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Biomedical subjects

Clifton P Titcomb

Publications and source records attributed to Clifton P Titcomb.

6 recordsLinked to original sources
PubMed2006

Mortality and Morbidity Liaison Committee--ISCS body mass index study.

OBJECTIVE: This study used the Impairment Study Capture System (ISCS) to examine the relationship between mortality and body mass index (BMI) in an insured population, particularly BMI in isolation from other risk factors. BACKGROUND: Large-scale studies of build in an insured population have traditionally been done on policies issued at standard premium rates. Insured mortality experience on elevated BMI is scarce or outdated. Increasingly competitive underwriting of build throughout the years has influenced what has been issued standard, and therefore, the relative experience of substandard to standard business. METHODS: We studied 241,966 policies submitted through the ISCS between 1989 and 2003 with actual height and weight and a code signifying abnormal build. Actual BMI were derived for these insureds. The average BMI was 35.0. Standardized mortality ratios (SMR) were computed using the 2001 Valuation Basic Table (VBT) as the expected basis. The average duration of exposure was 2.5 years. Results were stratified by underwriting factors of interest. RESULTS: Standardized mortality ratios rose quite modestly as BMI increased up until reaching severe obesity. Ratios for nonsmoker policies where elevated build was the only impairment saw SMR of 265% at BMI < 18.5, 130% at BMI 30.0-34.9, 160% at BMI 35.0-39.9 and 239% at BMI > or = 40.0. Ratios where other impairments were present tended to be higher in moderately obese ranges and lower at extremely obese ranges. No underwriting factor of significance impacted the pattern of ratios as BMI increased. CONCLUSIONS: While an average of 3 years may not be long enough to see the true manifestations of obesity, excess mortality is exhibited at low and high BMI ranges, especially when seen in isolation. The study is not a direct comparison of obese to non-obese subjects, but it is a point of reference for how obese insureds have fared vs standard issued policies. The relatively favorable experience may have more to do with the construction of the (standard) VBT table than any mitigating effect of modest obesity.

Adult↗
PubMed2005

Mortality study of policies on insured lives with diabetes mellitus known at time of issue.

BACKGROUND: This is an Impairment Study Capture System (ISCS) study of contemporary diabetes mellitus mortality among insured lives. Because the diagnosis and treatment of diabetes has changed during the last 15 years, many applicants may be expected to exhibit more favorable outcomes than in the past. The study covers policy-years durational experience extending to only 10 years. METHODS: We analyzed the total mortality experience of 41,972 insurance policies. The policies were issued at standard or substandard premium rates between 1989 and 2002 policy anniversaries. The number of policies terminated by death (actual deaths) is compared with expected deaths using the 2001 Valuation Basic Table (2001 VBT). Main outcome measures are expressed as mortality ratios (MR %) and excess death rates/1000 (EDR/M). Poisson confidence intervals are used to test the statistical significance of mortality ratios at the 95% confidence limit. RESULTS: The total experience is based on 103,104 policy-years exposure: males 57,888 policy-years (56%) and females 45,216 policy-years (44%). There were 495 policy-deaths 284 male and 211 female. Substandard risks represented the majority of the total exposure, 76,658 policy-years in both sexes combined (male 56%, female 44%). The mean duration of substandard exposure was 2.3 years. Total mortality for all insured age-groups and risk categories combined was 187%. The mortality ratios for policies rated standard had confidence intervals that were consistent with 100% of the 2001 VBT. The mortality ratios for policies rated substandard had confidence intervals that were above 100% of the 2001 VBT. Mortality ratios varied with the type of treatment. They were lowest in those treated with diet alone and highest in individuals treated with diet plus insulin. CONCLUSION: A clinical diagnosis of diabetes continues to demonstrate evidence of increased, but improving, mortality in insured individuals. The underwriting risk appraisal process effectively categorizes the risk, especially for the substandard classes where the ratings assigned to policies were consistent with the mortality results. The lack of significant differences in the mortality ratios between males and females as well as between nonsmokers and smokers indicate that the early duration variations by gender and smoking status in the 2001 VBT account for these differences in early duration diabetes mortality. Subsequent follow-up studies containing longer durations may show these differences emerging. Results must be interpreted with caution because of the small data set, limited number of ISCS participating companies, and durational experience extending to only 10 policy years.

Adolescent↗
PubMed2004

LVH: consequences associated with cardiac remodeling.

With increased hemodynamic stress, the heart must adjust to meet the greater demands placed upon it. This adjustment frequently involves an alteration or remodeling in its structure or geometry, which augments its performance and helps to maintain adequate function under changing conditions. One of the most important forms of remodeling that the heart may undergo is an increase in muscle mass in response to a pressure or volume overload or myocardial injury. This increase in muscle mass is known as left ventricular hypertrophy (LVH). LVH is of great importance from a risk selection perspective for two reasons: it is common, and it is associated with a significant increase in both morbidity and mortality risk. Thus, it is critical that both underwriters and medical directors be aware of this form of remodeling, its causes, diagnosis and consequences.

Age Factors↗
PubMed2003

Liver function tests: what is the risk?

Five laboratory assays are commonly called liver function tests (LFTs), although these tests are neither specific to the liver nor true measures of liver function. As a result, alanine aminotransferase (ALT or SGPT), aspartate aminotransferase (AST or SGOT), gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP) and bilirubin have proven problematic for clinicians and risk selection professionals alike. Further, underwriters and insurance medical directors find these tests difficult to assess because of the lack of data directly relating LFT elevations to mortality outcome. Nonetheless, the tests are frequently encountered, so a strategy for evaluating abnormal results is critical to ensure accurate and fair pricing. This paper reviews basic information on LFTs, available mortality data and the application of this knowledge to the underwriting process.

Actuarial Analysis↗
PubMed2003

Matters of the athletic heart.

Frequently an underwriter or medical director will question whether an increase in left ventricular mass represents pathologic left ventricular hypertrophy (LVH) or physiologic changes related to exercise. The LVH condition reflects end-organ damage related to abnormal hemodynamic stresses and confers an increased morbidity and mortality risk. When left ventricular mass is increased because of exercise, measured changes represent a normal, healthy cardiovascular system responding to the demands of that exercise. This article summarizes medical findings that distinguish pathologic LVH from an "athletic heart."

Diagnosis, Differential↗