CDT and Serum Alcohol: What is the Risk?

On The Risk vol.27 n.1 (2011) 

We analyzed the mortality of life insurance applicants

who had CDT or serum alcohol testing performed. Mortality among these applicants was determined by use of the Social Security Death Master File. This study comprised 1,355,552 applicants tested between 1995 and 2009, with 21,514 deaths on follow-up in 2010. The mean follow-up was 5.5 years (range 0 to 15). 

Albumin and All-Cause Mortality Risk in Insurance Applicants.

J. Insurance Medicine vol.42 (2010)

By use of the Social Security Death Master File, mortality was determined in 1,704,566 insurance applicants for whom blood samples were submitted to CRL. There were 53,211 deaths observed in this healthy adult population during a median follow-up of 12 years. 

Mortality Associated with Positive Hepatitis C and B Results.

On The Risk vol.26 n.3 (2010)

The mortality risk for being hepatitis C (HCV) or hepatitis B (HBV) positive in insurance applicants was studied in a tested applicant population of 513,755 lives followed for a median of 7 years (range 0 to 18 years).

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.