Actuarial Method Research Articles

Assocation between trapezium size and failure of total trapeziometacarpal prosthesis. A survival analysis.

To assess the survival function of cementless total trapezium metacarpal prostheses (TTMPs) at 20 years, to compare survival functions by trapezium size, and to evaluate the association between the instantaneous risk of TTMP failure and small trapezium size using a multivariate Cox regression model. This observational cohort study included 221 consecutive patients with a mean follow-up after TTMP of 137.3 months (maximum of 246 months). Kaplan-Meier and actuarial life-table methods were used to evaluate the survival function of thecohort. Kaplan-Meier survival curves were compared by trapezium size. Multivariate Cox regression analysis was used to determine the effect of potential confounders on the association between small trapezium and the instantaneous risk of TTMP failure. At the end of follow-up, there was a 89.01% chance of the TTMP surviving for 246 months or more. There was an association between TTMP survival time and trapezium size showing a significant trend such that the survival curves weresignificantly higher with larger trapezium size (Mantel-Cox test, p = 0.0001; WilcoxonBreslow test, p = 0.0002; Tarone-Ware test, p = 0.0001).The unadjusted Cox regression model showed a significant association between small trapezium size (smaller than 9 mm) and the instantaneous risk of TTPM failure (HR: 7.37, 95% CI: 2.46-22.07). In the multivariate Cox analysis, "age", "trapezium morphology", and "complications" were confounders in the association between small trapezium size and the hazard ratio of prosthetic failure (HR = 3.76; 95% CI 0.96 to 13.82). These results confirm the long-term functional survival of TTMP prostheses and reveal a significant increase in trend of the survival curve with larger trapezium size. Patient age, trapezium morphology, and the presence of post-surgical complications are confounders in the association between small trapezium size and the hazard ratio of TTMP failure.

Disparities in Overall Survival Rates for Cancers across Income Levels in the Republic of Korea.

The overall survival rates among cancer patients have been improving. However, the increase in survival is not uniform across socioeconomic status. Thus, we investigated income disparities in the 5-year survival rate (5YSR) in cancer patients and the temporal trends. This study used a national cancer cohort from 2002 to 2018 that was established by linking the Korea Central Cancer Registry and the National Health Insurance Service (NHIS) claim database to calculate the cancer survival rate by income level in the Republic of Korea. Survival data were available from 2002 onward, and the analysis was based on the actuarial method. We compared the survival of the earliest available 5-year period of 2002-2006 and the latest available 5-year period of 2014-2018, observing until 31 December 2021. Income level was classified into six categories: Medical Aid beneficiaries and five NHIS subtypes according to insurance premium. The slope index of inequality (SII) and relative index of inequality were used to measure absolute and relative differences in 5YSR by income, respectively. The 5YSR between the 2002-2006 and 2014-2018 periods for all cancers improved. A significant improvement in 5-year survival rates (5YSR) over the study period was observed in lung, liver, and stomach cancer. The SII of survival rates for lung (17.5, 95% confidence interval (CI) 7.0-28.1), liver (15.1, 95% CI 10.9-19.2), stomach (13.9, 95% CI 3.2-24.7), colorectal (11.4, 95% CI 0.9-22.0), and prostate (10.7, 95% CI 2.5-18.8) cancer was significantly higher, implying higher survival rates as income levels increased. The SII for lung, liver, and stomach cancer increased, while that of thyroid, breast, cervical, prostate, and colorectal cancer decreased over the study period. Although substantial improvement in the 5YSR was observed across cancer types and income levels from 2002 to 2018, this increase was not uniformly distributed across income levels. Our study revealed persistent income disparities in the survival of cancer patients, particularly for lung and liver cancer.

Longitudinal Analysis of Functional Capacity in Nursing Home Residents During the COVID-19 Pandemic.

