As an underwriter, it is common to review medical records indicating a history of "benign fatty liver disease" - especially in those patients with history of high BMI's that carry the majority of their weight through the mid section. Often times, there will be correlation to mildly elevated liver enzymes in a serum blood draw. In a number of underwriting assessments this finding, absent of any alcohol or hepatitis concerns, is typically treated as a non-debitable situation.
A recent research study has focused on the usefulness of utilizing specific laboratory panels to better identify non-alcoholic fatty liver disease (NAFLD) vs. advanced stage non-alcoholic steatohepatitis (NASH). The latter carrying a much higher rate of mortality impact from increased liver disease complications.
The study conducted on 541 patients in the NIH-funded NASH clinical research network found that there was correlation between specific lab/body habitus and biopsy proven advanced stage NASH. Specific areas of importance included; BMI, AST/ALT ratio, AST/platelet ratio, BARD score (BMI, AST/ALT ratio, diabetes), and cirrhosis discriminant score. Unfortunately, lab tests still are unable to clearly identify advanced NASH cases-but these tests are a step in the right direction for identifying situations that require further evaluation.
This will continue to be a problematic issue for underwriting professionals, especially in light of the increasing obesity issues that will affect increased diagnosis of NAFLD making it difficult to weed out those that are higher risk NASH cases.
Tuesday, March 30, 2010
Wednesday, March 10, 2010
Market Trends-Still struggling to find growth!
Two updated indices that track activity in life insurance and life settlement provided no encouragement for improvement in insurance related markets.
MIB (Medical Information Bureau) released February activity numbers yesterday, and the positive trend we saw in January was no where to be seen in the "flat" numbers reflected last month. The month was noted to be "off" -0.2% - all ages combined. One area that still shows promise for future growth is insurance applications on those over the age of 60-an age group that has historically reflected double digit growth over the past 13 months. February is a lower month of production historically so there is hope that moving into 2nd Q we could see moderate increases.
Amrita's Life Settlement Index also released February numbers reflecting a 73 point decline in transactions over January. The indication is that it is related to the policies in the market outpacing the funding to purchase and tightened provider buying perameters. As an LE provider in the space, the trend of lower production in life insurance seems to mirror life settlement as we have historically noted reduced case flow numbers in the first and early 2nd Q.
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MIB (Medical Information Bureau) released February activity numbers yesterday, and the positive trend we saw in January was no where to be seen in the "flat" numbers reflected last month. The month was noted to be "off" -0.2% - all ages combined. One area that still shows promise for future growth is insurance applications on those over the age of 60-an age group that has historically reflected double digit growth over the past 13 months. February is a lower month of production historically so there is hope that moving into 2nd Q we could see moderate increases.
Amrita's Life Settlement Index also released February numbers reflecting a 73 point decline in transactions over January. The indication is that it is related to the policies in the market outpacing the funding to purchase and tightened provider buying perameters. As an LE provider in the space, the trend of lower production in life insurance seems to mirror life settlement as we have historically noted reduced case flow numbers in the first and early 2nd Q.
Come Visit Us!
www.advanceduwsolutions.com
www.linkedin.com/in/tddavisaus
http://twitter.com/TraciDavisAUS
Tuesday, March 9, 2010
Smoking & Benefits of Reduction?
I recently came across an Israeli study that studied the effects of smoking cessation AND reduction in survivors of acute MI (myocardial infarction-acute heart attack). The focus was on long-term mortality in 1581 patients. Both genders were studied, the mean age of the patients was 54, 19% of those studied were women.
Participants in the study had their first cardiac event between 1992 and 1993 and were followed for more than 10 years. At baseline, 123 participants had never smoked, 70 were former smokers, and 234 were current smokers.
Results of the study indicated that of those that were persistent smokers, but noted to reduce at least 5 cigarettes daily status post MI, there was an associated 18% decline in mortality risk.
Although this was considered a "young" cohort of first time MI patients, it did reinforce a significant benefit smoking cessation, but more surprisingly, the benefit of moderate reduction in smoking.
