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  #371  
Old 06-10-2019, 03:33 PM
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https://news.wttw.com/2019/06/06/chi...ry-why#new_tab

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Chicago Has the Largest Life Expectancy Gap in the Country. Why?

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Chicago has the largest life expectancy gap in the country, according to a new analysis of the largest 500 U.S. cities by NYU School of Medicine. Residents living in the Streeterville community live to be 90, but just 9 miles away in Englewood, residents only live to be 60, the report found.

As startling as that figure is, it’s not news, says Dr. David Ansell, a primary care physician and senior vice president for community health at Rush University. “We’ve known this for years, and it’s just now gotten the attention of the public and others. That 30-year (life expectancy) age gap has been known for a long time,” he said.

A similar report was released last year, when the group West Side United announced a 16-year life expectancy gap between residents of West Garfield Park and the Loop. The group is made up of a coalition of local health care institutions and professionals, including Rush.

Ansell says health outcomes are not strictly a result of biology, behavior or beliefs. “Social conditions themselves … create these terrible gaps in disease and premature mortality.” Those health inequities are the subject of a new book co-authored by Ansell that details nearly a century of research on how Chicago’s structural and socioeconomic inequalities have impacted patients and hospitals.

While many people believe the term “health equity” means equal access to care, it actually means everyone has an equal opportunity to be healthy, according to Ansell. “Every man, woman and child should have the chance to lead a long and healthy life,” he said, adding that equal access to care is an important part of that.

“What seems to be driving the large gaps in life expectancy you see in Chicago are actually differences in social conditions under which people live, play and work,” he said.

Structural racism, a lack of investment in communities, and concentrated poverty are examples of social and structural conditions that contribute to Chicago’s health inequities. “These are forms of afflictions because in some ways they cause disease,” said Ansell. “There are solutions to them, but it’s not just health care alone.”

West Side United is one such effort to address health inequities. It launched last year to address social and structural determinants of health on the West Side. In the past two years the group has raised $10.5 million to invest in educational and employment opportunities on the West Side, among other things.

But to truly make an impact, all Chicagoans need to be involved, says Ansell. “We all have to worry about this. This affects all of us,” he said. “We all take great pride in our city, but we have to do a lot more to make sure everyone has access to the opportunities that lead to good health and then we won’t see these inequities.”

Those acts can be small. Last summer, a Rush medical student organized Saturday walks in Garfield Park with Rush employees. “These are beautiful neighborhoods, and people who live in these neighborhoods love their neighborhood and don’t like all the bad news about it,” Ansell said.

“We need to change the story of neighborhoods of being ‘of risk’ to them being neighborhoods of opportunity and great assets,” he said. “Sometimes you just have to show up.”


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  #372  
Old 06-11-2019, 10:31 AM
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I wonder if the gap would close much if they removed all the murders? Or are those considered part of the "health inequities"? Because they talk about, “These are forms of afflictions because in some ways they cause disease,” said Ansell. “There are solutions to them, but it’s not just health care alone.”
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  #373  
Old 06-11-2019, 10:38 AM
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I wonder if the gap would close much if they removed all the murders? Or are those considered part of the "health inequities"? Because they talk about, “These are forms of afflictions because in some ways they cause disease,” said Ansell. “There are solutions to them, but it’s not just health care alone.”
https://heyjackass.com/

As of right now:

Quote:
2019 Deadliest ‘hoods
Neighborhood Homicides Wounded Total
Englewood 20 71 91
Austin 23 59 82
Garfield Park 16 60 76
Humboldt Park 13 45 58
North Lawndale 9 39 48
Roseland 13 35 48
South Shore 9 32 41
Grand Crossing 9 30 39
Chicago Lawn 6 31 37
Auburn Gresham 11 24 35
Near West Side 6 21 27
South Chicago 7 20 27
Chatham 5 19 24
Little Village 3 20 23
West Town 3 14 17
All Others 56 255 311
You can follow the link to a map of where the murders are.
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  #374  
Old 06-12-2019, 12:41 PM
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https://www.aei.org/publication/red-...ir-stagnation/

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Red, white, and gray: Population aging, deaths of despair, and the institutional stagnation of America
Society and Culture

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Key Points

Americans are getting older while simultaneously dying younger, a rare demographic phenomena that is leaving the country economically and socially harmed.