The COVID-19 pandemic has raised concerns about nursing home (NH) residents' well-being, with recent studies indicating a significant increase in functional decline rate during this critical period. However, a comprehensive exploration of functional capacity trajectories in NH residents during the pandemic remains unexplored. This study aims to address this research gap by conducting an in-depth analysis of the impact of the COVID-19 pandemic on NH residents' functional capacity. A 24-month multicenter prospective study involving 123 NH residents from Spain, with data collected at 6-month intervals over 5 waves, starting just before the pandemic's onset. Functional capacity was assessed using the Modified Barthel Index, and data were analyzed employing the actuarial method, log-rank test, and Cox's regression. The likelihood of maintaining functional capacity was unfavorable, with only a 19.3% chance of preservation for a 1-point decline (FD-1) in Barthel scores and a 50.5% probability for a 10-point decline (FD-10). Personal hygiene, eating, and toilet use were identified as the most affected activities of daily living. Urinary continence decline emerged as a risk factor for FD-1, while fecal continence decline was associated with FD-10. The probability of maintaining functional capacity in the initial 6months of a pandemic was comparable to a 2-year non-pandemic follow-up. Pandemic-induced isolation strategies significantly impacted toileting and personal hygiene. Urinary decline was associated with minor functional decline (FD-1), while fecal decline correlated with major functional decline (FD-10). Notably, the number of days spent in room confinement did not significantly contribute to the observed decline. A substantial increase in the risk of FD among NH residents during the COVID-19 pandemic compared to the pre-pandemic period was found. It is crucial to implement urgent, targeted interventions that prioritize promoting physical activity and the implementation of mobility and toileting programs. These measures are pivotal for mitigating functional decline and enhancing the overall health and well-being of NH residents in a pandemic context.

Application of Projected Unit Credit Method and Entry Age Normal in Pension Fund Insurance of PT Pos Indonesia, South Aceh Regency

This study aims to analyze the application of the Projected Unit Credit (PUC) Method and the Entry Age Normal (EAN) Method in the context of pension fund insurance. The Projected Unit Credit Method and the Entry Age Normal Method are two actuarial approaches used to calculate liabilities and determine the required contributions in pension plans. The Projected Unit Credit Method calculates based on projected future salaries and benefits accumulated over the employee's working life, while the Entry Age Normal Method distributes the cost of retirement benefits evenly over the employee's working life. Data was collected from various pension plans that use both methods. Analysis was conducted to compare the accuracy of liability estimation, contribution stability, and the impact of each method on pension fund sustainability. The results show that the Projected Unit Credit Method provides a more realistic liability estimate by considering salary increases, while the Entry Age Normal Method offers better contribution stability from year to year. The selection of the appropriate actuarial method is highly dependent on the objectives and specific conditions of the pension program being managed. These findings are expected to help pension fund managers make more informed decisions to ensure the welfare of pension plan participants.

Machine Learning Approaches for Insurance Pricing: A Case Study of Public Liability Coverage in Morocco

As data-driven technologies continue to advance, the importance of machine learning (ML) techniques in enhancing the accuracy of insurance premium calculations cannot be overstated. That is especially crucial because traditional actuarial methods often fail to incorporate individual risk factors fully. This limitation significantly impacts the insurance industry's capacity to accurately determine premium prices, which in turn affects financial stability and customer satisfaction. This research seeks to assess the efficiency insurance premium calculations through different regression models in ML, including polynomial, decision tree, random forest, and gradient boosting. The study employs rigorous analysis techniques using a comprehensive dataset from a Moroccan vehicle insurance company, including claim history and insurance categories. The dataset is split into training and testing sets to assess the accuracy of the ML models using metrics such as Mean Squared Error (MSE), Root Mean Squared Error (RMSE), and the coefficient of determination (R-squared). Initial findings suggest that ML models greatly surpass traditional actuarial methods, indicating the potential for machine learning to transform premium pricing strategies. That could result in more customized and financially sustainable outcomes within the insurance industry. The findings of this paper are likely to contribute to national insurance premium policy and expand the existing literature on this subject in Morocco.

