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Welcome to CRL® and the last
Reference Point of 2010
Greetings!
As 2010 draws to a close, we are pleased to see so many new people signed up to receive Reference Point. If this is your first issue, welcome! One of the reasons we publish Reference Point is to share highlights of our ongoing research into how laboratory testing can better predict mortality. To that end, this last issue of 2010 would be a great place to offer you a handy, complete reference list to CRL's published research from the past few years. We hope you find this a useful reference source throughout 2011. In the right-hand column we've featured two of CRL's efficiency services. These are designed to complement our core laboratory testing services so that our customers can save even more time and money! To learn more about how CRL can assist your company please call your sales representative at 800.445.6917 or email InsuranceSales@CRLcorp.com |
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Glucosuria As A Mortality Risk Predictor When Blood Is Not Collected
On the Risk vol.26 n.2 (2010)
A 12-year follow-up mortality study of 1,857,902 insurance applicants tested for urine glucose shows that increasing glucosuria is associated with increasing mortality risk, as well as increasing serum glucose and fructosamine levels. The mortality relationship is age-dependent but remains little changed when the analysis is limited to those who deny a history of diabetes. In situations where urine is the only body fluid obtained, urine glucose levels are an effective risk predictor.
Mortality Associated With Positive Cocaine Test Results
On the Risk vol.26 n.1 (2010)
Current approaches to underwriting positive cocaine tests include decline or postponement followed by retesting and (if the retest is negative) assignment of a temporary flat extra premium. This study of over 4,500,000 insurance applicants followed for a mean of 11 years shows that the excess risk from cocaine use is moderately elevated and stable for many years, and is dependent on age, sex and smoking status; this calls into question these approaches. Those under age 60 have the highest prevalence and mortality ratios.
Underwriting Implications of Elevated Carcinoembryonic Antigen
On the Risk vol.25 n.3 (2009)
This follow-up study shows that CEA can detect early excess mortality risk in insurance applicants who are age 50 years and over. The addition of CEA testing beginning at age 50 for life insurance applicants could reduce early mortality by 3.2% if the threshold for requiring further evaluation were set at 10 ng/mL.
Non-Cigarette Tobacco Use - What Is The Risk
On the Risk vol.25 n.2 (2009)
An 8 to 10 year (mean 8.8 years) follow-up study of mortality among 2,193,014 insurance applicants who disclosed their cigarette smoking and other tobacco use status found that "nonsmokers" and "noncigarette tobacco users" who were positive for cotinine (=> 200 ng/mL) had mortality that was substantially elevated. Non-cigarette tobacco users who were negative for cotinine had mortality that was not significantly different than the mortality seen among cotinine-negative nonsmokers. The presence of cotinine in the urine is the key factor in determining mortality risk rather than how nicotine is consumed
Hemoglobin A1c and Mortality In Insurance Applicants: A 5-Year Follow-Up Study
On the Risk vol.25 n.1 (2009)
Hemoglobin A1c values of 6% and higher show a steady progressive increase in 5-year mortality risk, with a different rate of increase for different ages. The "cost" and "benefit" associated with various trigger levels of your screening test should be discussed with your laboratory. The potential benefit of additional HbA1c tests increases with face amount and with age.
Association of Cholesterol, LDL, HDL, Cholesterol/ HDL and Triglyceride with All-Cause Mortality in Life Insurance Applicant
Journal of Insurance Medicine 41:244-253 (2009)
Compared to other testing, lipid tests are only moderately predictive of all-cause mortality risk in a life insurance applicant population, and the risk is highly dependent on age and sex. The TC/HDL ratio may serve as a useful single measure to predict risk, but only if stratified by age and sex, and only if high HDL at younger ages and low TC at older ages are also recognized as being associated with increased mortality risk. Considering elevations of TC or triglyceride values in addition to the TC/HDL ratio does not improve risk discrimination in any age-sex subpopulation studied.
Mortality Associated with Bilirubin Levels in Insurance Applicant
Journal of Insurance Medicine 41:49-5 (2009)
Isolated elevations of bilirubin in this healthy screening population were not associated with excess mortality but values below the midpoint were. In association with other LFT elevations, bilirubin elevation further increases the mortality risk only at the highest elevations of other LFTs.
