2007 annual meeting ● assemblée annuelle 2007 vancouver 2007 annual meeting ● assemblée...
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2007 Annual Meeting ● Assemblée annuelle 2007
Vancouver
2007 Annual Meeting ● Assemblée annuelle 2007
Vancouver
Mortality ImprovementMortality Improvement
Mortality Improvement
• Agenda• Historical improvement Canada-Hardy’s paper
• Difference with the USA
• Improvement by cause of deaths
• Future improvement
Hardy Study
• Population data: 1921-2002
• Insured data: 1982-2001 (Ultimate only)
• No smoking status before 1992
• Insured data less reliable as influenced by underwriting requirements changes over the period covered.
Hardy Study
Hardy Study
• Improvement rates are ultimate and aggregate– Lack of data does not permit select rates, nor
smoker distinct rates.– Projection of mortality improvement for
periods longer than 25 years should be regarded with great caution.
– Cohort effect may exist but impact is mild.
Historical Mortality Improvement Rates: Hardy Study (1921-2002)
Historical Mortality Improvement Rates: Hardy Study (1921-2002)
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
0 10 20 30 40 50 60 70 80 90
Attained Age
Imp
rove
men
t
Male
Female
Mortality Improvement Canada
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+ All ages 25+1950-1960 4.4% 1.0% 1.4% 1.5% 0.8% 0.2% 0.1% -0.2% 0.4% 0.1%1960-1970 4.6% -1.0% 0.0% 0.1% 0.4% 0.2% 0.0% 1.0% 0.7% 0.5%1970-1980 3.1% 0.2% 0.6% 1.7% 1.2% 1.5% 1.3% 0.9% 1.1% 1.1%1980-1990 4.9% 3.2% 0.6% 1.6% 3.2% 2.2% 1.7% 0.8% 1.5% 1.4%1990-2000 4.2% 3.1% 4.0% 2.5% 2.8% 2.9% 2.4% 1.4% 2.1% 2.0%Total 1950-2000 4.3% 1.3% 1.3% 1.5% 1.7% 1.4% 1.1% 0.8% 1.1% 1.0%Total 1970-2000 4.1% 2.2% 1.8% 1.9% 2.4% 2.2% 1.8% 1.0% 1.6% 1.5%
0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+ All ages 25+1950-1960 4.7% 5.2% 5.0% 4.1% 2.4% 2.0% 1.9% 0.5% 1.5% 1.3%1960-1970 4.6% -0.2% 0.0% 0.6% 0.9% 1.2% 1.7% 2.1% 1.8% 1.7%1970-1980 3.1% 0.6% 2.3% 2.1% 1.6% 1.6% 1.8% 2.0% 1.9% 1.9%1980-1990 4.4% 3.3% 1.5% 2.5% 2.3% 1.6% 1.5% 0.9% 1.3% 1.2%1990-2000 4.1% 0.5% 2.6% 1.4% 1.7% 1.7% 1.5% 0.9% 1.2% 1.2%Total 1950-2000 4.2% 1.9% 2.3% 2.2% 1.8% 1.6% 1.6% 1.2% 1.6% 1.5%Total 1970-2000 3.9% 1.5% 2.2% 2.0% 1.9% 1.6% 1.6% 1.2% 1.5% 1.4%
Male Population
Female Population
US vs Canada
50
55
60
65
70
75
80
85
1929 1934 1939 1944 1949 1954 1959 1964 1969 1974 1979 1984 1989 1994 1999
Canada
US
Post Medicare- CanadaPre Medicare- Canada
1957: Canada passed legislation to allow the federal government to share in the cost of provincial hospital insurance plans. 1961: All 10 provinces and tw o territories had public insurance plans that provided comprehensive coverage for in-hospital care
Smoking cessation
Source: Pampel, F. (2002). Cigarette use and narrowing sex differential in mortality. Population and Devleopment Review, v28 n1, pp77-104
Improvement-Causes of Death
5-10% of deaths at key ages
1979-1998 improvementRespiratory
-1.0%
0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79
Age
% I
mp
rove
men
t
US
Canada
Improvement-Causes of Death
35-50% of deaths at key ages
Improvement 1979-1998CHD
-2.0%
0.0%
2.0%
4.0%
6.0%
8.0%
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79
Age
% I
mp
rove
men
t
US
Canada
Improvement-Causes of Death
5-10% of deaths at key ages
Improvement 1979-1998CVD
0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%9.0%
20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79
Age
% I
mp
rove
men
t
US
Canada
CHD-drugs
• RX:– Statins
• Decrease cholesterol levels
– Anti angina• Calcium channel Inhibitors,
nytro,...
– Beta blockers• Cardiac arrhythmia,
hypertension
Improvement-Causes of Death
Source: Ford & al. (2007): Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980–2000, NEJM vol 356, June 7,2007
% deaths prevented by change in risk factors
Smoking
BP
TC
Inactivity
BMIDiabetes
-40%
-20%
0%
20%
40%
60%
80%
1
Improvement-Causes of Death% of deaths prevented by treatment
Drugs as primary
prevention25%
Drugs as secondary prevention
19%
Drugs as treatment
31%
Non-drug treatment
25%
Source: Ford & al. (2007): Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980–2000, NEJM vol 356, June 7,2007
Future
• Mortality improvement vs death rate– No correlation
Future-Smoking• Proportion of smokers seems to have reach a plateau
Proportion smokerMales-Canada
0
10
20
30
40
50
60
70
1965 1974 1979 1983 1985 1990 1994 1995 1997 1998 1999 2000
Year
% S
mo
ker
18-24
25-34
35-44
45-64
65+
Proportion smokersFemales-Canada
0
10
20
30
40
50
1965 1974 1979 1983 1985 1990 1994 1995 1997 1998 1999 2000
Year
% S
mo
ker
18-24
25-34
35-44
45-64
65+
Future-Obesity
• Obesity– Potentially big impact– However only a secondary
risk factor– Indirect impact on mortality
Future-Obesity
Future-Obesity
Future-Obesity
Future-Obesity
• Impact on life insurance– Will probably keep increasing unless major
changes in behaviors.• Government campaigns?• Research?
– Risk factors for CVD have decreases over the last 40 years, except for diabetes, and this for all levels of BMI *.
* JAMA, April 20, 2005 – Vol 293, No. 15
Future- Advanced Medical Research
• Stem cell Research
• Cellular rejuvenation– Repair broken telomeres
• Cancer
Update on Mortality Improvement Sub-committee
• Goal: Propose mortality improvement basis for annuity and life insurance valuation
• Current draft of proposal:– Best estimate improvement scales would be the
same for life insurance and for annuity business – Mortality Improvement assumption would have
it’s own PfAD (insurance and annuity PfADs would be in opposite directions)
– Mortality improvement rates based on Hardy’s paper (Data from 1921 to 2002)
Questions