Experiences in C.D.T. testing

The value of carbohydrate deficient transferrin (CDT) as the most direct and most accurate indicator of alcohol abuse has been amply demonstrated in the scientific literature. The CDT assay used by GIB Laboratories to assess serum samples for significant levels of alcohol abuse was validated using 184 clinically defined positive and 203 clinically defined negative specimens. Using a defined cutoff of significance and a special testing algorithm, GIB Laboratories has determined, in this study, that the sensitivity of the commercial CDT enzyme immunoassay (CDT EIA) is 88 percent, the specificity is greater than 99 percent, and the intra- and inter-run reproducibility is less than seven percent, about three times more precise than most confirmatory tests for CDT. Given the very low expected frequency of true physiological causes of non-specificity (less than one percent), the excellent specificity of the assay (in GIB Laboratories' experience), and the technical problems, time delays, and costs associated with all "confirmatory" technologies, it cannot be recommended that CDT confirmatory testing be performed, unless an individual laboratory experiences unacceptable specificity in its screening tests. It would appear that, performing CDT "confirmatory" testing when the specificity of the screening test is as high as this study has found it to be, can result in three probabilities: 1) an increase in the number of false negative results; 2) few corrections in the very small number of false positive results; and 3) in greater cost and delay for the laboratory's clients.     

Diabetes update

The purpose of this article is to provide a general update of diabetes with a focus on newer developments that may impact risk assessment. The main reasons for concern about diabetes are the associated microvascular and macrovascular complications. Control of blood glucose levels, primarily assessed by measurement of hemoglobin A1c, has been shown to reduce the occurrence of microvascular complications. In conjunction with control of other risk factors, control of blood glucose levels reduces the occurrence of macrovascular complications. Type 1 diabetes is now known to be an autoimmune disease. For unknown reasons, the patient's immune system destroys its own pancreatic insulin-producing beta cells. The hallmark of type 2 diabetes is insulin resistance, which may be mediated by one of a number of gene defects. At some point, the pancreatic beta cells are unable to compensate for the insulin resistance by increasing insulin secretion. Type 2 diabetes then appears. Prediabetes, encompassing impaired fasting glucose and impaired glucose tolerance, is an important clinical entity that precedes the diagnosis of diabetes in many cases. Diet and exercise are the most important interventions for reducing the progression of insulin resistance to diabetes. Once diabetes develops, medications are matched to pathophysiology.     

Logistic Regression for Insured Mortality Experience Studies

Properly adapted statistical modeling methodology can be a powerful tool for coping with a broad range of challenges related to life and annuity insurance industries' experience studies. In this article, we present a logistic regression model based on U.S. insured mortality experience study with a focus on gaining study efficiency and effectiveness by addressing multiple analytical predicaments within one statistical modeling framework. These predicaments include but are not limited to (a) testing statistical significances or credibility of potential mortality drivers, (b) estimation of normalized mortality, slopes, and differentials, (c) quantification of study reliability, and (d) extrapolation for under-experienced mortality, smoothing between select and ultimate estimations, and development of basic experience tables.     

Patterns of Aging-Related Changes on the Way to 100

Abstract

The objective of this paper is to investigate dynamic properties of age trajectories of physiological indices and their effects on mortality risk and longevity using longitudinal data on more than 5,000 individuals collected in biennial examinations of the Framingham Heart Study (FHS) original cohort during about 50 subsequent years of follow-up. We first performed empirical analyses of the FHS longitudinal data. We evaluated average age trajectories of indices describing physiological states for different groups of individuals and established their connections with mortality risk. These indices include body mass index, diastolic blood pressure, pulse pressure, pulse rate, level of blood glucose, hematocrit, and serum cholesterol. To be able to investigate dynamic mechanisms responsible for changes in the aging human organisms using available longitudinal data, we further developed a stochastic process model of human mortality and aging, by including in it the notions of “physiological norms,” “allostatic adaptation and allostatic load,” “stress resistance,” and other characteristics associated with the internal process of aging and the effects of external disturbances. In this model, the persistent deviation of physiological indices from their normal values contributes to an increase in morbidity and mortality risks. We used the stochastic process model in the statistical analyses of longitudinal FHS data. We found that different indices have different average age patterns and different dynamic properties. We also found that age trajectories of long-lived individuals differ from those of the shorter-lived members of the FHS original cohort for both sexes. Using methods of statistical modeling, we evaluated “normal” age trajectories of physiological indices and the dynamic effects of allostatic adaptation. The model allows for evaluating average patterns of aging-related decline in stress resistance. This effect is captured by the narrowing of the U-shaped mortality risk (considered a function of physiological state) with age. We showed that individual indices and their rates of change with age, as well as other measures of individual variability, manifested during the life course are important contributors to mortality risks. The advantages and limitations of the approach are discussed.     