Cardiovascular Burden of the V142I Transthyretin Variant

Individual cohort studies concur that the amyloidogenic V142I variant of the transthyretin (TTR) gene, present in 3% to 4% of US Black individuals, increases heart failure (HF) and mortality risk. Precisely defining carrier risk across relevant clinical outcomes and estimating population burden of disease are important given established and emerging targeted treatments. To better define the natural history of disease in carriers across mid to late life, assess variant modifiers, and estimate cardiovascular burden to the US population. A total of 23 338 self-reported Black participants initially free from HF were included in 4 large observational studies across the US (mean [SD], 15.5 [8.2] years of follow-up). Data analysis was performed between May 2023 and February 2024. V142I carrier status (n = 754, 3.2%). Hospitalizations for HF (including subtypes of reduced and preserved ejection fraction) and all-cause mortality. Outcomes were analyzed by generating 10-year hazard ratios for each age between 50 and 90 years. Using actuarial methods, mean survival by carrier status was estimated and applied to the 2022 US population using US Census data. Among the 23 338 participants, the mean (SD) age at baseline was 62 (9) years and 76.7% were women. Ten-year carrier risk increased for HF hospitalization by age 63 years, predominantly driven by HF with reduced ejection fraction, and 10-year all-cause mortality risk increased by age 72 years. Only age (but not sex or other select variables) modified risk with the variant, with estimated reductions in longevity ranging from 1.9 years (95% CI, 0.6-3.1) at age 50 to 2.8 years (95% CI, 2.0-3.6) at age 81. Based on these data, 435 851 estimated US Black carriers between ages 50 and 95 years are projected to cumulatively lose 957 505 years of life (95% CI, 534 475-1 380 535) due to the variant. Among self-reported Black individuals, male and female V142I carriers faced similar and substantial risk for HF hospitalization, predominantly with reduced ejection fraction, and death, with steep age-dependent penetrance. Delineating the individual contributions of, and complex interplay among, the V142I variant, ancestry, the social construct of race, and biological or social determinants of health to cardiovascular disease merits further investigation.

Analysis of outcomes and prognostic factor in acute type A aortic dissection complicated with preoperative shock: A single-center study.

Acute type A aortic dissection (ATAAD) is a critical cardiovascular emergency that requires prompt surgical intervention for preserving life, particularly in patients with critical preoperative status. This retrospective study aimed to investigate the clinical features, early and late outcomes, and prognostic factors in patients undergoing aortic repair surgery for ATAAD complicated with preoperative shock. Between April 2007 and July 2020, 694 consecutive patients underwent emergency ATAAD repair at our institution, including 162 (23.3%) presenting with preoperative shock (systolic blood pressure <90 mm Hg), who were classified into the survivor (n = 125) and non-survivor (n = 37) groups according to whether they survived to hospital discharge. The clinical demographics, surgical information, and postoperative complications were compared. Five-year survival and freedom from reoperation rates of survivors were analyzed using the Kaplan-Meier actuarial method. Multivariate logistic regression analysis was used to identify independent risk factors for in-hospital mortality. The in-hospital surgical mortality rate in patients with ATAAD and shock was 22.8%. The non-survivor group showed higher rates of preoperative cardiopulmonary resuscitation, acute myocardial infarction, and cerebral infarction, and was associated with longer cardiopulmonary bypass time, higher rates of total arch replacement and intraoperative extracorporeal membrane oxygenation implementation. The non-survivor group had higher blood transfusion volumes and rates of malperfusion-related complications. Multivariate analysis revealed that preoperative cardiopulmonary resuscitation, prolonged cardiopulmonary bypass time, and total arch replacement were risk factors for in-hospital mortality. For patients who survived to discharge, the 5-year cumulative survival and freedom from aortic reoperation rates were 75.6% (95% confidence interval, 67.6%-83.6%) and 82.6% (95% confidence interval, 74.2%-91.1%), respectively. Preoperative shock in ATAAD is associated with a high risk of in-hospital mortality, particularly in patients who undergo cardiopulmonary resuscitation and complex aortic repair procedures with extended cardiopulmonary bypass. However, late outcomes are acceptable for patients who were stabilized through surgical treatment and survived to discharge.

Differences in survival and recurrence of colorectal cancer by stage across population-based European registries.

