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

{"title":"Liquid Biopsies and Critical Illness Insurance: Uncomfortable Bedfellows?","authors":"Timothy J. Meagher","doi":"10.17849/insm-48-1-1-8.1","DOIUrl":"https://doi.org/10.17849/insm-48-1-1-8.1","url":null,"abstract":"Liquid biopsies hold great promise for the diagnosis and treatment of cancer. Earlier recognition of recurrent and metastatic disease and better treatment choices based on liquid biopsies seem achievable in the near future. However, earlier cancer diagnosis, the most heralded application, will remain the most challenging. The impact of liquid biopsies on life insurance will be positive. The impact on critical illness insurance will be more nuanced. It will depend on 2 factors: the success of liquid biopsies as cancer screening tests and the ability of an insurer to use \"genetic information\" during risk selection. In jurisdictions where use is prohibited, critical illness insurance, as presently designed, may not be sustainable.","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49328384","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":"20-Year Comparative Survival and Mortality of Cancer of the Stomach by Age, Sex, Race, Stage, Grade, Cohort Entry Time-Period, Disease Duration & Selected ICD-O-3 Oncologic Phenotypes: A Systematic Review of 157,258 Cases for Diagnosis Years 1973-2014: (SEER*Stat 8.3.4).","authors":"A. Milano","doi":"10.17849/insm-48-1-1-19.1","DOIUrl":"https://doi.org/10.17849/insm-48-1-1-19.1","url":null,"abstract":"Background and Importance.-Globally, almost one million new cases of stomach cancer were estimated to have occurred in 2012 (952,000 cases, 6.8% of the total), making it the fifth most common malignancy in the world, after lung, breast, colorectal, and prostate. Gastric cancer was the world's third leading cause of cancer mortality in 2012, responsible for 723,000 deaths, 8.8% of total cancer deaths.1 In 2017, 28,000 new cases and 10,960 deaths are estimated for gastric cancer in the United States.2 Estimated United States prevalence counts on January 1, 2014, for patients diagnosed within the previous 5-years was 48,271 (SEER Cancer Statistics Review-2014). Prognostic indices of survival & mortality in patients with gastric cancer are related to tumor stage including nodal involvement, direct tumor extension beyond the gastric wall, and wide-spread dissemination. Tumor histologic grade (degree of loss of cellular differentiation), and oncotype-specific ICD-O-3 phenotypes also provides important prognostic information. By more than 90%, the most common histologic type of stomach cancer is adenocarcinoma. The National Cancer Institute (NCI) ICD-O-3 SEER Site/Histology Validation List catalog (September 18, 2015) enumerates almost 200 subtypes for gastric cancer sites C160-C166, C168-C169. Based on the results of molecular evaluation of 295 primary gastric adenocarcinomas reported to The Cancer Genome Atlas (TCGA) project in 2014, a novel classification separating gastric cancers into four subtypes according to Epstein-Barr virus positive status, microsatellite instability, chromosomal instability, or genomic stability was proposed.3> Of interest, Helicobacter Pylori infection and its role in the development of gastric cancer is not mentioned. All cancer has a genetic basis. However, given the histologic and etiologic heterogeneity of gastric cancer, eventual comprehensive molecular characterization and genomic sequencing with identification of chromosomal aberrations, nucleotide substitutions mortality follow-up study is focused on short- and long-term comparative patient outcomes of stomach adenocarcinoma, ICD-O-3 8140-8147, and other selected gastric cancer oncotypes. Objective.-To update trends in incidence, prevalence, short- and long-term survival, and mortality of gastric cancer using the statistical database of SEER*Stat 8.3.4 for diagnosis years 1973-2014 employing multiple case selection variables. Methods.-A retrospective, population-based study using nationally representative data from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program to evaluate 157,258 cases for diagnosis years 1973-2014 comparing multiple variables of age, sex, race, stage, grade, cohort entry time-period, disease duration and histologic oncotype: Relative survival statistics were analyzed in two cohorts: 1973-1994 and 1995-2014. Survival statistics were derived from: SEER*Stat Database: Incidence - SEER 9 Regs Research ","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43556491","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":"Gene Therapy for Cancer - A New Dimension and Challenge for Insurers.","authors":"A. Regenauer","doi":"10.17849/insm-48-1-1-6.1","DOIUrl":"https://doi.org/10.17849/insm-48-1-1-6.1","url":null,"abstract":":  Due to an increasingly better understanding of the human genome, the number of potential