All-Cause Mortality for Diabetics or Individuals with Hyperglycemia Applying for Life Insurance

Area of Science:

• Epidemiology
• Public Health
• Actuarial Science

Background:

• Diabetes mellitus and hyperglycemia are significant public health concerns.
• Accurate mortality risk assessment for diabetic populations is crucial for insurance and healthcare.
• Previous studies may lack comprehensive data on mortality in individuals with diabetes.

Purpose of the Study:

• To assess mortality rates in a large cohort of US life insurance applicants diagnosed with or exhibiting hyperglycemia.
• To analyze how mortality risk varies by treatment, age, Body Mass Index (BMI), and duration since application.
• To compare observed mortality to expected rates using established actuarial and population tables.

Main Methods:

• Retrospective cohort study of US life insurance applicants (2007-2014) with diabetes or hyperglycemia.
• Linked applicant data to death master files (Social Security Death Master File and commercial file) to determine vital status.
• Calculated Actual to Expected (A/E) mortality ratios using the Society of Actuaries 2008 Valuation Basic Table (2008VBT) and 2010 US population data.

Main Results:

• Overall A/E mortality ratios were 3.15 (full cohort) and 2.56 (reduced cohort) using 2008VBT, indicating substantially elevated mortality.
• Mortality ratios were higher for insulin users and decreased with increasing age.
• A J-shaped distribution of mortality was observed with increasing BMI, with lowest ratios in overweight/obese individuals.

Conclusions:

• Individuals with diabetes applying for life insurance exhibit significantly higher mortality than expected.
• Treatment modality (insulin use) and BMI are key factors influencing mortality risk in this population.
• Mortality risk assessment in diabetics requires consideration of multiple factors beyond diagnosis alone.