Recurrence after colorectal cancer resection is rarely documented in the general population while a key clinical determinant for patient survival. We identified 8785 patients with colorectal cancer diagnosed between 2010 and 2013 and clinically followed up to 2020 in 15 cancer registries from seven European countries (Bulgaria, Switzerland, Germany, Estonia, France, Italy, and Spain). We estimated world age-standardized net survival using a flexible cumulative excess hazard model. Recurrence rates were calculated for patients with initially resected stage I, II, or III cancer in six countries, using the actuarial survival method. The proportion of nonmetastatic resected colorectal cancers varied from 58.6% to 78.5% according to countries. The overall 5-year net survival by country ranged between 60.8% and 74.5%. The absolute difference between the 5-year survival extremes was 12.8 points for stage II (Bulgaria vs Switzerland), 19.7 points for stage III (Bulgaria vs. Switzerland) and 14.8 points for Stage IV and unresected cases (Bulgaria vs. Switzerland or France). Five-year cumulative rate of recurrence among resected patients with stage I-III was 17.7%. As compared to the mean of the whole cohort, the risk of developing a recurrence did not differ between countries except a lower risk in Italy for both stage I/II and stage III cancers and a higher risk in Spain for stage III. Survival after colorectal cancer differed across the concerned European countries while there were slight differences in recurrence rates. Population-based collection of cancer recurrence information is crucial to enhance efforts for evidence-based management of colorectal cancer follow up.

Non-life insurance: The state of the art of determining the superior method for pricing automobile insurance premiums using archival technique

The pricing of insurance premiums in the non-life insurance sector remains a challenging and complex task. It demands a delicate balance between accurately estimating risk exposure and ensuring profitability for insurers. Generalised Linear Regression Models (GLMs) have become the preferred methods for premium price modelling in the motor insurance sector. While the approach of using a single superior model on which predictions are based ignores the use of robust estimator models. This paper examines various methodologies and sheds light on superiority of twenty-two models compared to each other for pricing automobile insurance. These methods vary from traditional actuarial methods to the modern statistical models such as machine learning algorithms. By using archival technique, their inferiority and superiority are explored, considering the ever-changing landscape of risk factors and market dynamics. Furthermore, it highlights the potential benefits of leveraging these methods and the mechanism for pricing short-term insurance, particularly in motor vehicle insurance. It also develops a framework that can be used in pricing to cater to risk analysis constituents to mitigate uncertainties and provide good services to clients. Our findings show that ANN, NN, XGB, random forest (RF) are superior models, and we conclude that the modern statistical methods can accurately estimate the risk exposure as compared to traditional methods such as the GLMs.

Survival of adult AML patients treated with chemotherapy in the U.S. population by age, race and ethnicity, sex, calendar-year period, and AML subgroup, 2001–2019

Population-based survival studies of adult acute myeloid leukemia (AML) have not simultaneously evaluated age at diagnosis, race and ethnicity, sex, calendar period or AML subtypes/subgroups among chemotherapy-treated patients. For 28,473 chemotherapy-treated AML patients diagnosed at ages ≥20 years in population-based cancer registry areas of the Surveillance, Epidemiology, and End Results Program (2001-2018, followed through 2019), we evaluated 1-month through 5-year relative survival (RS) and 95% confidence intervals (95% CI) using the actuarial method in the SEER∗Stat Survival Session and overall survival (OS) using multivariable Cox regression to estimate proportional hazard ratios (HR) and 95% CI. RS decreased with increasing age (20-39, 40-59, 60-74, 75-84, ≥85 years) at AML diagnosis. RS declined substantially within the first month and, except for acute promyelocytic leukemia, decreasing patterns continued thereafter for core binding factor AML, AML with antecedent condition/therapy, and all other AML. For all ages, acute promyelocytic leukemia RS stabilized after the first year. For total AML the hazard of death was significantly increased for non-Hispanic (NH)-Black (HR=1.18, 95% CI=1.12-1.24) and NH-Pacific Islander patients (HR=1.31, 95% CI=1.11-1.55) compared with NH-White patients. In contrast, NH-Asian and Hispanic patients had similar OS to NH-White patients across all ages and most AML subgroups. Males had significantly inferior survival to females with some exceptions. Compared to 2001-2006, in 2013-2018 OS improved for all age and AML subgroups. Chemotherapy-treated U.S. adults with AML have notable differences in survival by age, race and ethnicity, sex, calendar-year period, and AML subgroup. Despite survival gains over time, our findings highlight the need for improving early outcomes across all AML subgroups, older ages, and Black and Pacific Islander patients and long-term outcomes among most treated groups. Intramural Research Program of the U.S. National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics, and the U.S. Food and Drug Administration, Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology.