molecular targets, and therefore, potential applications by gene therapies is also increasing. After almost two decades of basic research, the first gene therapeutics are now entering the market. They are among the most expensive types of treatment in medicine. Over the next 10 years, the number and volume of their applications will increase significantly. So, our healthcare systems and inherently health insurance companies will face considerable challenges that will require new approaches to financial solutions. This article first describes the mode of action of the first gene therapies of cancer and their by now known side effects. Subsequently, the cost problems are dealt with and possible financing options are pointed out.","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48542703","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":"JIM Reading List.","authors":"","doi":"10.17849/insm-48-1-1-7.1","DOIUrl":"https://doi.org/10.17849/insm-48-1-1-7.1","url":null,"abstract":"","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42553155","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":"Behcet's Disease.","authors":"David S Williams","doi":"10.17849/insm-48-1-1-3.1","DOIUrl":"https://doi.org/10.17849/insm-48-1-1-3.1","url":null,"abstract":"<p><p>Behcet's disease is a rare systemic vasculitis disorder of unknown etiology characterized by recurrent attacks of acute inflammation affecting multiple parts of the body.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"48 1","pages":"103-105"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37065056","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":"Predicting Life Expectancy: Precise Science or Fool's Errand?","authors":"Timothy Meagher","doi":"10.17849/insm-48-1-1-4.1","DOIUrl":"https://doi.org/10.17849/insm-48-1-1-4.1","url":null,"abstract":"","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"48 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37065054","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":"To What Extent Are Main Accident-Insurer Cases Representative of All Significantly Injured? A Swiss Monocenter Perspective.","authors":"Thomas Gross,&nbsp;Sabrina Morell,&nbsp;Felix Amsler","doi":"10.17849/insm-48-1-1-14.1","DOIUrl":"https://doi.org/10.17849/insm-48-1-1-14.1","url":null,"abstract":"<p><p><b>Background and Objectives.-</b>Even though Switzerland has a compulsory insurance system, there is a lack of detailed information on the treatment and outcome following trauma. The objective of this evaluation was to examine to what extent cases insured by the largest accident-insurer (Suva) are representative of all significantly injured. <b>Methods.-</b>Trauma center analysis of all ≥16 year old trauma patients with a New Injury Severity Score (NISS) ≥8, comparing the characteristics of Suva- vs non-Suva cases (chi-square; univariate explained variance R²; multivariate logistic regression analysis, Nagelkerke R²). <b>Results.-</b>Over 7 years, 2233 trauma patients were treated at the hospital, of whom 29.4% were Suva-insured. Compared to non-Suva-insured, Suva cases were younger (41.6 vs 64.2, R² = 0.23) and more often male (88.0% vs 59.4%; R² = 0.08). In multivariate analysis, these two factors together explained 37.5% of the differences between groups. No other investigated factor explained more than 2%. If only those patients of obligatory working age were analyzed (n = 1264), Suva cases (50.6%) were more often male than non-Suva-insured (n = 562 [87.8%] vs n = 393 [63.0%], resp.; p<0.001, R² = 0.08). In multivariate analysis, other factors taken together were only 2.6% of the variance. <b>Conclusions.-</b>Significantly injured patients in Switzerland may be considered comparable from a statistical point of view whether insured by the main accident-insurer or not, provided groups are adequately controlled for age and gender. Other differences appear to be only marginal. Respecting these limitations such data can justifiably be given as Swiss reference statistics and the relevant insurer outcome information used for international comparison.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"48 1","pages":"65-78"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37343369","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":"Association of Carcinoembryonic Antigen with Mortality in an Insurance Applicant Population.","authors":"S. Rigatti, R. Stout","doi":"10.17849/insm-48-1-24-35.1","DOIUrl":"https://doi.org/10.17849/insm-48-1-24-35.1","url":null,"abstract":"Objectives.- To quantify the mortality risks associated with elevated levels of carcinoembryonic antigen (CEA). Background.