alcohol use

"The World Health Organization has estimated that, by 2020, motor vehicle accidents (MVAs) will be second only to ischemic heart disease as a cause of years of life lost and third as a cause of disability after ischemic heart disease and depression." "Although alcohol-related fatal crashes were substantially reduced between 1982 and 1995, there has been little change over the last 10 years."

People stop consuming alcohol for a variety of reasons. Some of those reasons – for example, joining a religious group where alcohol use is frowned upon or finally capitulating to nagging by a teetotaling spouse – have no insurability implications.

To determine insurability of applicants age 65 and over on the same basis as we do at younger ages all but guarantees a botched job. This is because factors that we know contribute to premature death in young and middle-aged adults differ dramatically from those linked to excess geriatric mortality. These examples give clear evidence of this too-often-overlooked reality.

In underwriting, we are seeing an increasing number of cases of chronic hepatitis C and nonalcoholic fatty liver disease (especially nonalcoholic steatohepatitis, NASH) wherein the proposed insured has not had a sufficient clinical workup to determine if advanced liver pathology (significant fibrosis, cirrhosis) is present. This is a key determination regarding insurability and the absence of this information has forced us to take uncertain actions…certainly insuring some who are bad risks while postponing others who are insurable.

Alcohol overuse – often but not always identified as “abuse” – and alcohol dependency (alcoholism, a disease) have been insidiously associated with substantial excess mortality – going back to an excellent study by Lincoln National Re in the late 1970s if not before – and well as fulminant excess morbidity.

With the introduction of widespread screening with blood profiles in the mid-1980s, we obtained the results of the gamma-glutamyltransferase (GGT) test on a vast number of insurance applicants. This test has a well-known and profusely-documented association with heavy drinking. In addition, we also had the results of two other tests associated, albeit less strongly so, with alcohol excess, HDL-C and AST (especially when the AST:ALT ratio is significantly elevated).

Why is this subject so important?

Because of the heavy use of pharmaceuticals at ages 65 and over, a phenomenon sometimes described as “polypharmacy.”

Why is this subject important?

“A high serum ferritin level may serve as a surrogate marker for poor health.”

Raymond Gambino, MD
LAB REPORT
17(1995):91

We can say the same for an abnormally low serum ferritin, especially in males over 50 and post-menopausal females, doubly so if they are known to have microcytic/Fe-deficiency anemia or GI symptoms.