How Can We Identify Life Insurance Applicants at Higher Risk for a Drug Overdose Death?
Consulting Medical Director Michael Fulks discusses new data from the CDC for evaluating drug use, potential overdose risk, and life insurance implications.
Recently on the CRL blog we discussed a shift in causes of mortality away from cancer and heart disease toward accidental deaths, with the change largely due to an increase in fentanyl drug overdose deaths. But the data lacked detail as to how we can identify who is high risk for an overdose; our biases may not reflect reality.
Two recent short articles from the CDC help provide context. The first article confirms that although people ages 25-44 have the largest number of drug deaths, all age bands from 15 to >65 show a similar recent increase. This increase is being seen across all ethnicities and both sexes. Interestingly, around 75% of those dying had documented evidence of substance abuse other than alcohol, and <10% of those dying were being treated for pain. This raises the possibility that testing for fentanyl and other drugs of abuse might identify those at risk, while a prescription history might be less helpful. It also showed the highest risk in U.S. counties with the greatest income disparity, a key to why people might be at risk but less useful in identifying at-risk individuals.
A second CDC report looked at occupations at the highest risk of overdose death. It is not surprising to find “construction and extraction” a clear winner, with “food prep and server” second followed by near identical risk for “transportation, building, and maintenance.” The risk for these groups is 50% to >100% higher than the average for all occupations.
This information might be seen as somewhat reassuring to the individual life insurance industry, where the focus is more on applicants with higher (discretionary) income and because applicant testing might be useful to reduce risk. But it is more worrisome as well; the increasing mortality from substance use is nearly universal across age, gender and ethnicity.
About the Author
Michael Fulks, MD, Consulting Medical Director, is board-certified in internal and insurance medicine. After leaving practice, he served as a medical director, creating or editing several underwriting manuals and preferred programs. More recently, Mike has consulted for CRL participating in its mortality research on laboratory test results, BP and build, and in the development of risk-scoring tools for laboratory and non-laboratory data.