US Life Research Articles

Updated USPSTF screening guidelines may reduce lung cancer deaths.

By nearly doubling the number of patients eligible for screening, as many as 60,000 US lives may be saved-but concerns may limit acceptance.

The growing rural-urban divide in US life expectancy: contribution of cardiovascular disease and other major causes of death.

BackgroundThe US rural disadvantage in life expectancy (LE) relative to urban areas has grown over time. We measured the contribution of cardiovascular disease (CVD), drug-overdose deaths (DODs) and other major causes of death to LE trends in rural and urban counties and the rural–urban LE gap.MethodsCounterfactual life tables and cause-of-death decompositions were constructed using data on all US deaths in 1999–2019 (N = 51 998 560) from the Centers for Disease Control and Prevention.ResultsDuring 1999–2009, rural and urban counties experienced robust LE gains, but urban LE increased by 1.19 years more in women and 0.86 years more in men compared with rural LE. During 2010–2019, rural counties experienced absolute declines in LE (women −0.20, men −0.30 years), whereas urban counties experienced modest increases (women 0.55, men 0.29 years). Counterfactual analysis showed that slowed CVD-mortality declines, particularly in ages 65+ years, were the main reason why rural LE stopped increasing after 2010. However, slow progress in CVD-mortality influenced LE trends more in urban areas. If CVD-mortality had continued to decline at its pre-2010 pace, the rural–urban LE gap would have grown even more post 2010. DODs and other causes of death also contributed to the LE trends and differences in each period, but their impact in comparison to that of CVD was relatively small.ConclusionsRural disadvantage in LE continues to grow, but at a slower pace than pre 2010. This slowdown is more attributable to adverse trends in CVD and DOD mortality in urban areas than improvements in rural areas.

A Palestinian window of opportunity? The PLO, the US and the Iranian hostage crisis

ABSTRACT When the US embassy in Teheran was stormed in 1979, and the embassy personnel taken hostage, the PLO saw an opportunity to engage with the United States. Since the early 1970s the PLO had tried to open a political channel with the USA. While several back-channels had been attempted none resulted in direct political talks between the US and the PLO. The US was bound by a secret agreement with Israel, as part of Sinai II, having promised not to negotiate with the PLO. When the US hostages were taken in 1979, the PLO attempted to use their contacts in the new Iranian regime to negotiate on behalf of the US. While this channel did not result in a major breakthrough in the hostage negotiations, it is a case which illustrates a paradox in US Middle East policy: The US was unwilling to negotiate with the Palestinians when it was their conflict that was at stake, but once US lives were in the balance, the US administration was more than willing to open a direct channel to the PLO. Arafat, for his part, was equally willing to step up, hoping to make political gains further down the line.

It's RILA time: An introduction to registered index‐linked annuities

AbstractRegistered index‐linked annuities (RILAs) are increasingly popular equity‐based retirement savings products offered by US life insurance companies. They combine features of fixed‐index annuities and traditional variable annuities (TVAs), offering investors equity exposure with downside protection in a tax‐deferred setting. This article introduces RILAs to the academic literature by describing the products' key features, developing a general pricing model, and deriving the providers' hedging strategy by decomposing their liabilities into short‐term European options. Numerical illustrations show that RILAs offer investors similar risk profiles (in the long run) as TVAs with maturity guarantees, and that many products currently sold appear to be priced quite favorably for investors. For providers, RILAs may be a preferable alternative or complement to TVAs as they greatly simplify the management of the embedded equity risk and can naturally reduce the TVA capital requirements. These features position RILAs as a viable long‐term solution for this product space.

Molly McCarthy, MBA, BSN, RN, RN-BC

Molly McCarthy, MBA, BSN, RN, RN-BC

Efficient valuation of variable annuity portfolios with dynamic programming

AbstractThe valuation of variable annuity portfolios presents major challenges for US life insurers. Recent studies propose machine learning and metamodeling techniques based on selecting a few representative guarantees. However, these methods face a critical trade‐off between speed and accuracy. In contrast, I propose a recursive dynamic programming approach and demonstrate its ability to value a large and highly heterogeneous variable annuity portfolio with a high degree of accuracy and within a few seconds—even under stochastic interest rates and volatility—since the heavy computational burden can be fully front‐loaded (in a one‐time effort at the guarantee's pricing stage). This makes the dynamic programming approach ideally suited for all variable annuity applications, including the computation of reserves and capital requirements and to determine the insurer's hedging position. Moreover, dynamic programming can naturally incorporate optimal policyholder behavior into the insurer's valuation.