As Americans age, their institutions and laws age with them: Administrative and regulatory bloat can be seen in areas as wide ranging as labor law, zoning, criminal justice, higher education, and public and private debt—all of which points to a general ossification of American society.

Policymakers can solve most of the problems noted in this report through direct legislative fixes. However, while formally simple, these fixes may be politically challenging and often require political action by state or local officials, rather than federal ones.
This is change in mortality rates.


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  #375  
Old 06-12-2019, 12:49 PM
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The above is absolute change in rates (i.e. q_x for 2015-2017 minus q_x for 2012-2014)

Here are the relative changes:




(the extra mortality for younger ages is primarily suicides and drug overdoses)
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  #376  
Old 06-12-2019, 12:56 PM
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https://freebeacon.com/issues/aei-re...dying-younger/

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AEI Report: Americans Are Getting Older and Dying Younger

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A recent paper on American demographics bodes ill for the country's economic and social health.

The report by Lyman Stone, adjunct fellow at the American Enterprise Institute, finds that while the American population is becoming older, life expectancies of working-age people are declining. This trend, in tandem with the straining of the country's institutions, has serious implications for America's future.

According to Stone's analysis, the American population is becoming older as the baby boomer generation enters their senior years. This trend would not be very surprising, but it has been augmented by significant increases in the mortality rate of working-age adults, who suffer from what Stone refers to as "deaths of despair." The main force driving death among this population is the spike in recent years of drugs and alcohol abuse, and to a lesser extent suicide, murder, and traffic accidents.

The quantitative increase in mortality rates is far from paltry. Stone writes that "the odds that a 32-year-old will die in a given year rose by almost 25 percent between 2012-2014 and 2015-2017."

The economic and social implications of this pattern are troubling. The report explains how growth of the labor force has been stunted by mortality just as the older segment of the American population enters retirement and becomes a fiscal strain on government budgets.

America's demographic challenges are compounded by flaws in the country's institutions, for which Stone blames policy choices made by the boomer generation and their parents. Once dynamic, America's institutions are now "hidebound by an increasingly heavy weight of rules and regulations." The paper cites stringent regulations on land and work, high incarceration rates, higher-costing but less valuable education, and growing debt as major examples of institutional degeneration that will hinder the country in the future.

Stone warns that this combination of demographic trends and institutional weakness will create a future in which we "will see a rapid increase in fiscal pressure on taxpayers, all to pay for the past, not the future." Pressure on local, state, and governmental services will be massive. The challenges, Stone writes, may be even greater "if fertility is lower than expected, or if prime-age workers die at a higher rate while older people live longer."

The report's findings are bleak, but Stone believes there are policy measures that can be taken to give the United States a better outlook. Regulations can be eased in order to give working-age people better economic prospects. This can be done by repealing land use rules and loosening certain work licensure requirements. The government can also reduce incarceration. Young people can be encouraged to take vocational training rather than become indebted for college degrees that may prove of little value. While Stone admits such measures are hardly politically feasible, government can cut back commitments to providing benefits and entitlements such as Social Security.

But, Stone emphasizes, the responsibility for creating a brighter future for America lies not just with the federal government. Policy responses must be driven as well by lawmakers at the state and local levels who are willing to face and address the dangers foretold by America's demographic trajectory.


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  #377  
Old 06-12-2019, 01:49 PM
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The above is absolute change in rates (i.e. q_x for 2015-2017 minus q_x for 2012-2014)



(the extra mortality for younger ages is primarily suicides and drug overdoses)
So medicine is getting better as evidenced by the youngest and oldest having better mortality, but the working age population is a lot more likely to kill themselves or OD.

