Hemoglobin Screening Independently Predicts All-Cause Mortality

Abstract

Objective .- Determine if the addition of hemoglobin testing improves risk prediction for life insurance applicants. Method .- Hemoglobin results for insurance applicants tested from 1993 to 2007, with vital status determined by Social Security Death Master File follow-up in 2011, were analyzed by age and sex with and without accounting for the contribution of other test results. Results .- Hemoglobin values ≤12.0 g/dL (and possibly ≤13.0 g/dL) in females age 50+ (but not age <50) and hemoglobin values ≤13.0 g/dL in all males are associated with progressively increasing mortality risk independent of the contribution of other test values. Increased risk is also noted for hemoglobin values >15.0 g/dL (and possibly >14.0 g/dL) for all females and for hemoglobin values >16.0 g/dL for males. Conclusion .- Hemoglobin testing can add additional independent risk assessment to that obtained from other laboratory testing, BP and build in this relatively healthy insurance applicant population. Multiple studies support this finding at older ages, but data (and the prevalence of diseases impacting hemoglobin levels) are limited at younger ages.

Is LDL cholesterol associated with long-term mortality among primary prevention adults? A retrospective cohort study from a large healthcare system

“…Importantly, HDL-C exerts several physiological roles, prevents oxidation of LDL and inhibits expression of proinflammatory cytokines by macrophages, as well as expression of adhesion molecules by endothelial cells,44–46 and it is inversely associated with both all-cause and CVD mortality risks 18 19. Moreover, it is likely not coincidental nor trivial that the field of life insurance medicine recognises and prioritises the importance of HDL-C over LDL-C in determining underwriting classifications 16 17 47. Unfortunately, from a public health perspective, a meta-analysis of 31 randomised controlled trials on the use of HDL-C modifying treatments showed little to no effect on cardiovascular and all-cause mortality 48…”

“… 18 19 Moreover, it is likely not coincidental nor trivial that the field of life insurance medicine recognises and prioritises the importance of HDL-C over LDL-C in determining underwriting classifications. 16 17 47 Unfortunately, from a public health perspective, a meta-analysis of 31 randomised controlled trials on the use of HDL-C modifying treatments showed little to no effect on cardiovascular and all-cause mortality. 48 …”

“…Third, the field of life insurance medicine, which focuses principally on predicting mortality hazards, 15 arguably conducts the most robust actuarial analyses of life expectancy. Notably, in this field, the T-C/HDL-C (high-density lipoprotein cholesterol) ratio has been shown to be the best single measure of all-cause mortality risk among various lipid tests, including LDL-C. 16 This is further supported by examination of selected life insurance underwriting guidelines (obtained publicly and summarised) from a large US insurance company. 17 As seen in online supplemental table 2 , T-C and HDL-C are used jointly in policy underwriting, whereas LDL-C is not used, and lipid-lowering therapy is not emphasised.…”

Diagnostik erhöhter Leberwerte in der Primärversorgung – Befunde einer Studienreihe aus haus- und fachärztlicher Perspektive

“…Dass Leberwerterhöhungen mit vermehrter Mortalität und Begleiterkrankungen einhergehen, ist inzwischen von diversen Arbeiten belegt worden 2 5 6 7 8 9 10 . Verbreitete Ursachen sind Alkoholabusus, Medikamenteneinnahme, die nichtalkoholische Leberverfettung und Virushepatitiden 11 12 13 14 .…”

Diagnostik erhöhter Leberwerte in der hausärztlichen Versorgung – Eine Befragung zu Voraussetzungen, Vorgehen und erlebten Herausforderungen von Allgemeinmedizinern

“…Verschiedene Arbeiten konnten belegen, dass Leberwerterhöhungen mit vermehrter Mortalität einhergehen [4][5][6][7][8][9]. Häufige Ursachen sind Alkoholabusus, Medikamenteneinnahme, die nichtalkoholische Leberverfettung und Virushepatitiden [10][11][12][13].…”