If the industry treated smoking as a rated impairment which carried debits, combo debits might be war- ranted. For example, in our Cox models from Strategy 1 in women, we see that diabetes has a hazard ratio of 2 which is equivalent to 100 debits, while smok - ing had a hazard ratio of 3 (200 debits). If we were to add those debits together, we get 300, equivalent to a hazard ratio of 4, but we see from our analysis that the HR for diabetic smokers was about 5.4 (440 debits). The equivalent exercise in men produces a closer result, where the debits for smoking and diabetes would be 247 (154+93), just 27 debits shy of the 275 debits calculated for diabetic smokers. In this example, we see that there can be impacts, not
only from the traditional way of handling smokers, but the traditional way of combining debits from multiple impairments. Conclusion Within the constraints of the available data, this study demonstrated that additional debits for diabetic smokers, beyond those already applied explicitly for diabetes on top of an elevated mortality expectation for smoking, are likely not warranted. Additional studies from other sources, as well as investigations of other diseases commonly carrying combo debits, should be performed.
About the Author Steven Rigatti, MD, is a medical consultant for Clinical Reference Laboratories, and serves as a consultant to several life insurance companies and related service providers. He is a graduate of Worcester Polytechnic Institute and the University of CT School of Medicine, and is board-certified in family medicine and insurance medicine. He joined the life insurance industry at MetLife in 2007, later moving to MassMutual and becom - ing the Chief Medical Director there in 2015. In 2017, he formed his current company Rigatti Risk Analytics. He is currently the chair of the Mortality Committee of the American Academy of Insurance Medicine and has strong interests in data analysis and biostatistics, and is currently enrolled in the Masters in Analytics program at Georgia Tech.
SCENES FROM THE 2024 CIU ANNUAL GENERAL MEETING
Erica Hind, (Partner Re).
Shawn James, (Gen Re).
ON THE RISK vol.40 n.3 (2024)
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