Lifetime Costs of Patients with Chronic Lymphocytic Leukemia

Introduction:Patients with genomic aberrations del(11q), del(17p), and mutated IGHV in chronic lymphocytic leukemia (CLL) are at the highest risk for poor outcomes including shorter time to initial treatment, non-response to therapy (refractory disease), relapse, reduced progression-free survival (PFS) and overall survival (OS). Response to CLL therapy has typically been defined as complete remission (CR) or partial remission (PR), although recent evidence demonstrates that minimal residual disease (MRD) status is a more comprehensive indicator of treatment response. MRD negativity (MRDn) versus positivity (MRDp) has been associated with better PFS and OS independent of treatment response. There is little evidence on how economic outcomes such as lifetime costs vary by these response categories. The objective of this study was to quantify the difference in CLL-related lifetime costs for patients across four response categories: MRDn/CR, MRDn/PR, MRDp/CR, and MRDp/PR.Methods:A 19-state cohort Markov model to estimate the clinical outcomes and direct medical costs of CLL for patients achieving the four response categories of interest was created. A cohort of newly diagnosed CLL patients were simulated in quarter-year cycles through disease progression until all patients in the cohort died. Transition probabilities through diagnosis, treatment response, relapse, and death were estimated using data from clinical trials and the published literature. Mortality was estimated using US Life Table data from 2010 and CLL-specific mortality estimates from the literature. Patients were stratified into high risk (del(11q), del(17p), and unmutated IgVH) and low risk (all other patients) groups in the model. Treatment costs and subsequent response rates were modeled after 2017 NCCN guidelines and current clinical practices. All cost parameters were converted to 2016 USD and future costs were discounted at a rate of 3%.Results:The model estimates that lifetime CLL-related costs range from $140,250 - $368,844 per patient and that patients achieving MRDn/CR after first line (1L) therapy experience the lowest lifetime costs. Tables 1 and 2 show the incremental change in costs across various response categories after 1L and second line (2L) therapy. The most substantial cost savings were associated with MRDn responses compared to MRDp responses. Patients achieving MRDn in 1L therapy, on average, incurred 30% lower costs than those who were MRDp (Table 1). This effect was also observed among CR patients in which, patients achieving MRDn/CR in 1L therapy, on average, had 19% lower costs than patients achieving MRDp/CR. The results are consistent in 2L therapy (Table 2).Conclusion:MRDn is associated with reduced CLL-related lifetime costs regardless of clinical response (CR or PR). Previous research has indicated that MRD status is the most significant predictor of PFS and OS and this study implies that patients achieving MRDn will also incur less lifetime costs related to CLL. [Display omitted] DisclosuresSail:AbbVie Inc: Employment, Equity Ownership, Other: I am an employee of AbbVie, Inc and may own AbbVie and/or Abbott stock. Ward:Precision Health Economics: Employment, Other: research funding from AbbVie Inc. Iyenger:AbbVie Inc: Employment, Equity Ownership, Other: I am an employee of AbbVie, Inc and may own AbbVie and/or Abbott stock. Silverstein:Precision Health Economics: Employment, Other: research funding from AbbVie Inc. Espinosa:Precision Health Economics: Employment, Other: research funding from AbbVie Inc. Keim:AbbVie Inc.: Employment, Equity Ownership, Other: I am an employee of AbbVie, Inc and may own AbbVie and/or Abbott stock. Meissner:AbbVie Inc.: Employment, Equity Ownership, Other: I am an employee of AbbVie, Inc and may own AbbVie and/or Abbott stock. Frasco:Precision Health Economics: Employment, Other: research funding from AbbVie Inc.

Hometown Prison: Whiteness, Safety, and Prison Work in Upstate New York State

ABSTRACTMass incarceration has been shown to be a force of racializations and class inequality in US life, but little literature has focused on the lives of prison guards. Highlighting the lived experiences of prison guards at two state maximum security prisons in Elmira, New York, a small multiracial city in central New York State, this article uses Cedric Robinson's notion of racial capitalism to show how prison expansion unfolds in New York State at the end of the twentieth century. Guard labor includes both the physical work of control and of basic social reproduction and is done by people who are connected to the cultures, histories, and political economies in which they were raised, what Elmirans often call one's “hometown.” I examine prison guards’ narratives of their racial encounters inside and outside the prison, their sense of their racialized selves, and their relationship to what they see as often boring, violent, and stigmatized work. I show how the expansion of the carceral state over the past forty years, the period most often referred to as mass incarceration, maintains Fordism's labor hierarchies in a retooled racialization: as jailer and jailed. [prisons, whiteness, carceral state, racial capitalism, post‐Fordism]

Repligen to acquire French membrane manufacturer Polymem

US life sciences company Repligen Corp has entered into an agreement to purchase Polymem SA, the French hollow fiber membranes and modules manufacturer.