Not sure what the answer is. Thanks for putting this together.
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Old 06-13-2019, 02:19 PM
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https://www.japantimes.co.jp/news/20.../#.XQGLh8hKiUl

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Male managers in Japan have higher mortality rate than in Europe, study finds

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Men in managerial positions or professional occupations in Japan have a higher mortality rate than their counterparts in Europe, according to a scientific study published in late May.

The study was conducted on men who were aged between 35 and 64 during the period from 1990 to 2015 in Japan, South Korea and eight European countries including Denmark and Switzerland, by a team of researchers from the University of Tokyo and European institutes.

The findings, reported in the Journal of Epidemiology & Community Health, said that the mortality rate of “upper nonmanual workers” increased in Japan in the second half of the 1990s following the collapse of the asset-inflated bubble economy. The trend was possibly due to changes in their social and work environments — such as having to work in dual roles, as a manager and a worker, following restructuring, for example, according to the report.

The economic crisis saw managers and the professional class lose decision-making discretion, suffering greater psychological stress and an increasing workload, while overtime hours for most other occupations decreased, the study said.

Cancer made the largest contribution to rising mortality in this occupational category, with suicide also factoring heavily.

The article also referred to previous studies that suggested heavy job demands and long working hours made it difficult for such workers to make time for health checkups.

In 2015, 375 of every 100,000 people in the managerial and professional classes died — almost 1.4 times the figures seen for lower nonmanual workers such as clerical and service employees.

While the mortality rate among managers and professionals has been declining since the 2000s, this could be set to reverse once more, as a recent labor reform law in Japan exempts certain categories of skilled professionals with high wages, such as consultants and financial traders, from the legal cap otherwise applied to working hours.

Yasuki Kobayashi, professor of public health at the University of Tokyo, noted that managers who are supposed to be able to regulate their own schedules tend to drive themselves to work long hours.

“It is necessary to continue labor reforms and to be equipped with statistical analyses to understand the situations of those with bad health,” he said.

In South Korea, the mortality rate among managers and professionals rose in the late 2000s, following the 2008 global financial crisis triggered by the collapse of the U.S. investment bank Lehman Brothers Holdings Inc. As in Japan, cancer made the largest contribution.

In Europe, the trend was reversed, with manual workers consistently having higher mortality rates than upper nonmanual workers.


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  #379  
Old 06-14-2019, 05:03 PM
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HEART DISEASE

https://quillette.com/2019/06/12/the...heart-disease/

Quote:
The Real Gender Gap in Heart Disease

Spoiler:
Because I’m that guy, I took a poll at the recent family barbecue.


“Heart disease—who has it worse? Men or women?” I asked. The answers came quickly. My mother-in-law and sister-in-law said, “Women.” My father-in-law, arms crossed, said confidently, “Men.”

My mother-in-law remembered hearing about how heart disease affected women more than men during the February American Heart Association (AHA) “Go Red for Women” campaign. Apparently, the message wasn’t heard by the men at this family gathering. They were moved by stories of men—fathers, brothers, friends—they knew who died from heart disease. We are taught that facts should trump feelings, evidence should trump anecdotes, and at first glance it would appear the men are too in touch with their feelings.

It is the mission of advocacy organizations like the AHA to raise awareness. Charts like this one are widely disseminated and used in countless presentations on the topic:


Figure 1

The graph demonstrates that over the last few decades the number of women dying from heart disease has been significantly higher than men dying from heart disease. In the year 2000 alone the gap is the most impressive, with 70,000 more women dying than men. The problem with this chart is that it is completely misleading.

Mortality in this case is best judged by death rates that take into account age and the population at risk rather than the crude number of deaths. The following table assembled from the CDC database for heart disease deaths by gender and age group for the year 2000 paints a more descriptive picture. The number of men dying from heart disease exceeds women in almost every age group. It’s not even close.