Self-Correcting Method for Highly Effective Office-Based Helicobacter pylori Therapy Using Cumulative Test of Cure Data.

Helicobacter pylori infections have become resistant to many previously highly effective antimicrobial regimens resulting in clarithromycin, metronidazole, or fluoroquinolone-containing therapies becoming unsuccessful. Pretreatment susceptibility testing is only widely available in the United States but is still rarely done. Here, we propose a framework to monitor H. pylori eradication in small clinical settings by routinely assessing the effectiveness of therapy. Because of the small sample size in individual practice's, we assume an acceptable cure rate of ≥80% (preferred cure rate ≥85%) in adherent patients, with a dichotomous outcome (cured vs. failed) and consecutive patient enrollment. To obtain results (feedback) in a timely manner, for individual practices, cure rates can be estimated after 10 patients. Large practices which acquire patients more rapidly can delay analysis until a total of 104 H. pylori-infected patients, assuming a baseline cure rate of at least 85% with the preferred regimen. We show how data from individual practices can be utilized to improve the effectiveness of H. pylori treatment decisions. The method consists of recording and accumulating the confirmation of cure data for successive small groups of patients. These data are then analyzed as binary outcomes (pass-fail) and serve as the basis for studying and improving the effectiveness of H. pylori treatment decisions. A simple actuarial method can serve outpatient clinics to ensure a reliable test-to-cure method and avoid futile Hp regimens.

A Proposal of a Pension Plan Design Based on Collective Pension Funds

This work proposes a design of an alternative pension plan based on collectivity with the characteristics of hybrid plans. Based on actuarial methods and financial modeling of some of the variables involved, numerical modeling of collective plans is performed to achieve this objective. Then, various scenarios were carried out to simulate a pension fund based on an institution database. At the end of each period, the replacement rate value for each plan member is calculated with a target of 30% of the last salary. As the plan works collectively, surpluses and deficits are distributed uniformly among the plan members. The results are that it is possible to achieve a replacement rate of 70% in the form of a life annuity due with 30 years of service, a contribution rate of 15% of the salary, and an investment portfolio of 60% of assets invested in equities and 40% in bonds.

Drawing on real estate assets for investment in smart silver villages

The existing housing stock in Europe, including scattered farmhouses, is grossly inadequate for long-term care (LTC) at home. Renovating these houses suitable for LTC requires a considerable new investment. An alternative is to sell or transfer ownership of family homes and farms and buy a residential unit in a retirement community by taking out a reverse mortgage loan. We present an approach to investing in the removal of barriers in part of an extended retirement home or the purchase of a property in a Smart Silver Village (SSV) from farm transfer subsidies if permitted by the call for proposals to encourage the rejuvenation of farm ownership. Our approach includes the actuarial present value method and periodic longevity insurance premia. It also includes funds from the agricultural transfer program for younger members of farming households. Moreover, it allows older farmers to move to a SSV if they pass the farm on to their successors and receive a portion of the reimbursement from government funds. This way, they become co-investors alongside the municipality in the SSV located relatively close to their respective farms. The current retirement home location in Slovenia is quite far from the farms. Existing reverse mortgage contracts in EU member states end when a homeowner moves into an assisted living home. Our approach with minor adjustments applies to all EU Member States.

Payout Phase of Defined Contribution Systems: the Case of Slovakia

The paper aims to assess various aspects concerning the payment phase of the old-age pension scheme, the socalled second pillar of the pension system in Slovakia. However, the conclusions may also be useful for other pension systems. Using the Lee-Carter model and standard actuarial methods, we conclude that the second pillar is advantageous for the high-income groups or in case of high performance of pension funds. We also address the issue of deferring the purchase of a lifetime annuity. Deferral can be beneficial when the yield of the pension fund exceeds a certain threshold value. This threshold usually raises with increasing age. We argue that the temporary pension is a disadvantageous product and its recent cancellation is correct. The main contribution of the paper subsists in a three-state model of long-term care insurance, using which we calculate corresponding replacement rates. Combined with a lifetime annuity, long-term care insurance can be beneficial.