Using Liver Enzymes as Screening Tests to Predict Mortality Risk
Journal of Insurance Medicine 40:191-20 (2008)
Our results suggest that changes are needed in the approach toward the results of screening LFTs. GGT and AP are strong linear predictors of relative mortality risk in all 3 age/sex groups. This predictive value extends from the lowest values (healthiest) to the highest values. Above the middle 50% band of the population, AST is less predictive and ALT has very limited predictive value. However, low values of transaminases also predict increased risk. The mortality risk associated with multiple LFT elevations can be approximated by adding the risk of each elevation.
Increased Mortality Associated with Elevated Carcinoembryonic Antigen in Insurance Applicants
Journal of Insurance Medicine 39:251-258 (2007)
This study shows that CEA can detect the risk of early excess mortality in life insurance applicants, and provides the information needed for objective decision making on the part of a life insurer regarding the possible use of CEA as a screening tool. It also provides a reference for evaluating CEA results from other sources.
Relationship of Hemoglobin A1c to Mortality in Nonsmoking Insurance Applicants
Journal of Insurance Medicine 39:174-181 (2007)
The importance of even small elevations of hemoglobin A1c above 5.9% is apparent. It is suggested that for screening, it is the degree of blood sugar elevation as measured by hemoglobin A1c rather than the diagnostic label that is critical in mortality risk assessment.
Improvements In Cotinine Testing of Insurance Applicants
On the Risk vol.22 n.1 (2006)
The authors recommend reducing the cotinine screening test threshold for a positive result from 500 ng/mL to 200 ng/mL. Samples with initial cotinine results between 200 ng/ml and 1,000 ng/ml will require confirmation testing by GC/MS if the applicant applies as a non-tobacco user. While all samples with screening results that exceed 1,000 ng/ml were confirmed as positive by GC/MS, any applicant who vehemently denies tobacco use should be confirmed with a more definitive test for cotinine, which is GC/M
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Clinical Reference Laboratory
8433 Quivira Road | Lenexa, Kansas | 1-800-445-6917
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 SWIFT SCREEN
Professional. Custom. Efficient. When a case requires ECG review, your turnaround time doesn't have to be affected. Clinical Reference Laboratory offers Swift Screen, an ECG review service you can order along with your applicant's laboratory testing. Our team of respected medical directors from the insurance industry are available to review ECGs using your specific guidelines. Turnaround time is less than 24 hours. BenefitsYour own medical/ underwriting staff are freed up to focus on other cases All ECG reviews are custom, performed according to your guidelines Quick access to top medical directors' opinions any time you need it To learn more about Swift Screen, please contact your CRL Sales Representative.
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"CRL was a very valuable partner in some recent mortality studies we conducted. They shared analysis of their own mortality data, helping direct our hypotheses and at our request, worked with our actuaries to dig deeper. CRL provided great attention to detail within very tight timeframes. They were an outstanding overall partner that we will continue to look to for our ongoing R&D work"
~ Genworth Financial
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 DOCUMENT IMAGING
Quicker, Cleaner Document Delivery
Part II exams, applications, consent forms, lab tickets, and any additional paperwork: delivered all at once, already in digital form - and even faster than before.
Clinical Reference Laboratory's document services make this a reality. No more collecting multiple documents from multiple sources, or waiting for that last document to complete the case file. Instead, all exam and lab documents related to a new policy arrive to the carrier already digitized and indexed. As a result, your skilled staff spends less time chasing paper and more time focused on underwriting.
When an examiner ships specimens and paperwork to CRL®, our Document Center will prepare and scan the associated documents, producing excellent images of the originals with our high-speed scanners. All documents are then indexed and transmitted along with the lab results.
CRL will store the original documents at our secure facility for 60 days before destroying them in a secure manner.
To learn more about Document Imaging, please contact your
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ACLI 2011
Feb 26 - Mar 1, 2011
The Ritz-Carlton
New Orleans, LA
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