Abstract P206: Modeling The Impact Of The Tobacco 21 Policy In El Paso, Texas

Introduction: On December 20, 2019, the federal Tobacco 21 (T21) law was passed. This new legislation raised the minimum legal purchase age for tobacco products from 18 to 21 years. Thirty-three states in the US have implemented the law, but 19 states have yet to enact it. Public health practitioners and policymakers need more evidence on the impact of the T21 Policy at the local level to encourage adequate enforcement. Objective: To project the health and economic impact of the T21 Policy in El Paso, Texas, which is the focus area of the Heart Racial and Ethnic Approaches to Community Health (REACH) Program implemented by the American Heart Association. Methods: Using an agent-based model of smoking behavior and a microsimulation model of cardiovascular disease, we projected the long-term effects of the T21 Policy on smoking prevalence and cardiovascular health outcomes in El Paso, Texas. Population characteristics and model parameters were estimated based on data from the National Health Interview Survey, US Life Tables, and the National Health and Nutrition Examination Survey. Annual smoking prevalence was derived from the Texas Behavioral Risk Factor Surveillance System and County Health Rankings. The policy effects were determined from established effect sizes from published literature. Results: The estimated prevalence of smoking in El Paso, Texas decreased by 2.7% among 18-24 year olds and by 5.2% among 25-44 year olds in 20 years with the implementation of the T21 policy; these results are statistically significant (p<0.01 for both population groups). Our results also revealed that the T21 Policy could prevent cardiovascular disease such as coronary heart disease (CHD) and stroke. Specifically, compared to the no-policy situation, the policy would prevent 5.4 CHD events (from 305.2 to 299.8) per 1,000 adults and 10.8 stroke events (from 232.6 to 221.8) per 1,000 adults over lifetime. The model also projected a reduction in health care costs due to the T21 Policy, as the estimated lifetime health care costs decreased from $425,672 per person without the T21 Policy to $423,376 per person with the policy. Conclusions: This study provides important information for policymakers to understand the potential impacts of the T21 Policy in El Paso, Texas. The projected decreases in tobacco use, cardiovascular disease, and health care costs as a result of the T21 Policy could assist in advocating for T21 Policy enactment in other areas of the US.

Recovering from Trump: Biden's first 100 days

US President Joe Biden's initial actions stayed Donald Trump's assault on health and the new administration has begun to redress injustices and flawed social policies that set the stage for Trump's ascendance. These long-standing policy failures contributed to US life expectancy falling 3·4 years behind that of other G7 nations over the past four decades.1

Modest Gains Confer Large Impact: Achievement of Optimal Cardiovascular Health in the US Population

Modest Gains Confer Large Impact: Achievement of Optimal Cardiovascular Health in the US Population

Social Inequality and the Future of U.S. Life Expectancy.

Despite decades of progress, the future of life expectancy in the United States is uncertain due to widening socioeconomic disparities in mortality, continued disparities in mortality across racial/ethnic groups, and an increase in extrinsic causes of death. These trends prompt us to scrutinize life expectancy in a high-income but enormously unequal society like the United States, where social factors determine who is most able to maximize their biological lifespan. After reviewing evidence for biodemographic perspectives on life expectancy, the uneven diffusion of health-enhancing innovations throughout the population, and the changing nature of threats to population health, we argue that sociology is optimally positioned to lead discourse on the future of life expectancy. Given recent trends, sociologists should emphasize the importance of the social determinants of life expectancy, redirecting research focus away from extending extreme longevity and towards research on social inequality with the goal of improving population health for all.

Beyond deaths per capita: comparative COVID-19 mortality indicators

ObjectivesFollowing well-established practices in demography, this article discusses several measures based on the number of COVID-19 deaths to facilitate comparisons over time and across populations.SettingsNational populations in 186 United Nations...

Interventions to Address the Opioid Crisis—Modeling Predictions and Consequences of Inaction

Invited commentary: The scale of the opioid crisis in the United States highlights the need to identify and implement the most effective approaches to prevent overdose fatalities. Over the last 15 years, deaths due to opioid overdoses have exceeded 500 000,1 and declines in overall US life expectancy are partly explained by this increase in overdose mortality. The Healing Communities Study (HCS), part of the National Institutes of Health Healing Addiction Long-Term initiative to address the opioid crisis, is testing whether an integrated set of evidence-based prevention and treatment interventions can reduce overdose mortality by 40% over a 3-year period (the first year to select interventions and train personnel and 2 years of implementation).....

Female and male US Olympic athletes live 5 years longer than their general population counterparts: a study of 8124 former US Olympians

ObjectiveTo quantify US female and male Olympic athletes’ longevity and the years of life lost or saved due to multiple causes of death as compared with the US general population.MethodsFormer...

Learning From England's Best Practice Tariff: Process Measure Pay-for-Performance Can Improve Hip Fracture Outcomes.

