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Mortality Morbidity Experience: Driving Forces Future Trends

Mortality

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Mortality Morbidity Experience: Driving Forces Future Trends

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    1. Mortality & Morbidity Experience: Driving Forces & Future Trends

    2. Mortality & Morbidity Experience SIAS paper - “Mortality in the next Millennium” Critical Illness trends Cancer trends - incidence & mortality Heart disease trends - incidence & mortality The future

    3. Mortality in the next Millennium

    4. Mortality in the next Millennium The fundamental idea In order to predict the future you need to understand the forces that have driven trends in past

    5. Mortality in the next Millennium Another idea Trends are best understood by looking at patterns in population experience

    6. Five key forces The “cohort effect” The “ageing” of mortality improvement Increased uncertainty at younger ages Changes in the prevalence of cigarette smoking Widening socio-economic class differentials

    7. Illustration of “cohort effect” population of England & Wales - males

    8. Illustration of “cohort effect” population of England & Wales - females

    9. Illustration of “ageing” of mortality improvement population of England & Wales - females

    10. Illustration of “ageing” of mortality improvement population of England & Wales - females

    11. Illustration of “ageing” of mortality improvement population of England & Wales - males

    12. Acceleration of scientific advances Scientific breakthroughs are occurring at a faster and faster pace Human knowledge is doubling every 10 years Computer power is doubling every 18 months The Human Genome Project produced a first draft in 2000

    13. Uncertainty at younger ages population of England & Wales - males

    14. Changes in the prevalence of cigarette smoking

    15. Widening socio-economic class differentials The differential between the mortality of different socio-economic classes has been growing since the Second World War CMI investigations have also shown more rapid improvements than the general population

    16. An alternative basis for future mortality projection An alternative “cohort” projection was constructed in which: trends were projected by year of birth not attained age (to allow for the impact of the cohort effect) improvement rates reduce from current levels to “long-term” averages as the smoking effect unwinds The new CMI basis (CMIR17) is equivalent to: 1.1% p.a. improvements for a 65-year-old male The “cohort” basis is equivalent to: 2.4% p.a. improvements for a 65-year-old male

    17. Mortality in the next Millennium Key Conclusions Life expectancy at retirement is likely to increase at a faster rate than ever before The new CMI basis (CMIR17) significantly understates the likely improvements Profound implications for:- the annuity market life offices with GAO’s pension funding

    18. Critical Illness Trends

    19. Previous views on future trends Society of Actuaries in Ireland Working Party (1994): for reserving recommended 1% to 3% p.a. increase in incidence Werth & Mannion (1998): 2.8% p.a. increase in incidence? Critical Illness Healthcare Study Group (2000): current reserving practice for guaranteed CI products is 1% to 2% p.a. increase in incidence

    20. Critical Illness - major areas of “concern” Earlier diagnosis of cancer Low-grade cancers (e.g. prostate) Increasing cancer incidence Increasing use of CABG & angioplasty Improved detection of micro-strokes & mini-heart attacks Genetic testing Weak definitions Anti-selection

    21. Cancer

    22. Trends in cancer incidence - females

    23. Trends in cancer mortality - females

    24. Trends in cancer incidence - males

    25. Trends in cancer mortality - males

    26. Improvements in cancer survival

    27. Lung cancer incidence - males

    28. Cancer (other than lung) incidence - males

    29. Cancer (other than lung) incidence - females

    30. Cancer (other than lung) incidence - females

    31. Mortality from cancers related to smoking - males

    32. Mortality from cancers related to smoking - males

    33. Cancer - summary Incidence of smoking-related cancer is highly dependant on year of birth, especially for men Incidence of other cancers has changed less over time, but there is evidence of increases for men New screening programmes & earlier detection can have a significant impact over a short period of time Survival rates are improving for virtually all cancers It is highly likely that mortality rates from cancer will reduce in coming decades

    34. Heart disease

    35. Recent improvements in heart disease mortality England & Wales population - people aged 65-69

    36. Heart disease mortality - males

    37. Heart disease mortality - males

    38. Heart disease - an international perspective

    39. Heart disease - an international perspective

    40. Heart disease mortality - summary Heart disease mortality is highly dependant on year of birth Between 1985 & 1995 heart disease mortality improved by 4.3% p.a. for men 4.0% p.a. for women In the late 1990s improvements have been even more rapid Most experts predict that the improvements in coming decades will be very significant

    41. Heart-related critical illness claims Many critical illness policies include:- heart attack CABG surgery multi-vessel angioplasty Heart attack incidence has been reducing significantly in recent years (e.g. 3.6% p.a. for men aged 45-64 between 1981-82 & 1991-92) This is consistent with the improvements in mortality plus evidence (e.g. MONICA Project) that approx 2/3 of mortality reduction is due to fewer heart attacks

    42. Operations involving CABG or MVA

    43. Heart disease - risk factors & treatments

    44. Factors influencing future CI claims

    45. The Future

    46. The Future - critical illness In the long-term the underlying incidence of “critical illnesses” will actually reduce Heart disease incidence is already reducing steadily Cancer incidence will reduce as a result of behaviour modification stemming from greater understanding However critical illness claims are likely to increase because of earlier detection The effects are difficult to quantify, but the example of breast cancer screening is useful

    47. The Future - mortality Accelerating improvements at older ages will be amplified by generational effects By 2030 the main causes of death may well be pneumonia, dementia & “old-age” Using a range of different techniques - such as cause of death modelling - is a good way to assess the reasonableness of future projections

    48. The Future There will be a massive increase in information relating to:- the incidence of illness mortality & demographics Intensification of price competition will reduce profit margins Changes in distribution may reduce market imperfections and increase the risk of anti-selection Hence the need to maximise the potential of the new information

    49. Mortality & Morbidity Experience Driving Forces & Future Trends

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