NT-proBNP Predicts All-Cause Mortality in a Population of Insurance Applicants, Follow-up Analysis and Further Observations.

Objective: - Further refine the independent value of NT-proBNP, accounting for the impact of other test results, in predicting all-cause mortality for individual life insurance applicants with and without heart disease.

Method: - Using the Social Security Death Master File and multivariate analysis, relative mortality was determined for 245,322 life insurance applicants ages 50 to 89 tested for NT-proBNP (almost all based on age and policy amount) along with other laboratory tests and measurement of blood pressure and BMI.

Results: - NT-proBNP values ≤75 pg/mL included the majority of applicants denying heart disease and had the lowest risk, while values >500 pg/mL for females and >300 pg/mL for males had very high relative risk.

2014 CRL Build Study of Life Insurance Applicants.

Objective .- Determine the impact of build on insurance applicant mortality accounting for smoking, laboratory test values and blood pressure. Method .

Hemoglobin Screening Independently Predicts All-Cause Mortality.

Objective .- Determine if the addition of hemoglobin testing improves risk prediction for life insurance applicants. Method .

Changing the "Normal Range" for Blood Pressure from 140/90 to 130/Any Improves Risk Assessment.

Objective .- Redefine the "normal" reference range for blood pressure from <140/90 to one that more effectively identifies individuals with increased mortality risk. Method .

2014 CRL Blood Pressure Study of Life Insurance Applicants.

Objective .- Define the relative mortality risk by systolic (SBP) and diastolic blood pressure (DBP) in a relatively healthy cohort split by age and sex with adjustment for smoking status, other findings and admitted heart disease history. Method .

NT-proBNP as a predictor of all-cause mortality in a population of insurance applicants.

Objective: Quantify the independent value of NT-proBNP in predicting all-cause mortality for individual life insurance applicants and establish risk-based reference ranges.

Method: By use of the Social Security Death Master File and multivariate analysis, relative mortality was determined for 144,027 life insurance applicants tested (almost all routinely rather than for cause) for NT-proBNP along with other laboratory testing and measurement of BP and BMI.

Results: Risk increased substantially for NT-proBNP values > 300 pg/mL in women and > 200 pg/mL in men after age, smoking status and other cardiovascular risk factors were accounted for.

Serum globulin predicts all-cause mortality for life insurance applicants.

Objective: Determine the relative mortality in apparently healthy adults with various levels of serum globulin.

Method: By use of the Social Security Death Master File, mortality in 2010 was determined for 7.7 million life insurance applicants age 20 to 89 providing blood samples with valid globulin results between 1992 and 2006.

Urine protein/creatinine ratio as a mortality risk predictor in non-diabetics with normal renal function.

Objective: Determine the relative mortality in apparently healthy adults with various levels of urinary protein measured by urine protein/creatinine (p/c) ratio.

Method: By use of the Social Security Death Master File, mortality in 2010 was determined for 7.5 million life insurance applicants age 20 to 89 providing urine samples between 1992 and 2006.

Trends in mortality of insurance applicants with HIV infection.

Objective: Provide a brief review of HIV history and determine the relative mortality of life insurance applicants who are HIV positive and how that has changed over time with advances in treatment.

Method: By use of the Social Security Death Master File and multivariate analysis, mortality of those HIV positive relative to those HIV negative was determined for life insurance applicants from 1991 to 2009.

Results: Relative mortality varied by type of testing (blood, urine or oral fluid) and by age, ranging from 320% at the oldest ages to over 1300% at the youngest ages for applicants with blood testing.

Scoring life insurance applicants' laboratory results, blood pressure and build to predict all-cause mortality risk.

Objective: Evaluate the degree of medium to longer term mortality prediction possible from a scoring system covering all laboratory testing used for life insurance applicants, as well as blood pressure and build measurements.

Method: Using the results of testing for life insurance applicants who reported a Social Security number in conjunction with the Social Security Death Master File, the mortality associated with each test result was defined by age and sex. The individual mortality scores for each test were combined for each individual and a composite mortality risk score was developed.

Albumin and all-cause mortality risk in insurance applicants.

Objective: Determine the relationship between albumin levels and all-cause mortality in life insurance applicants.

Method: By use of the Social Security Death Master File, mortality was determined in 1,704,566 insurance applicants for whom blood samples were submitted to Clinical Reference Laboratory. There were 53,211 deaths observed in this healthy adult population during a median follow-up of 12 years.

Mortality associated with bilirubin levels in insurance applicants.

Objective: Determine the relationship between bilirubin levels with and without other liver function test (LFT) elevations and relative mortality in life insurance applicants.

Method: By use of the Social Security Death Master File mortality was determined in 1,905,664 insurance applicants for whom blood samples were submitted to the Clinical Reference Laboratory. There were 50,174 deaths observed in this study population.

Association of cholesterol, LDL, HDL, cholesterol/ HDL and triglyceride with all-cause mortality in life insurance applicants.

Objective: Determine the relationship between various lipid tests and all-cause mortality in life insurance applicants stratified by age and sex.

Method: By use of the Social Security Death Master File, mortality was determined in 1,488,572 life insurance applicants from whom blood samples were submitted to Clinical Reference Laboratory. There were 41,020 deaths observed in this healthy adult population during a median follow-up of 12 years (range 10 to 14 years).

Increased mortality associated with elevated carcinoembryonic antigen in insurance applicants.

Objective: Determine the relationship between the carcinoembryonic antigen (CEA) value and all-cause mortality in life insurance applicants aged 50 years and over.

Method: By use of the Social Security Master Death Index, mortality was examined in 115,590 insurance applicants aged 50 and up for whom blood samples for CEA were submitted to the Clinical Reference Laboratory. Results were stratified by CEA value (<5 ng/mL, 5 to 9.

Relationship of hemoglobin A1c to mortality in nonsmoking insurance applicants.

Objective: Determine the relationship between hemoglobin A1c value and 5-year, all-cause mortality in nonsmoking life insurance applicants.

Method: By use of the Social Security Master Death Index, mortality was examined in 286,443 non-smoking insurance applicants aged 40 and up for whom blood samples for hemoglobin A1c were submitted to the Clinical Reference Laboratory. Results were stratified by hemoglobin A1c value, gender and age bands 40 to 59, 60 to 69 and 70 and up.

Using liver enzymes as screening tests to predict mortality risk.

Objective: Determine the relationship between liver function test results (GGT, alkaline phosphatase, AST, and ALT) and all-cause mortality in life insurance applicants.

Method: By use of the Social Security Master Death File, mortality was examined in 1,905,664 insurance applicants for whom blood samples were submitted to the Clinical Reference Laboratory. There were 50,174 deaths observed in this study population.