Figure 2

The absolute number of men dying in the prime of their lives is staggering. Between the ages of 35 and 64, 92,000 men die every year, which is twice as many men as women, and equivalent to those who died in the Korean War and Vietnam War combined. Even after the age of 75 when more women die than men in total, men die at higher rates because there simply are far fewer men left alive. The gap in numeric deaths in 2000 only exists because of the over-85 age group, where many more women than men die. Put another way, when elderly women eventually die, they die of heart disease.

A better way of representing mortality data to avoid this type of misinterpretation is to use the age adjusted mortality rate—a weighted average that takes into account mortality within age groups and the important denominator of people at risk of dying.

The following chart plotting the age adjusted mortality rate by sex is more accurate, though less politically convenient. Men have been dying at higher rates than women over time, and the gap appears to be constant.


Figure 3

To be clear, heart disease in women is well-deserving of attention. While the large portion of deaths do occur in women in later years, cardiovascular disease remains an important contributor to female mortality even at younger ages. As noted in the chart and graph below, cardiac disease is the second leading cause of death even among women aged 35 to 64, though again, at absolute rates far lower than their male counterparts. The wider public certainly needs to be aware that men have no particular ownership of cardiovascular disease, but the messaging to try to raise awareness of cardiac disease in women is misleading.



Figure 4

A good clinician chooses a diagnostic path based on an understanding of underlying risk. The 20-year-old with chest pain gets a different workup than the 55-year-old with chest pain. If the risk of death between men and women varies by a factor of two in the 35 to 64 age group, is it cause for alarm if men are worked up for heart disease at different rates by their doctors?

This wouldn’t be some sort of controversial sexist departure from standard practice. Every day, cardiologists use risk calculators with the difference in cardiac disease rates by sex baked into the algorithms to help decide if patients may be candidates for drug therapy like lipid lowering statins. The higher the risk of a heart attack, the higher the yield of drug treatment.

As an example, the commonly used cardiac risk calculator below was used to calculate risk on two patients. The only difference between the two patients is their sex. The man meets the threshold for therapy with a statin, the woman does not. Is the algorithm sexist?



Figure 5


Since it is the mission of professional organizations like the American College of Cardiology and the AHA to promote the importance of the disease they represent, messaging campaigns to identify lower risk groups that should be screened less aggressively are likely not to be on the menu in the foreseeable future. But the peculiar trend as reflected in remarks by prominent cardiologists is to specifically accentuate both screening for cardiac disease in women, and the possibility that the care women receive is inferior to men.

Examining a few of the pillars this claim rests on is revealing. One commonly held notion is that women may not have the hallmark symptoms of a heart attack—chest pain or discomfort—that has typically defined the disease. The theory goes that approaching women’s complaints with a typical “male-derived” framework of expected symptoms of heart disease may result in delays and subsequently poorer outcomes. But an attempt to source the frequency of atypical presentations by sex suggests that the complaints of women and men when it comes to heart attacks may not be that different.


Figure 6

A summary of a number of large trials that included the clinical presentation of heart attacks by sex demonstrates that 28 percent of men and 37 percent of women presented without chest pain. A difference to be sure, but not enough to recommend a different and more aggressive screening strategy for women when the underlying disease being screened for appears to be more indolent in women. Curiously, the same crowd that finger wags about overtesting and overdiagnosis is silent here. The hallmark of this genre of research seems to be that the message matters more than the evidence.

Honing the Evidence to Match the Message

Consider a recent article published in the Journal of the American Heart Association that seeks to study differences in the treatment between men and women. The article focuses on two important times—the time from symptom onset to a blocked artery being opened, and the time from arriving at the hospital to opening the problem artery. The article is presented as more proof of a sex-based difference in treatment of cardiac disease because it finds a statistically significant delay in time to treatment women.


The path to statistical significance in this case is courtesy of log transformation of the raw data that is notable only because its need arises from the treatment times between men and women being clustered in such close proximity to one another.