- Carcinoembryonic antigen is cell surface glycoprotein and has been associated with the presence of high grade or metastatic cancers of the colon as well as other malignant and non-malignant disease. Prior publications have demonstrated the utility of CEA levels in the determination of mortality risk in life insurance applicants. The aim of this paper is to further characterize this risk with a larger set of data containing additional person-years of follow-up, more outcomes, and additional variables potentially associated with occult malignancy. Methods.- By use of the Social Security Death Index, mortality was examined in 321,574 insurance applicants age 50 years and older, who submitted blood samples to Clinical Reference Laboratories for testing including CEA. Results were stratified by age group and by CEA level (<5 ng/mL, 5 to 9.9 ng/mL, 10+ ng/mL), though other thresholds were tested. Mortality comparisons were carried out using Cox models and tabular methods with the 2015 smoker-distinct Valuation Basic Tables as a comparator. Results.- Relative mortality is increased at CEA levels above 4.0 ng/mL in both smokers and non-smokers. This association is persistent in Cox models when albumin, BMI and cholesterol are included as covariates. The strongest association with mortality risk occurred in the first 3-4 durations. The 3-year cumulative mortality ratio when using the 2015 VBT as baseline was 6.51 when comparing the group with CEA levels of 10+ ng/mL, compared to those with levels below 5.0 ng/mL. Conclusion.- This study shows that CEA is strongly associated with the risk of early excess mortality in life insurance applicants, and this risk appears not to be mitigated by consideration of other markers thought to be associated with occult malignancy.","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"48 1 1","pages":"24-35"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42748733","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":"AHRR Methylation is a Significant Predictor of Mortality Risk in Framingham Heart Study.","authors":"R. Philibert, Meeshanthini V Dogan, J. Mills, J. Long","doi":"10.17849/insm-48-1-1-11.1","DOIUrl":"https://doi.org/10.17849/insm-48-1-1-11.1","url":null,"abstract":"Background.-The ability to predict mortality is useful to clinicians, policy makers and insurers. At the current time, prediction of future mortality is still an inexact process with some proposing that epigenetic assessments could play a role in improving prognostics. In past work, we and others have shown that DNA methylation status at cg05575921, a well-studied measure of smoking intensity, is also a predictor of mortality. However, the exact extent of that predictive capacity and its independence of other commonly measured mortality risk factors are unknown. Objective.-To determine the capacity of methylation to predict mortality. Method.-We analyzed the relationship of methylation at cg05575921 and cg04987734, a recently described quantitative marker of heavy alcohol consumption, to mortality in the Offspring Cohort of the Framingham Heart Study using proportional hazards survival analysis. Results.-In this group of participants (n = 2278) whose average age was 66 ± 9 years, we found that the inclusion of both cg05575921 and cg04987734 methylation to a base model consisting of age and sex only, or to a model containing 11 commonly used mortality risk factors, improved risk prediction. What is more, prediction accuracy for the base model plus methylation data was increased compared to the base model plus known predictors of mortality (CHD, COPD, or stroke). Conclusion.-Cg05575921, and to a smaller extent cg04987734, are strong predictors of mortality risk in older Americans and that incorporation of DNA methylation assessments to these and other loci may be useful to population scientists, actuaries and policymakers to better understand the relationship of environmental risk factors, such as smoking and drinking, to mortality.","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47094571","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":"All-Cause Mortality for Life Insurance Applicants with the Presence of Bundle Branch Block.","authors":"Stephen A Freitas,&nbsp;Ross MacKenzie,&nbsp;David N Wylde,&nbsp;Jason Von Bergen,&nbsp;J Carl Holowaty,&nbsp;Margaret Beckman,&nbsp;Steven J Rigatti,&nbsp;Daniel Zamarripa,&nbsp;Stacy Gill","doi":"10.17849/insm-48-1-1-12.1","DOIUrl":"https://doi.org/10.17849/insm-48-1-1-12.1","url":null,"abstract":"<p><p><b>Objective.-</b>To determine the all-cause mortality of life insurance applicants who have a bundle branch block. <b>Background.-</b>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. <b>Methodology.-</b>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. <b>Results.-</b>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. <b>Conclusion.-</b>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.</p>","PeriodicalId":39345,"journal":{"name":"Journal of insurance medicine (New York, N.Y.)","volume":"48 1","pages":"36-47"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37349134","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}