Assessing Delayed Retirement Policies Linked to Dynamic Life Expectancy with Stochastic Dynamic Mortality

The question of how to effectively alleviate the financial pressure on pension insurance due to the increase in life expectancy has become an important issue in the reform of China’s social security system. This paper introduced two life expectancy-related delayed retirement schemes, namely the fixed expected retirement residual life and the fixed life burden ratio. We modeled the financial balance of the employee pension fund and the pension wealth of employees with a dynamic retirement age according to pension policy. Using the population mortality data, the dynamic retirement age under the two schemes was estimated under the stochastic mortality model. Following this, the impact of the two delayed retirement schemes was quantitatively assessed from the perspectives of the financial sustainability of the pension fund and the pension wealth of employees using insurance actuarial methods. This study found that the two life expectancy-related delayed retirement schemes have obvious effects on reducing the gap between the income and expenditure of the pension fund and increasing the pension wealth of employees. Moreover, it found that the fixed expected retirement residual life program contributes more than the fixed life burden ratio program to improve the financial sustainability of the pension fund and the pension wealth benefits of employees.

FROZEN INITIAL LIABILITY METHOD TO DETERMINE NORMAL COST OF PENSION FUND WITH VASICEK INTEREST RATE MODEL

Civil servants have an important role in national development, so increasing their productivity is needed. The pension fund program is given as a form of effort by government agencies to ensure employee welfare when entering retirement. This research discusses the normal cost of the defined benefit pension program using one of the actuarial valuation methods, namely Frozen Initial Liability (FIL), by taking into account the stochastic interest rate following the Vasicek model. The data used in this study are lecturers majoring in MIPA, Faculty of Science and Technology, Universitas Jambi, consisting of 8 people of female gender with the status of being a participant since 2022. Based on the calculation results obtained that in the period 0-30 years, the normal cost for each group member is constant, namely per year or per month. When the working period entered 31 years, one by one the participants began to enter their retirement period, which resulted in a change in the normal cost value. At 38 years of service, there was only one participant with a normal cost of per year or by per month. Changes in normal cost tend to decrease when retirement program participants also decrease. In the period of more than 38 years, all participants have retired so that normal cost payments are stopped.

Criterion Validation of Tau PET Staging Schemes in Relation to Cognitive Outcomes.

Utilization of NIA-AA Research Framework requires dichotomization of tau pathology. However, due to the novelty of tau-PET imaging, there is no consensus on methods to categorize scans into "positive" or "negative" (T+ or T-). In response, some tau topographical pathologic staging schemes have been developed. The aim of the current study is to establish criterion validity to support these recently-developed staging schemes. Tau-PET data from 465 participants from the Alzheimer's Disease Neuroimaging Initiative (aged 55 to 90) were classified as T+ or T- using decision rules for the Temporal-Occipital Classification (TOC), Simplified TOC (STOC), and Lobar Classification (LC) tau pathologic schemes of Schwarz, and Chen staging scheme. Subsequent dichotomization was analyzed in comparison to memory and learning slope performances, and diagnostic accuracy using actuarial diagnostic methods. Tau positivity was associated with worse cognitive performance across all staging schemes. Cognitive measures were nearly all categorized as having "fair" sensitivity at classifying tau status using TOC, STOC, and LC schemes. Results were comparable between Schwarz schemes, though ease of use and better data fit preferred the STOC and LC schemes. While some evidence was supportive for Chen's scheme, validity lagged behind others-likely due to elevated false positive rates. Tau-PET staging schemes appear to be valuable for Alzheimer's disease diagnosis, tracking, and screening for clinical trials. Their validation provides support as options for tau pathologic dichotomization, as necessary for use of NIA-AA Research Framework. Future research should consider other staging schemes and validation with other outcome benchmarks.

