Mortality Risk Prediction by an Insurance Company and Long-Term Follow-Up of 62,000 Men 英文参考文献.docVIP

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Mortality Risk Prediction by an Insurance Company and Long-Term Follow-Up of 62,000 Men 英文参考文献.doc

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Mortality Risk Prediction by an Insurance Company and Long-Term Follow-Up of 62,000 Men 英文参考文献

MortalityRiskPredictionbyanInsuranceCompanyand Long-TermFollow-Upof62,000Men EricJ.G.Sijbrands1*,ErikTornij2,3,SietskeJ.Homsma2,3 1Division of Pharmacology, Vascular and Metabolic Diseases, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands, 2Actuarial Department,Nationale-Nederlanden–INGGroup,Rotterdam,TheNetherlands,3MedicalDepartment,Nationale-Nederlanden–INGGroup,Rotterdam,TheNetherlands Abstract Background:Insurancecompaniesusemedicalinformationtoclassifythemortalityriskofapplicants.Addinggenetictests to this assessment is currently being debated. This debate would be more meaningful, if results of present-day risk prediction wereknown. Therefore, we comparedthe predicted withthe observed mortality of men who appliedfor life insurance,anddeterminedtheprognosticvalueoftheriskassessment. Methods:Long-termfollow-upwasavailablefor62,334maleapplicantswhosemortalityriskwaspredictedwithmedical evaluation and they were assigned to fivegroups with increasing risk from 1 to 5. We calculated all cause standardized mortality ratios relative to the Dutch population and compared groups with Cox’s regression. We compared the discriminativeabilityofriskassessmentsasindicatedbyaconcordanceindex(c). Results: In 844,815 person years we observed 3,433 deaths. The standardized mortality relative to the Dutch male populationwas0.76(95percentconfidenceinterval,0.73to0.78).Thestandardizedmortalityratiosrangedfrom0.54inrisk group 1 to 2.37 in group 5. A large number of risk factors and diseases were significantly associated with increased mortality.Thealgorithmofpredictionwassignificantly,butonlyslightlybetterthansummationofthenumberofdisorders andriskfactors(c-index,0.64versus0.60,P,0.001). Conclusions: Men applying for insurance clearly had better survival relative to the general population. Readily available medicalevaluationenabledaccuratepredictionofthemortalityriskoflargegroups,butthedeceasedmencouldnothave beenidentifiedwiththeappliedprediction