and interpret medical billing and diagnostic codes are equally capable of returning fact-based evidence of tobacco history. At Milliman IntelliScript, in fact, we’re seeing hard evidence of nicotine use in 16.4% of all combined Irix Prescription Data and Medical Data hits. And we’ve observed that more than 80% of this data is new information to carriers—it was not disclosed by applicants or found by their other risk assessment methodologies.
in our proprietary data broadly mirrors published research—as seen in the Society of Actuaries (SOA) Valuation Basic Table, for example—proving that double (or greater) mortality is sustained for a long time. We all know that smoking greatly increases the risk of developing lung cancer; it’s responsible for 80- 90% of all lung cancer deaths. 3 But that’s just the beginning. Smoking increases the risk for cancer in other organs throughout the body, notably the bladder, mouth, esophagus, liver and pancreas; it even increases the risk for blood cancer (e.g., acute myeloid leukemia). Non-cancer harms include in - creased risk and/or severity of chronic obstructive pulmonary disease (COPD), cardiovascular disease, coronary heart disease, stroke and diabetes with its attending complications, such as kidney disease. 4 Nicotine packs a real double whammy: it not only increases the likelihood of developing many chronic conditions—ranging from asthma to rheumatoid arthritis 5 — it also significantly elevates the mortality associated with those conditions.
In a word: Tobacco, smoking and nicotine
Throughout this article, we generally refer to nico- tine use or dependence rather than referencing a specific tobacco or smoking status. This is because many medical diagnosis and procedure codes indi- cate nicotine without specifying a means of deliv- ery. We know through overlap analyses that these records most often correspond to smokers, but some percentage of reported nicotine use is accounted for by users of smokeless tobacco products or people using nicotine “vapes.” Where Else Can You Get Instant Identification of Sustained Double Mortality?
Risk of Relapse
Ratio of Smoker vs. Non-Smoker Mortality
Nicotine is a readily available and remarkably addic - tive substance, resulting in high rates of relapse after quitting attempts. In 2015, a CDC survey 6 found that nearly 70% of adults who smoked cigarettes were interested in quitting; a majority of respondents had tried to quit in the previous year, but only 7% of smok - ers had managed to stay off cigarettes for 6 months. The American Cancer Society once estimated that people who successfully kicked their habit had tried and relapsed anywhere from 8 to 10 times. 7 A 2013 study published in the Journal of Drug and Alco- hol Dependence 8 estimated that the risk of relapse for smokers was greater than 50% in the first year. Smokers who succeed in quitting for a full year have a slightly less than 50% chance of relapse, but relapse rates remain significant for several years. High relapse rates should concern insurers underwriting “ex-smokers ” .
Conventional wisdom has long held that smokers have roughly twice the mortality of nonsmokers. As far as rules of thumb go, that’s reasonable; although, depending on their age and whether they’re male or female, smokers’ mortality ranges from around 150% for younger smokers to nearly 300%. As a consumer reporting agency subject to the Fair Credit Report - ing Act, Milliman IntelliScript’s tools consider up to 7 years of an applicant’s prior history. What we see Source: This data drawn from the SOA’s 2015 Valuation Basic Table Re- port illustrates smokers’ elevated mortality, especially in the age bands of most interest to life insurers.
ON THE RISK vol.40 n.3 (2024)
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