Screening potential elderly preferred markers: exploratory analysis of Cardiovascular Health Study (CHS) data

The Cardiovascular Health Study (CHS) analyzes risk factors for coronary heart disease and stroke in people age 65 and older. Since CHS is designed to comprehensively study cardiovascular risk factors in an elderly population, it provides a unique opportunity to study the association of risk factors with mortality, as well as morbidity risk. With the growth of the elderly as population and life insurance market segments, the need to more precisely stratify mortality within a standard risk group of the elderly has grown as well. This exploratory analysis assesses medical factors that could be used to improve mortality risk stratification within a "standard" mortality population, using the CHS public use data set. Participants with a personal history of cardiovascular disease, diabetes, or major electrocardiographic abnormalities were excluded from the analysis in order to mimic a standard life insurance selection process. Then, Cox proportional hazards regression was used to study 10 medical risk factors. This model suggested that forced vital capacity >80% predicted, serum creatinine <1.5 mg/dL (133 mcmol/L), hemoglobin >11 g/dL (110 g/L), and serum albumin >3.5 mg/L (35 mmol/ L) are significantly associated (p = 0.05) with favorable mortality. C-reactive protein <1 mg/L is associated with favorable mortality at borderline significance levels (p = 0.09). On the other hand, a family history of cardiovascular disease (MI and/or stroke) and low BMI (<26 kg/m2) are associated with unfavorable mortality in the analysis. Total to HDL cholesterol ratio of <6, presence of supine systolic blood pressure < or = 140 mmHg, and the presence of minor rest electrocardiographic findings were not statistically significant factors in the multivariate model. Further assessment of the predictive value of the "significant" medical factors identified is required in insured lives.     

The Metabolic Syndrome and All-Cause Mortality in an Insured Lives Population

Abstract

Metabolic syndrome and its association with mortality have not been studied in insured lives populations. The Swiss Re Study evaluated metabolic syndrome prevalence and associated mortality from all causes and circulatory disease in a cohort of 35,470 predominantly healthy individuals, aged 18–83 years, who were issued life insurance policies between 1986 and 1997. Metabolic syndrome was defined using the National Cholesterol Education Program (NCEP) Expert Panel Adult Treatment Panel (ATP) III guidelines. The NCEP obesity criteria were modified with a prediction equation using body mass index, gender, and age substituted for waist circumference. Adjustments also were made for nonfasting triglyceride and blood glucose values. Risk ratios for policyholders identified with metabolic syndrome were 1.16 (P = .156) for mortality from all causes and 1.45 (P = .080) for mortality from circulatory disease compared with individuals without the syndrome. Risk was proportional to the number of components, or score, of the metabolic syndrome present. Risk ratios for metabolic syndrome score were 1.14 (P < .001) for mortality from all causes and 1.38 (P < .001) for mortality from circulatory disease compared with individuals without metabolic syndrome factors. In both all-cause and circulatory death models, relative risk was highest for the blood pressure risk factor. Based on a modified NCEP definition, increased mortality risk is associated with metabolic syndrome in an insured lives cohort and has life insurance mortality pricing implications.     

Railroad Development and Land Value

Land owners in the rural Midwest experienced significant capital gains during the late 1840s and early 1850s. A primary catalyst of increasing land values was the construction of new railroads. Land in close proximity to new railroads became more valuable because of decreased transportation costs. We use a straightforward model of land price determination to estimate the impact on land values of distance from the railroad. The estimates allow us to infer a lower bound for capital gains attributable to the construction of railroads in Knox County, Illinois, during the 1850s. Knox County landowners reaped capital gains of more than $270,000—9% of the value of land.     