For many smokers plagued with the challenges of quitting, these benefits of smoking reduction are at least a positive step toward encouraging smokers to make initial "first steps".
Participants in the study had their first cardiac event between 1992 and 1993 and were followed for more than 10 years. At baseline, 123 participants had never smoked, 70 were former smokers, and 234 were current smokers.
Results of the study indicated that of those that were persistent smokers, but noted to reduce at least 5 cigarettes daily status post MI, there was an associated 18% decline in mortality risk.
Although this was considered a "young" cohort of first time MI patients, it did reinforce a significant benefit smoking cessation, but more surprisingly, the benefit of moderate reduction in smoking.
For many smokers plagued with the challenges of quitting, these benefits of smoking reduction are at least a positive step toward encouraging smokers to make initial "first steps".
"It has been my experience that folks who have no vices have very few virtues" Abraham Lincoln (1809-1865)
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Friday, February 19, 2010
Trends in Cardiovascular Disease
I recently happened across two studies which focused on hospital mortality rates associated with patients presenting with acute coronary ischemia. One study performed by the National Health and Nutrition Examination Survey (NHANES) noted a .6% decline in death in men (ages 35-44) and 1.3% decline in men (ages 45-54).
The other study from the National Registry of Myocardial Infarction (examining hospital mortality for men and women presenting with acute coronary ischemia) between the years of 1994-2006 noted decreases in associated mortality as well. Specifically, among the oldest men and women (over the age of 85) hospital mortality decreased 8.7%! The bad news for women is that in the later cohort-hospital mortality remained higher among women-especially those under the age of 60.
Although the reduction in hospital related mortality has dropped, the modest improvement in survival of the patients overall suggests that it is extremely important to continue focusing on modifying factors that lead to cardiovascular risk and progression. The risk factors, for young and old, continue to include; control of blood pressure, lipids, and weight and a lifestyle with consistent physical activity, along with controlled co-morbid factors such as diabetes.
The other study from the National Registry of Myocardial Infarction (examining hospital mortality for men and women presenting with acute coronary ischemia) between the years of 1994-2006 noted decreases in associated mortality as well. Specifically, among the oldest men and women (over the age of 85) hospital mortality decreased 8.7%! The bad news for women is that in the later cohort-hospital mortality remained higher among women-especially those under the age of 60.
Although the reduction in hospital related mortality has dropped, the modest improvement in survival of the patients overall suggests that it is extremely important to continue focusing on modifying factors that lead to cardiovascular risk and progression. The risk factors, for young and old, continue to include; control of blood pressure, lipids, and weight and a lifestyle with consistent physical activity, along with controlled co-morbid factors such as diabetes.
"Walking is the best possible exercise. Habituate yourself to walk very far"
Thomas Jefferson (1743-1826)
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Monday, February 15, 2010
Barretts Esophagitis-Increased Risk of Colon Cancer
Recently, researchers in the Netherlands released results of the largest cohort study of the relative risk of Barretts Esophagitis (BE) patients developing future Colorectal Cancer (CRC).
This large based population study involved over 42,000 BE patients. Over the course of the 5 year study, 713 participants (1.7%) were diagnosed with CRC.
All CRC diagnosis were made over the age of 40, the majority of those developed the cancer in their 50's (96%). Most excess risk was identified during colonoscopy following the recent BE diagnosis, as such, no change in baseline colonoscopy testing was felt to be warranted.
What this blogger takes away from this study is the importance of thorough screening in individuals newly diagnosed with BE. As an underwriter I have had the benefit of Insurance MD's in the past that theorized the increased associated risk; planting the seed that these cases must be underwritten with care!
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This large based population study involved over 42,000 BE patients. Over the course of the 5 year study, 713 participants (1.7%) were diagnosed with CRC.
All CRC diagnosis were made over the age of 40, the majority of those developed the cancer in their 50's (96%). Most excess risk was identified during colonoscopy following the recent BE diagnosis, as such, no change in baseline colonoscopy testing was felt to be warranted.
