Life Insurance and Overweight

Two items were selected for this month's Classics in Obesity. The first is an extract from the Report of the Joint Committee on the Medico Actuarial Mortality Investigation published in 1913 (1). The second is an extract from DeLamar Lectures by Louis Dublin from 1927 (3). It is selected because Dublin and the insurance industry played a major role in the focus on the increased risk of death among the overweight. In his lecture in 1926 Dublin says, “The conviction that body build affects longevity has been general for a long time.” But when was this concept first identified and how long did it take to impact research in obesity? The idea was clearly enunciated in the material published by the Association of Life Insurance Medical Directors and the Actuarial Society of America in 1913 that increased mortality was associated with increased deviations in body weight. I have plotted the 1913 data below (Figure 1). The increase in mortality with increasing upward deviation is readily apparent. But there is little evident impact of deviations below average.     

The Added Value of Medical Testing in Underwriting Life Insurance

Background

In present-day life-insurance medical underwriting practice the risk assessment starts with a standard health declaration (SHD). Indication for additional medical screening depends predominantly on age and amount of insured capital. From a medical perspective it is questionable whether there is an association between the level of insured capital and medical risk in terms of mortality. The aim of the study is to examine the prognostic value of parameters from the health declaration and application form on extra mortality based on results from additional medical testing.

Methods

A history register-based cohort study was conducted including about 15.000 application files accepted between 2007 and 2010. Blood pressure, lipids, cotinine and glucose levels were used as dependent variables in logistic regression models. Resampling validation was applied using 250 bootstrap samples to calculate area under the curves (AUC’s). The AUC was used to discriminate between persons with and without at least 25% extra mortality.

Results

BMI and the overall assessment of the health declaration by an insurance physician or medical underwriter showed the strongest discrimination in multivariable analysis. Including all variables at minimum cut-off levels resulted in an AUC of 0.710 while by using a model with BMI, the assessment of the health declaration and gender, the AUC was 0.708. Including all variables at maximum cut-off levels lead to an AUC of 0.743 while a model with BMI, the assessment of the health declaration and age resulted in an AUC of 0.741.

Conclusions

The outcome of this study shows that BMI and the overall assessment of the health declaration were the dominant variables to discriminate between applicants for life-insurance with and without at least 25 percent extra mortality. The variable insured capital set by insurers as factor for additional medical testing could not be established in this study population. The indication for additional medical testing at underwriting life-insurance can possibly be done on limited variables instead of the obligatory medical testing based on age and the amount of insured capital.