Questionnaire based mortality assessment: an exploratory analysis of NHANES III

The need for speed and efficiency in life insurance underwriting has never been greater. With increasing acquisition costs, the need for timeliness to complete the sales process, and the need for accurate mortality prediction a great deal of resources have been devoted to the development of non-traditional underwriting processes and criteria in hopes of streamlining the process. In this paper, we describe an exploratory analysis of mortality linked data from the US NHANES III study. Our goal for this analysis was to identify mortality predictors that would be good candidates for further investigation in insurance applicants, especially in the context of simplified issue products which focus on younger age applicants. We identified aerobic exercise, dental health, alcohol beverage type and quantity, and dietary components and patterns as factors that may hold promise as mortality predictors in persons age 17-65. Though the limitations of this analysis preclude the immediate use of these factors as underwriting criteria, it does appear that several of these hold promise, and should be tested in an insurance application context. Focus groups, market testing, or even insertion as non-actionable questions in a subset of applications may be ways to collect further data on them.     

Pricing of guaranteed minimum withdrawal benefits in variable annuities under stochastic volatility,stochastic interest rates and stochastic mortality via the componentwise splitting method

This paper values guaranteed minimum withdrawal benefit (GMWB) riders embedded in variable annuities assuming that the underlying fund dynamics evolve under the influence of stochastic interest rates, stochastic volatility, stochastic mortality and equity risk. The valuation problem is formulated as a partial differential equation (PDE) which is solved numerically by employing the operator splitting method. Sensitivity analysis of the fair guarantee fee is performed with respect to various model parameters. We find that (i) the fair insurance fee charged by the product provider is an increasing function of the withdrawal rate; (ii) the GMWB price is higher when stochastic interest rates and volatility are incorporated in the model, compared to the case of static interest rates and volatility; (iii) the GMWB price behaves non-monotonically with changing volatility of variance parameter; (iv) the fair fee increases with increasing volatility of interest rates parameter, and increasing correlation between the underlying fund and the interest rates; (v) the fair fee increases when the speed of mean-reversion of stochastic volatility or the average long-term volatility increases; (vi) the GMWB fee decreases when the speed of mean-reversion of stochastic interest rates or the average long-term interest rates increase. We investigate both static and dynamic (optimal) policyholder's withdrawal behaviours; we present the optimal withdrawal schedule as a function of the withdrawal account and the investment account for varying volatility and interest rates. When incorporating stochastic mortality, we find that its impact on the fair guarantee fee is rather small. Our results demonstrate the importance of correct quantification of risks embedded in GMWBs and provide guidance to product providers on optimal hedging of various risks associated with the contract.     

Men, children and the future of the family in the third millennium

This paper examines the effects of demographic change on the foundations of the family. The “first” demographic transition — the massive declines in fertility and mortality — is shown to have undermined the traditional male–female relationship based on parenthood. This has led to the gender revolution in the public sphere. The “second” demographic transition — the increases in divorce and cohabitation — is shown to have undermined the father–child relationship, reflecting women's control over children, a control that increased continually during the first demographic transition. This paper argues that the gender revolution needs to be brought into the family, increasing women's ability to compete in employment and men's ability both to choose whether to assume parental responsibility and to maintain active parental roles with their children.     

Exercise test on the older patient: is it still as predictive as for the younger patient?

Exercise testing predicts both cardiac events and mortality after age 65, just as it does for younger patients. In both age groups, functional aerobic capacity itself is a potent indicator of mortality risk. In the elderly, achievement of predicted functional aerobic capacity identifies favorable mortality even in the presence of CAD and CAD risk factors.     

Infant mortality: an insured population perspective

Many insurers offer life coverage to individuals during the first year of life. The policies tend to have small face values, but frequently contain premium waiver or additional purchase options. General population mortality is significantly higher at this age relative to older children and even middle-aged adults. This article presents the mortality experience of an insured cohort in which death occurred under 1 year of age. In summary, the insured population's mortality rate was significantly lower and the leading causes of death were different than the general population.     