Delayed Retirement and Evaluation of the Payment Ability of Jiangxi Province’s Basic Pension Fund in China

The current payment pressure on the basic pension fund of Jiangxi Province in China is continuously increasing, and what impact will the upcoming delayed retirement policy have on the payment capacity of this province’s pension fund? This study evaluates the impact of two representative delayed retirement policies on the payment capacity of the basic pension fund in Jiangxi Province using actuarial methods. We found that delayed retirement is beneficial for improving the current and cumulative balances of the pension fund, significantly improving the future payment capacity of the pension fund. Moreover, the favorable effect of delayed scheme 2 is stronger than that of scheme 1. Given the favorable effects of the delayed retirement, the Chinese government should seize the time to formulate feasible delayed retirement policies to enhance the sustainable operation ability of the basic pension fund and ensure the timely and full payment of pension benefits for retirees.

Factors associated with exclusive breastfeeding of children under six months of age in Cote d’Ivoire

BackgroundDespite benefits of exclusive breastfeeding (EBF) and its strategic place in the national guidelines for infant and young child feeding, its practice remains insufficient in Cote d’Ivoire. It is therefore important to identify its early stopping associated factors. We aimed to (i) assess the extent of children’s exposure to exclusive breastfeeding and the associated explanatory factors for discontinuation before six months, and (ii) to profile non-exclusively breastfed children and interrelationships between these factors.MethodsA secondary analysis of data from the 2016 Cote d’Ivoire Fifth Multi Indicator Cluster Survey (MICS5) of 980 children under six months of age was conducted in this study. Data were analyzed using the actuarial method of survival hazard estimation combined with the Wilcoxon (Gehan) test, discrete time proportional hazards regression models, and Multiple Correspondence Analysis (MCA) to profile the children.ResultsMaternal exposure to counseling session, age at delivery, and child sex were significantly associated with the likelihood of discontinuing exclusive breastfeeding before the first six months of life. Children deprived of EBF resided in urban areas, in high and very high economic welfare households. Their mothers had a secondary education or higher and had three or fewer children.Logistic analysis showed that health status and sex of the child were significantly associated (P < 0.001) with exclusive breastfeeding. An extremely important and rarely studied factor is that children who were sick in weeks prior to the survey were more likely to remain exclusive breastfeeding (adjusted OR 1.80; 95% Confidence Interval (CI) 1.452, 2.234). Girls are less likely to be exclusively breastfed than boys (adjusted OR 1.48; 95% CI 1.22, 1.798). Low standard of living was associated with early cessation of EBF (adjusted OR 2.15; CI 1.325, 3.499). The duration of the exclusive breastfeeding was significantly longer among mothers with high exposure to medical discourse (adjusted OR 0.74; CI 0.595, 0.91).ConclusionsImproving the practice of exclusive breastfeeding in Cote d’Ivoire requires strengthening the capacities of health professionals in terms of advice and assistance to mothers for the practice of exclusive breastfeeding and its maintenance until six months of age, regardless of the health status and sex of the child.

THE RELIABILITY OF RESERVES VALUATION IN INSURANCE COMPANIES

Starting from the theory of probabilities, which represents an attempt to investigate uncertainty, insurance companies must calculate their insurance premiums in such a way as to cover all their operational expenses and obtain the expected benefit, preserving the principle of equity and solidarity. In commercial insurance, statistical research plays a special role in estimating the level of insurance activity and its prospects. For this purpose, the events that take place in insurance are measured, ordered, systematized and aggregated through observation (collection), processing and analysis. Estimating the risk and the insurer’s obligations based on inadequate or incorrect data is an extremely dangerous situation. Therefore, it is extremely important for the insurer to establish the best possibility of observing and using the data. Basing premium rates and reserves is an important activity for insurance companies. If insurers do not accurately set premium rates that reflect the size of the risk, they may suffer losses due to the financial imbalance created between premiums and indemnities or due to adverse selection. The actuary deals with this within the insurance company, using various actuarial statistical methods. The Chain-Ladder method is one of the most popular claims reserving techniques. The aim of this study is to back-test the chain-ladder method. We use a stochastic scenario generator that allows us to simulate arbitrarily many upper claims reserving triangles of similar characteristics for which we also know the corresponding lower triangles. Based on these simulated triangles, we analyse the performance of the chain-ladder claims reserving method. The substantiation of technical reserves must be based on specific methods because there is a possibility that two insurers may use different calculation techniques for similar obligations and obtain totally different results, thus disrupting profitability and financial soundness.