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

{"title":"May Some Lung Cancers Be Insurable?","authors":"Rod Richie","doi":"10.17849/insm-53-1-1-2.2","DOIUrl":"10.17849/insm-53-1-1-2.2","url":null,"abstract":"","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":" ","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung and Bronchus Cancer - 20-Year Comparative Mortality and Survival Analysis by Age, Sex, Race/Ethnicity, Stage, Grade, Disease Duration, Selected ICD-O-3 Oncophenotypes, and Cohort Entry Time-Period: A Systematic Review of 588,785 Cases for Diagnosis Years 1975-2022.","authors":"Anthony F Milano","doi":"10.17849/insm-53-1-1-66.1","DOIUrl":"https://doi.org/10.17849/insm-53-1-1-66.1","url":null,"abstract":"<p><p>Cancers of the lung and bronchus are broad terms for a common, deadly, complex, heterogenous and histologically diverse group of respiratory malignancies that comprise the leading cause of global cancer incidence and mortality accounting for an estimated 2 million diagnoses and 1.8 million deaths, and occurs through a complicated multistage process that results from the combination of carcinogen exposure, the primary etiology of which is tobacco smoking and genetic susceptibilities. This pathologic scourge is the second most common cause of cancer in men and women (after prostate and breast cancer, respectively). The mean age of diagnosis by sex is 67 years old and by race in Whites-67, Blacks-64, Others (AI/AN-American Indian/Alaska Native, API-Asian/Pacific Islander)-66 years. In this short and long term retrospective population-based analysis of 588,785 microscopically confirmed lung and bronchus case mortality and survival study, data is derived from the National Cancer Institute (NCI) Surveillance, Epidemiology, End-Results programs, SEER*Stat software version 9.0.42 released October 19, 2025, and SEER Registry (Incidence - SEER Research Data, 8 Registries, Nov 2024 Submission (1975-2022) released April 2025. This comparative cohort entry time-period analysis is intended to provide age-adjusted epidemiologic, demographic short and long-term survival and mortality data for convenient reference by all physicians, scientists, insurance underwriters and others interested in cancer mortality follow-up.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"53 1","pages":"12-77"},"PeriodicalIF":0.0,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147310911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing Insulin Resistance: The Triglyceride-Glucose (TyG) Index and Its Variants.","authors":"Rodney C Richie","doi":"10.17849/insm-53-1-1-7.2A","DOIUrl":"10.17849/insm-53-1-1-7.2A","url":null,"abstract":"<p><p>The predictive value in determining a person's insulin resistance (IR) is relevant for underwriters and medical directors of life and disability insurance companies as these measurements may screen for the future development of prediabetes and type 2 diabetes, metabolic dysfunction diseases, and cardiovascular disease morbidity and mortality. This treatise is a review of the importance of early recognition of IR by the routine measurements of the triglyceride-glucose (TyG) index and its variants. A review of PubMed for relevant articles reveals that most large studies have been done in Asian populations, suggesting that these measurements may not have gained sufficient attention in the U.S. and European disability and life insurance markets.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":" ","pages":"5-11"},"PeriodicalIF":0.0,"publicationDate":"2026-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146165893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When Is a Test Genetic? The Case of Multi-Cancer Early Detection Tests.","authors":"Timothy Meagher","doi":"10.17849/insm-53-1-1-4.2","DOIUrl":"https://doi.org/10.17849/insm-53-1-1-4.2","url":null,"abstract":"<p><p>Multi-cancer early detection (MCED) tests are increasingly popular. Are these tests \"genetic,\" and if so, can insurers use them in the risk assessment process? This article reviews definitions of genetic tests. It then reviews the motivation for limiting insurers' access to genetic tests and examines the wording in the legislation in 3 countries and 1 US state. It then attempts to establish whether MECD results are included in the legislation.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prostate Cancer Insurability: Population Identification Within the Insurability Corridor and the Right to be Forgotten.","authors":"Antoine Moll, Eric Raymond, Théo Schneider, Anthony Vuillaume, Mark Li, Denis Charles, Valentine Sarrazin, Manuel Plisson","doi":"10.17849/insm-52-3-1-10.2","DOIUrl":"10.17849/insm-52-3-1-10.2","url":null,"abstract":"<p><strong>Introduction.—: </strong>Prostate cancer is one of the most common cancers, with an approximate global annual incidence of 1.5 million men and nearly 400,000 deaths. Treatment options include surgical resection, radiotherapy, and high-intensity focused ultrasounds, often combined with hormone deprivation therapy. Insurability of prostate cancer patients is evaluated based on tumor severity using the AJCC and TNM classifications, along with PSA levels and Gleason Scores. To control the risk, life insurers use medical selection, albeit many individuals may be excluded from coverage. Regulations, such as France's \"Right to Be Forgotten,\" allow standard rate acceptance for certain prostate cancer survivors under specific conditions.