The objective of this study was to evaluate England's Best Practice Tariff (BPT) and consider potential implications for Medicare patients should the US adopt a similar plan. Since the beginning of the Affordable Care Act, Medicare has renewed efforts to improve the outcomes of older adults through introduction of an expanding set of alternative-payment models. Among trauma patients, recommended arrangements met with mixed success given concerns about the heterogeneous nature of trauma patients and resulting outcome variation. A novel approach taken for hip fractures in England could offer a viable alternative. Linear regression, interrupted time-series, difference-in-difference, and counterfactual models of 2000 to 2016 Medicare (US), HES-APC (England) death certificate-linked claims (≥65 years) were used to: track US hip fracture trends, look at changes in English hip fracture trends before-and-after BPT implementation, compare changes in US-versus-English mortality, and estimate total/theoretical lives saved. A total of 806,036 English and 3,221,109 US hospitalizations were included. After BPT implementation, England's 30-day mortality decreased by 2.6 percentage-points (95%CI: 1.7-3.5) from a baseline of 9.9% (relative reduction 26.3%). 90- and 365-day mortality decreased by 5.6 and 5.4 percentage-points. 30/90/365-day readmissions also declined with a concurrent shortening of hospital length-of-stay. From 2000 to 2016, US outcomes were stagnant (P > 0.05), resulting in an inversion of the countries' mortality and >38,000 potential annual US lives saved. Process measure pay-for-performance led to significant improvements in English hip fracture outcomes. As efforts to improve US older adult health continue to increase, there are important lessons to be learned from a successful initiative like the BPT.

Reductions in 2020 US life expectancy due to COVID-19 and the disproportionate impact on the Black and Latino populations.

COVID-19 has resulted in a staggering death toll in the United States: over 215,000 by mid-October 2020, according to the Centers for Disease Control and Prevention. Black and Latino Americans have experienced a disproportionate burden of COVID-19 morbidity and mortality, reflecting persistent structural inequalities that increase risk of exposure to COVID-19 and mortality risk for those infected. We estimate life expectancy at birth and at age 65 y for 2020, for the total US population and by race and ethnicity, using four scenarios of deaths-one in which the COVID-19 pandemic had not occurred and three including COVID-19 mortality projections produced by the Institute for Health Metrics and Evaluation. Our medium estimate indicates a reduction in US life expectancy at birth of 1.13 y to 77.48 y, lower than any year since 2003. We also project a 0.87-y reduction in life expectancy at age 65 y. The Black and Latino populations are estimated to experience declines in life expectancy at birth of 2.10 and 3.05 y, respectively, both of which are several times the 0.68-y reduction for Whites. These projections imply an increase of nearly 40% in the Black-White life expectancy gap, from 3.6 y to over 5 y, thereby eliminating progress made in reducing this differential since 2006. Latinos, who have consistently experienced lower mortality than Whites (a phenomenon known as the Latino or Hispanic paradox), would see their more than 3-y survival advantage reduced to less than 1 y.

Effects of US state preemption laws on infant mortality

Studies show that raising the minimum wage in a US state above the federal minimum wage can reduce infant mortality rates in those states. Some states have raised their minimum wage in recent decades, while many others did not, and have prohibited local authorities from doing so by enacting preemption laws. This study investigates how the recent emergence of state preemption laws that remove local authority to raise the minimum wage has affected infant mortality rates. Using county- and state- level data spanning 2001 through 2018, this study models infant mortality rates as a function of minimum wage levels, controlling for confounders. The estimated model, combined with information on the timing, location, and level of preempted minimum wages, is then used to estimate the number of infant deaths that occurred in 2018 that could be attributed to state preemption of local minimum wage increases. In the 9 largest (pop. > 250,000) metro counties most directly affected by state preemption, we estimate that in 2018, 25 infant deaths were attributable to preemption. This equates to a 5.4% reduction in these counties' infant mortality rate. When considering all large metro counties in preemption states, as many as 605 infant deaths could be attributed to preemption. State preemption laws that remove local authority to enact health-promoting legislation, such as minimum wage increases, are a significant threat to population health. The growing tide of these laws, particularly since 2010, may be contributing to recent troubling trends in US life expectancy.

Unregulated corporate financial statements and analysts' target price accuracy: evidence from embedded value reporting by life insurers

Multiple studies support the value relevance of embedded value (EV) disclosures by life insurance companies. To the best of our knowledge, this is the first paper to examine the impact of EV voluntary disclosure on analysts' target price forecast accuracy. Our findings support the proposition that EV is a valuable supplemental information in and should be of special interest to financial reporting policy makers, financial analysts, managers, and academics. Our analysis suggests that life insurers that currently do not disclose EV should consider disclosing the measure, and financial analysts in the US should encourage US life insurers to disclose EV to support their valuation of life insurers' stocks. We contribute to the extant literature on embedded value, and voluntary disclosures, by providing evidence that suggests that EV disclosure helps improve the accuracy of analyst forecasts.