The impact of multiple structural changes on mortality predictions

Most mortality models proposed in recent literature rely on the standard ARIMA framework (in particular: a random walk with drift) to project mortality rates. As a result the projections are highly sensitive to the calibration period. We therefore analyse the impact of allowing for multiple structural changes on a large collection of mortality models. We find that this may lead to more robust projections for the period effect but that there is only a limited effect on the ranking of the models based on backtesting criteria, since there is often not yet sufficient statistical evidence for structural changes. However, there are cases for which we do find improvements in estimates and we therefore conclude that one should not exclude on beforehand that structural changes may have occurred.     

Mortality risk assessment in the elderly: the utility of delayed word recall

Cognitive impairment is an important predictor of mortality in the elderly. An extended delayed word recall (DWR) is one of the most sensitive tests for cognitive impairment. A mortality study was performed on a population of long-term care insurance applicants aged 70 and older who were underwritten during the years 1995-2003 and who had cognitive testing by DWR. Within this relatively short period of time, individuals with DWR score of 0-5 compared to those with DWR score of 6-10 had a markedly worse mortality outcome overall and also when analyzed by gender, underwriting age, underwriting year or smoking status.     

Determinants of academic cheating behavior: The future for accountancy in Ireland

This paper considers the potential for improving the reputation of the Irish accountancy profession by exploring undergraduate accounting students’ intolerance of academic cheating as a predictor of future attitudes to unethical workplace practices. The study reports that females are significantly more intolerant of cheating than males. Further, with regard to ethical ideology, idealism was found to have a significant positive association with intolerance of cheating while relativism reported no association. It is anticipated that the growing admission of women to professional accountancy membership together with educational intervention to increase idealism may improve ethical attitudes and help restore the profession's reputation.     

Mortality Inequality in the Czech Republic*

We examine the evolution of mortality and mortality inequality among the 77 districts of the Czech Republic ranked by a new poverty index, from 1994 to 2016. The country experienced dramatic improvements in mortality for all age categories and both genders, but with very little variation in inequality. Inequality in mortality has remained substantially stable, increasing only for females aged 20–64.     

Ambiguity intolerance and financial reporting alternatives

Authoritative accounting pronouncements almost always require more, rather than less, financial reporting disclosures and accountants rarely, if ever, act to overturn the required disclosures. Since the personality literature suggests that desire for more information is linked to an individual's intolerance for ambiguity, this study tested selected hypotheses about the relationship between accountants' intolerance for ambiguity and their desire for financial reporting alternatives. The findings of the study did not disclose a significant relationship between accountants' intolerance for ambiguity and their desire for financial reporting alternatives. However, the results did disclose a relationship between education level and two dependent variables: desire for disclosure and consistency of desired disclosures with generally accepted accounting principles. Therefore, additional research should pay more attention to the effects of demographic information, which may in fact be more informative than many previously tested variables such as personality characteristics.     

Effect of increasing body weight on morbidity and mortality in South Korea

The number of overweight and obese people in South Korea is increasing due to changes in exercise and dietary habits. The World Health Organization estimated that 45% of Korean men and 54% of women were overweight in 2005, and the percentages are expected to increase to 66% and 67%, respectively, by 2015. Studies have also found that more than 10% of Korean children and adolescents are now obese. These trends are important from both a public health and an insurance perspective because weight gain increases the likelihood of diabetes, cardiovascular disease, cancer, and other disorders that affect morbidity and mortality.     

A proposition of generalized stochastic Milevsky–Promislov mortality models

The aim of this article is to propose a new approach to the estimation of the mortality rates based on two extended Milevsky and Promislov models: the first one with colored excitations modeled by Gaussian linear filters and the second one with excitations modeled by a continuous non-Gaussian process. The exact analytical formulas for theoretical mortality rates based on Gaussian linear scalar filter models have been derived. The theoretical values obtained in both cases were compared with theoretical mortality rates based on a classical Lee–Carter model, and verified on the basis of empirical Polish mortality data. The obtained results confirm the usefulness of the switched model based on the continuous non-Gaussian process for modeling mortality rates.