</p><p><strong>Methods.—: </strong>By matching patient data from the SEER database with mortality tables, we established a Cox survival prostate cancer model for patients sharing similar long-term survival risk and compared it with that of the general population.</p><p><strong>Results.—: </strong>By investigating risks in populations of various age ranges, we defined groups with variable survival risk. To distinguish insurable from uninsurable, we have defined a so-called \"acceptance corridor,\" which delimits the boundary within the expected normal range of survival for a group of age and the highest acceptable premium. This corridor is delimited with an upper boundary depicted where the risk is equal to the standard population and a lower boundary where the risk of death is higher than that of the normal population or where the risk overpasses the maximum acceptable premium of 250%.</p><p><strong>Conclusion.—: </strong>In this paper, we have revisited the risk of individuals with a history of prostate cancer and have provided estimates of risk belonging within an acceptance corridor of insurability, broadening options for standard rate. This method may be further used to evaluate the impacts of regulatory guidelines, rules, and regulations, such as the right to be forgotten, to cancer patient populations.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":" ","pages":"116-125"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Will Hiring a Board-Certified Specialist Improve Your Company's Unfavorable Underwriting Results?","authors":"John R Iacovino","doi":"10.17849/insm-52-3-1-2.2","DOIUrl":"10.17849/insm-52-3-1-2.2","url":null,"abstract":"<p><p>Some underwriting departments believe hiring a board-certified specialist from a clinical background will improve their life underwriting, expectancy estimations, and profitability. This is not a panacea for solving adverse underwriting expectations. The need is a potential red flag indicating internal underwriting deficiencies. The specialist comes with their own limitations, the most prominent being the lack of any experience in insurance medicine and risk selection. You will be depending on the least experienced medical director to correct your problems. Likely, one or more internal underwriting practices could be the root cause of the unfavorable results.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":" ","pages":"126-127"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leukemia - 20-Year Comparative Survival and Mortality Analysis by Age, Sex, Race, Cohort Entry Time-Period, Disease Duration, Major Subtypes and Other Histologic Categories: A Systematic Review of 142,713 Cases for Diagnosis Years 1975-2022.","authors":"Anthony F Milano","doi":"10.17849/insm-52-3-1-32.1","DOIUrl":"10.17849/insm-52-3-1-32.1","url":null,"abstract":"<p><p>Leukemia is a broad term for a heterogenous group of hematologic malignancies that arise from the abnormal proliferation of leukocytes. It occurs most often in adults older than 55, but also is the most common cancer in children younger than 15, and accounts for more than 25% of cancer deaths in this age group. In this United States long term retrospective population-based analysis of 143,713 microscopically confirmed leukemia cases, mortality and survival study, 1975-2022, data is derived from the NCI Surveillance, Epidemiology and End-Results Programs, SEER*Stat software versions 8.4.5 and SEER*Stat 9.0.40.0, and, SEER Registry - Incidence - SEER Research Data, 8 Registries, Nov 2024 Sub (1975-2022). This comparative cohort entry time-period analysis is intended to provide age-adjusted epidemiologic, demographic, short and long-term survival and mortality data for convenient reference by all physicians, scientists, insurance underwriters, and others interested in cancer mortality follow-up.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"52 3","pages":"148-179"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Steatotic Liver Diseases (SLDs): A Review.","authors":"Rodney C Richie","doi":"10.17849/insm-52-3-1-9.2","DOIUrl":"10.17849/insm-52-3-1-9.2","url":null,"abstract":"<p><p>Liver steatosis is now the politically correct term for excessive fat in the liver (fatty liver). Its incidence and prevalence, in lockstep with diabetes and obesity, continue to climb to over 2 billion persons worldwide. It is the most common cause of chronic liver disease and the leading cause of liver-related morbidity and mortality. This treatise, resulting from a selection of PubMed literature of relevant steatosis studies since the nomenclature change in 2023, will include the change in the names for the steatotic liver entities, documenting the contribution of metabolic dysfunctions (obesity, diabetes, hypertension, and dyslipidemias) to the pathology of insulin resistance and alcohol in the evolution of these liver diseases. The various modalities for measuring the degree of fat, fibrosis, and cirrhotic scarring of the liver will be discussed, followed by a review of the mortality implications of the subcategories of liver steatosis, including intrahepatic cirrhosis and malignancy, extrahepatic malignancies, and cardiovascular disease. Finally, a review of treatments to address these entities will be briefly reviewed.