriaga. RESULTS: Life expectancy at age 60 increased in the 1970s and 1980s, whereas life expectancy at age 85 decreased (men) and stagnated (women) in the 1980s, and has decreased in both sexes since 1985/89. The decomposition by age showed that constant mortality rates in women aged 85-89, and increasing mortality rates at ages 85+ (men) and 90+ (women) have caused this lack of increase in life expectancy. The decomposition by cause of death showed that smaller mortality reductions from other cardiovascular and cerebrovascular diseases, which contributed most to the increase in life expectancy at age 85 in the 1970s, and mortality increases from, amongst others, chronic obstructive pulmonary disease (COPD), mental disorders and diabetes mellitus produced the decrease (men) and plateau (women) in life expectancy at age 85. CONCLUSIONS: Life expectancy at advanced ages stopped increasing during the 1980s in The Netherlands due to mortality increases at ages 85+ (men) and 90+ (women). Cause-specific trends suggest that, in addition to (past) smoking behaviour in men, changes in the distribution of morbidity and frailty in the population might have contributed to this stagnation.

Age Distribution↗
PubMed2005

Assessment of subjective health and health-related quality of life in persons with acquired or degenerative brain injury.

PURPOSE OF REVIEW: Health-related quality of life is a new outcome variable in neurology. Several generic measures aim at assessing this variable in adults with neurological diseases. Disease-specific measures are still rare; however, individuals with neurological diseases frequently suffer from cognitive impairment, yet are often excluded from health-related quality of life investigations. When included in such studies, cognitive functioning is not monitored via neuropsychological evaluation, possibly leading to methodological problems. Papers from May 2004 until July 2005 are reviewed with respect to psychometric quality and information about persons after traumatic brain injury, stroke, Parkinson's disease or dementia. RECENT FINDINGS: Several new cross-sectional and longitudinal outcome studies are reviewed. The Medical Outcome Study Short Form with 36 items, the Sickness Impact Profile and the Nottingham Health Profile were identified as the most frequently used measures in neurology. For traumatic brain injury, two new generic instrument validations (Life Satisfaction Index-A, Subjective Quality of Life Profile) and one internationally validated disease-specific development (Quality of Life after Brain Injury) were found; for stroke, one disease-specific tool (Burden of Stroke Scale) was identified. In Parkinson's disease, the disease-specific health-related quality of life measure Parkinson's Disease Questionnaire-39 is well validated. In dementia, three dementia-specific instruments (Quality of Life for Dementia, Quality of Life in Late-Stage Dementia Scale and Quality of Life in Alzheimer's Disease Scale) seem to be valid. SUMMARY: In neurology, only a few measures have been developed and validated for respondents with cognitive impairment, often showing poorer validity results than studies involving healthy persons. Health-related quality of life assessment should therefore be validated in the specific diseases and, if necessary, combined with a neuropsychological evaluation and a disease-specific health-related quality of life measure.

Animals↗
PubMed2003

Life insurance and breast cancer risk assessment: adverse selection, genetic testing decisions, and discrimination.

Life insurance industry access to genetic information is controversial. Consumer groups argue that access will increase discrimination in life insurance premiums and discourage individuals from undergoing genetic testing that may provide health benefits. Conversely, life insurers argue that without access to risk information available to individuals, they face substantial financial risk from adverse selection. Given this controversy, we conducted a retrospective cohort study to evaluate the impact of breast cancer risk information on life insurance purchasing, the impact of concerns about life insurance discrimination on use of BRCA1/2 testing, and the incidence of life insurance discrimination following participation in breast cancer risk assessment and BRCA1/2 testing. Study participants were 636 women who participated in genetic counseling and/or genetic testing at a University based clinic offering breast cancer risk assessment, genetic counseling, and BRCA1/2 testing between January 1995 and May 2000. Twenty-seven women (4%) had increased and six (1%) had decreased their life insurance since participation in breast cancer risk assessment. The decision to increase life insurance coverage was associated with predicted breast cancer risk (adjusted OR 1.03 for each 1% absolute increase in risk, 95% CI 1.01-1.10) and being found to carry a mutation in BRCA1/2 (OR 5.10, 95% CI 1.90-13.66). Concern about life insurance discrimination was inversely associated with the decision to undergo BRCA1/2 testing (RR 0.67, 95% CI 0.52-0.85). No respondent reported having life insurance denied or canceled. In this cohort of women, these results indicate that information about increased breast cancer risk is associated with increase in life insurance purchasing, raising the possibility of adverse selection. Although fear of insurance discrimination is associated with the decision not to undergo BRCA1/2 testing, there was no evidence of actual insurance discrimination from BRCA1/2 testing.

Breast Neoplasms↗