It’s no surprise then, that the statistically significant delay in the time between hitting the doors of the hospital to opening the blocked artery amounted to just seven minutes. The time between symptom onset to therapy was longer, approaching 30 minutes for women. The study implies that delays for women result in worse outcomes. But while these times are statistically significantly different, no correlation between these time delays and poorer outcomes was found, arguing against the delays being clinically meaningful. Only in passing does the study mention that the delays are not correlated with poorer outcomes, a fact that would suggest other mechanisms account for the gender outcome gap. For example, women presenting with heart attacks are certainly older and may be sicker in ways that can’t completely be adjusted for.

There are also two types of heart attacks (STEMI/NSTEMI) that were studied—the more serious kind identified by electrocardiogram (STEMI), and the other kind typically identified by cardiac enzyme markers found in the blood (NSTEMI). Interestingly, only the more serious type of heart attack observed a delay in treatment by gender. If gender really does have such a powerful impact on delays in getting appropriate care, it seems strange that the effect is not seen with the less serious type of heart attack, especially as there’s more room for variation in the treatment of these heart attacks.

The paper, like many in this genre, is a masterpiece of confirming bias while glossing over the fact that, in the three years of study, more than three times as many men presented with heart attacks. And perhaps the most important information in the paper also gets lost: only 65 percent of women and 69 percent of men were treated within the widely accepted 90-minute target time for the opening of an artery. Instead of a call to action to improve these numbers for all, the authors choose to focus on the “statistically significant” four percent difference between men and women.

In a twist of black comedy, despite the fact that one reason proffered for the longer time for women between symptom onset and a health system encounter is that women live alone at higher rates without a companion to activate emergency services, there is no mention that a potential solution might be to try and keep more male companions alive. This is not a message likely to find currency in a paper meant to highlight female disadvantage.

Politicians and salesmen have long understood persuasion is the art of bending facts to support a side. The surprise here is that this pablum is coming from within the academic class, a venerated and trusted group. The facts don’t stand a chance against those who see the world through a lens of patriarchy and male privilege. At the very least, one would expect the intelligent designers of this one-note world to recognize a failure of the male patriarchy when it occurs in as spectacular a fashion as happens with men and heart disease. In what can only be described as a landslide victory for the matriarchy, men turning 35 are half as likely to make it to 45 as their female counterparts. The same dismal statistic awaits men who make it to 45, and those who make it to 55. Inexplicably the messaging on cardiovascular disease somehow white-washes all of this.


The story of historical female systemic disadvantage is a very real one but the presence of a long list of bonafide grievances gives no license for the creation of new grievances based on bad analysis. Men die of heart disease at rates that are well beyond women. Full stop. The roots of this gap are likely rooted in biology; controlling for traditional cardiac risk factors like serum lipid levels, blood pressure and smoking seem to have no impact on the poorer outcomes seen in men.

In the end, the decision on testing and therapy is a tricky one. I recently took care of a physician’s wife who had developed exertional dyspnea and fatigue. Despite negative initial testing pointing away from her heart being the culprit, the knowledge she belonged to a relatively lower risk group didn’t stop her from getting a coronary CT scan that was prompted in part by an anxious and loving husband who knew all too well about women and their atypical presentation. I ordered it with some misgivings about the cascade of further diagnostics and treatment that carry their own very real harms when one proceeds down a path of testing low risk patients. Luckily, the odds being in her favor, the test was clean.

But played out on a larger scale with an anxiety ridden populace and their physicians searching furiously to stamp out the epidemic that isn’t, we may very well end up doing more harm than good. In the battle between biology and created “truths” that arise from the perceived grievances peddled by a coterie of motivated academics, I have a simple recommendation: Choose biology. It’s the best thing for men. And women.



Dr. Anish Koka is a board-certified internist and cardiologist practicing in Philadelphia. He can be followed on Twitter @anish_koka.


There are a variety of graphs/tables in there, but I will copy over only two:





The author used less-than-ideal screenshots.
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Old Yesterday, 03:09 PM
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Preliminary U.S. mortality experience
https://www.soa.org/resources/resear...prev-2018-exp/

https://www.soa.org/globalassets/ass...v-2018-exp.pdf

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