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":" ","pages":"128-136"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mortality Risk of High BMI in Life Insurance Applicants and the US Population.","authors":"Steven J Rigatti, Stephanie Tanasia Saputra, Jean-Marc Fix","doi":"10.17849/insm-52-3-1-11.1","DOIUrl":"10.17849/insm-52-3-1-11.1","url":null,"abstract":"<p><strong>Objectives.—: </strong>This study seeks to quantify the mortality effect of high levels of body mass index (BMI) on life insurance applicants and participants in the National Health and Nutrition Examination Survey (NHANES) in univariate models and in successive models controlling for BMI-related diseases and conditions.</p><p><strong>Background.—: </strong>It is well established that a high BMI is associated with increased all-cause and cardiovascular mortality; however, the quantitative effect of controlling for related diseases and conditions is not well understood.</p><p><strong>Methods.—: </strong>Data were collected from over 7 million life insurance applicants submitting samples to Clinical Reference Laboratories (CRL) and 23,486 NHANES participants with available BMI and mortality status. Cox models were utilized, treating BMI as both a continuous predictor and as a categorical variable within various age and sex groups. Six Cox models were constructed in each age-sex-data group: a univariate model controlled only for age, then 5 more successively controlling for disease status (hypertension, diabetes, and heart disease), liver function tests, blood pressure/renal function, and finally hemoglobin A1c.</p><p><strong>Results.—: </strong>Overall, the effect of high BMI on mortality hazard was highest in the univariate model, and lower with successively controlled models. In the life insurance data, the residual effect of BMI in the final models was still significant above a BMI of about 35. In the NHANES data, the effect remained significant only above a BMI of about 40. In the continuous models, the hazard of BMI was persistently significant for both sexes in the CRL models, only for men in the final NHANES model.</p><p><strong>Conclusion.—: </strong>Based on this study, the effect of high BMI on mortality is significantly blunted when accounting for diseases and conditions that are associated with high BMI.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"52 3","pages":"180-190"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Myeloid Leukemia - A Review of Current Status.","authors":"Clifton P Titcomb","doi":"10.17849/insm-52-3-1-7.2","DOIUrl":"10.17849/insm-52-3-1-7.2","url":null,"abstract":"<p><p>Chronic myeloid leukemia (CML) is a myeloproliferative disorder in which there is a neoplastic proliferation of mature granulocytes. The cancer results from a reciprocal translocation of the breakpoint cluster region (BCR) on chromosome 22 and the ABL1 gene region on chromosome 9 - t (9;22). The result is an abnormal fusion gene on chromosome 22 known as the Philadelphia chromosome. It represents 15% to 20% of all leukemias in the United States with an estimated incidence rate of 1 to 2 cases per 100,000. About 50% of affected individuals are asymptomatic. Diagnosis depends on demonstrating the presence of the Philadelphia chromosome. CML occurs in 3 phases. The most common is the chronic phase characterized by an indolent course and <15% blast cells in the myeloid space. The remaining advanced phases are the accelerated (15%-30% blasts) and the blast phase (>30% blasts). Without treatment, progression is slow but relentless to the advanced stages and occurs over 3 to 5 years. Survival is markedly reduced once these latter stages are reached. The recognition that the BCR-ABL1 fusion gene was a key driver of the disease process led to the development of tyrosine kinase inhibitor (TKI) drugs that targeted the genetic basis for the cancer. The first of these was imatinib, which was released in 2001. Since then both second and third generations of the drug class have been approved. These medications have been demonstrated to reduce the ratio of abnormal to normal BCR:ABL1 transcripts. They are most effective if used in the chronic phase. The degree of this molecular response has been demonstrated to correlate with limitation of progression of disease and improvement, often marked, of survival. Most individuals who respond well require lifelong use of the medication. However, a subset of the responders may achieve treatment-free remission (TFR) without ongoing therapy. For those individuals who are in the advanced state of the disease, do not respond to the TKI drugs or cannot tolerate them, allogeneic hematopoietic stem cell transplantation (SCT) is an alternative therapy that can achieve long-term survival in some cases.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":" ","pages":"137-143"},"PeriodicalIF":0.0,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}