What this blogger takes away from this study is the importance of thorough screening in individuals newly diagnosed with BE. As an underwriter I have had the benefit of Insurance MD's in the past that theorized the increased associated risk; planting the seed that these cases must be underwritten with care!
Quote of the Day:
"Happiness is nothing more than good health and a bad memory"
Albert Schweitzer (1875-1965)
Come visit us!
www.advanceduwsolutions.com
TD on LinkedIn: www.linkedin.com/in/tddavisaus
TD Twitter: http://twitter.com/TraciDavisAUS
Wednesday, February 3, 2010
Trends in Life Insurance and Life Settlement
Two recent indices (one tracking life insurance sales, the other life settlement transactions) have both reflected a positive trend in the markets.
Medical Information Bureau (MIB) noted a continued trend towards growth in life insurance policy applications-especially on older applicants (60+ year olds) which reflected an outstanding YTD increase of 13% over 2008 sales.
Amrita Life Settlement Index just posted it's inaugural index (the first of its kind in the LS market) reflecting an increase in LS transactions (as reported by provider firms in the market) from its benchmarked 500 points to 528. A modest growth but a positive trend nontheless. This blogger is looking for future indices from this group that are more specific and refined-and have no doubt they are committed to providing a quality and reliable reporting for years to come.
Any growth is positive, and after the year we all experienced (whether from a life insurance or life settlement view point) it is quite welcome as we move into a new year!
Quote of the Day:
Medical Information Bureau (MIB) noted a continued trend towards growth in life insurance policy applications-especially on older applicants (60+ year olds) which reflected an outstanding YTD increase of 13% over 2008 sales.
Amrita Life Settlement Index just posted it's inaugural index (the first of its kind in the LS market) reflecting an increase in LS transactions (as reported by provider firms in the market) from its benchmarked 500 points to 528. A modest growth but a positive trend nontheless. This blogger is looking for future indices from this group that are more specific and refined-and have no doubt they are committed to providing a quality and reliable reporting for years to come.
Any growth is positive, and after the year we all experienced (whether from a life insurance or life settlement view point) it is quite welcome as we move into a new year!
Quote of the Day:
"Small opportunities are often the start of great enterprises "
Demosthenes (384 BC-322 BC)
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Wednesday, January 6, 2010
Who Knew? Salt over the Shoulder is Healthier than Salt Consumed
A recent article in Journal Watch brought to light a large scale research study that focused on determining if daily salt intake could prevent cardiac and stroke events. Upon review of 13 studies from 1968 through 2008, which incorporated over 177,000. participants, the researches were able to determine that those participants in the "high consumption" range had significantly increased cardiac (relative risk 1.14)and stroke (relative risk 1.23) events. The difference in salt intake between high risk and average was a mere 5g (1 tsp.) of daily salt intake.
Breaking the information gleaned from this study down, into relative terms that we can all identify with, by decreasing your daily intake of salt by 1 tsp. (86 mmol of sodium) you could reduce your risk of cardiac events by 17% and stroke by an astounding 23%!
Leave the vascular devils at bay by throwing your excess salt over your shoulder instead of sprinkling it on your meal!
Quote of the Day:
I have always regarded myself as the pillar of my life.
Meryl Streep (1949 - )
Contact us:
www.advanceduwsolutions.com
TD on LinkedIn:
www.linkedin.com/in/tddavisaus
TD on Twitter:
http://twitter.com/TraciDavisAUS
Breaking the information gleaned from this study down, into relative terms that we can all identify with, by decreasing your daily intake of salt by 1 tsp. (86 mmol of sodium) you could reduce your risk of cardiac events by 17% and stroke by an astounding 23%!
Leave the vascular devils at bay by throwing your excess salt over your shoulder instead of sprinkling it on your meal!
Quote of the Day:
I have always regarded myself as the pillar of my life.
Meryl Streep (1949 - )
Contact us:
www.advanceduwsolutions.com
TD on LinkedIn:
www.linkedin.com/in/tddavisaus
TD on Twitter:
http://twitter.com/TraciDavisAUS
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