precision underwriting

Last month we discussed five of the most common diagnoses codes among female life insurance applicants. Now, we are shifting that focus to male applicants and taking a look at their top five diagnoses revealed through LabPiQture™, as well as some of their surprising non-disclosure results discovered through laboratory testing.

Top five diagnoses codes among male life insurance applicants

male life insurance applicants top 5 diagnoses

Source: ExamOne

Three of the top five male diagnoses are the same as our female segment analysis. The two diagnoses that reached that top five in males, but not females are type 2 diabetes mellitus (#12 for females) and encounter for screening malignant neoplasms (#7 for females).

Type 2 diabetes mellitus

In a recent ExamOne study of results between January 2018 and May 2019, diabetes was confirmed in 4.8% of male applicants. In the cases of confirmed diabetes, 33.9% of these male applicants did not disclose they had this condition. Diabetes non-disclosure is often unintentional because many applicants are unaware they have it.

Encounter for screening malignant neoplasms

Encounter for Screening for Malignant Neoplasms (Z12) is an interesting illustration of the need to interpret a diagnosis in the context of the data source from which it is derived; in this case, clinical testing results. In general use, Z12 could reference a broad array of cancer screens, conducted by an equally diverse set of methods; mammograms, colonoscopies, MRIs, and digital rectal exams (DREs) are all included within this code. Within a LabPiQture context, however, only encounters associated with laboratory tests are generally reported. For cancer screens, this strongly implies PSA testing – which is, of course only performed on males.

Non-disclosure in male applicants  

Hypertension

Hypertension, also known as high blood pressure, is one of the top three diagnoses for males. We discovered that 58.6% of confirmed hypertensive males did not acknowledge an elevated blood pressure at the time of their interview/exam. According to the Mayo Clinic, individuals can live with hypertension for years without any symptoms. Continuing to live with uncontrolled high blood pressure can lead to other health concerns including heart attack, stroke, heart failure and even dementia.

Obesity

In the same analysis of ExamOne applicants, 33.3% of male applicants were considered obese. Obesity is confirmed by obtaining an applicant’s height and weight, in addition to the self-reported medical history. However, 18.4% of obese male applicants reported a BMI <30. Male applicants were 2.5 times as likely to understate their weight as to overstate it, and 2.8% of males understated their weight by 25 lbs. or more, including 1% who understated it by at least 40 lbs. Obesity can be a concern for insurers as it can lead to high blood pressure, high cholesterol, Type 2 diabetes, heart disease, stroke and even death.

Laboratory insights help insurers see a clearer picture of their applicants

Through both the historical laboratory data of LabPiQture and laboratory test results, insurers can build a retrospective and current picture of their applicants. LabPiQture provides insurers with past laboratory test results related to preventive care, diagnostic information and disease monitoring. Current laboratory testing obtained during the paramedical exam provides insights of what the applicant is living with today. The combination of data creates a very accurate perspective of an applicant’s health for underwriters to evaluate.

Using laboratory testing history databases to evaluate applicant risk can provide underwriters a more complete picture of applicant health. Laboratory history data provides quick access to physician-ordered laboratory testing results, it verifies applicant self-reported medical disclosure, and it can reduce costs as a possible alternative to an Attending Physician Statement order. Recently, we presented some of the benefits of using this data in the underwriting process.

LabPiQture™, ExamOne’s unique laboratory testing results database, provides deep insights into the health history of applicants. During Women’s Health Month, we’ve taken a deeper look at the conditions most commonly diagnosed in female life insurance applicants.

Top five diagnoses found in historical laboratory reports of female life insurance applicants

top-diagnoses-female-life-insurance-applicant

Encounter for general exam without complaint, suspected or reported diagnosis
This encounter captures most general exams that are not the result of a complaint or other diagnosis. In laboratory data, this code is most commonly associated with routine non-OBGYN checkups, and is seen commonly in both men and women. For underwriting, this can generally be considered a low-risk code and may indicate an applicant who is active in maintaining his or her health.

Disorders of lipoprotein metabolism and other lipidemias
Lipid metabolism disorders affect the conversion of lipids into energy, oftentimes causing harmful amounts of lipids to build up in the body. These build-ups can result in cell and tissue damage in the brain, nervous system, liver, spleen and bone marrow. In laymen’s terms, this is the most common code for high cholesterol and is generally associated with lipid panel (total cholesterol, HDL, triglycerides, etc.) results.

Encounter for other special exam without complaint, suspected or reported diagnosis
In our data, these almost exclusively indicate OBGYN encounters involving pap smears. This code can be used to capture encounters related to dental, vision and hearing; however these do not generate laboratory/tissue specimens. Pap smears are the most common tissue pathology results in the LabPiQture database and are often accompanied by HPV (a virus linked to cervical cancer) screens.

Essential (primary) hypertension
This is high blood pressure that doesn’t have a known secondary cause and tends to develop gradually over many years. Risk factors of primary hypertension include age, weight, family history and tobacco use. Complications may include heart attack or stroke, aneurysm, heart failure, and metabolic syndrome—which increases the chance of developing diabetes.

Encounter for screening for infectious and parasitic diseases
This encounter can denote screenings for various bacterial or viral diseases, such as tuberculosis and HIV. As a screening code, this header is most often associated with STD (including HPV) panels. In the large majority of cases (as in HPV and prenatal screens), these are routine tests with comparatively low positivity rates. In certain subpopulations, however, this code can be suggestive of high-risk behavior, including intravenous drug use.

Other common diagnoses in female life insurance applicants

Insurers should also be aware of additional diagnoses among female life insurance applicants, such as the following.

(E03) Other hypothyroidism – 13.6%

(E11) Type 2 diabetes mellitus – 10.8%

(R73) Elevated blood glucose level – 9.0%

(E66) Overweight and obesity – 5.4%
This statistic is interesting to note for insurers, especially since an ExamOne study found a notable rate of obesity nondisclosure in female applicants.

female-applicant-obesity-nondisclosure

Summary of the analyzed population

In our analysis of the most common diagnoses in female life insurance applicants, the mean age of a female applicant with a LabPiQture hit was 45. The mean encounter count for a female hit was 19, but this conceals a substantial level of variation. The median encounter count was 10, while 13% of hits involved only a single encounter, and 1% of hits involved 73 or more unique testing events.

Gathering a comprehensive health picture of your applicants

Laboratory history data can be a valuable resource for insurers determining applicant health risk. When evaluating this type of diagnosis data, it’s also important to remember that some codes are tentative, or ruled-out by subsequent testing, and do not always confirm the current presence of a disease. This is where additional health data sources can further inform or confirm suspected conditions.

Check back on the blog next month when we take a look at the most common diagnoses in male life insurance applicants based on LabPiQture data.

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