title: Cholesterol screening and life assurance.
abstract: OBJECTIVE
  To examine how insurance companies assess proposals for life assurance from applicants with raised cholesterol concentrations and to determine the excess mortality rating applied.
  
  
  METHODS
  Survey of 49 companies underwriting term life assurance.
  
  
  METHODS
  United Kingdom.
  
  
  METHODS
  Four fictional men aged 30 seeking 20 year term policies paying benefit only on death. Two had total cholesterol concentrations of 6.4 and 8.1 mmol/l but no other cardiovascular risk factors; one was overweight, hypertensive, smoked 20 cigarettes daily, and had a total cholesterol concentration of 8.1 mmol/l; and one had possible familial hypercholesterolaemia and a total cholesterol concentration of 10.7 mmol/l after treatment.
  
  
  METHODS
  Percentage excess mortality rating.
  
  
  RESULTS
  All companies used explicit criteria to assess the mortality risk associated with hyperlipidaemias, and 47 companies applied the same criteria to men and women. No excess mortality rating was imposed on an applicant with a total cholesterol concentration of 6.4 mmol/l, but a small excess was applied to an applicant with a concentration of 8.1 mmol/l (median excess 50%, range 0-75%). When multiple cardiovascular risk factors were present the same concentration of 8.1 mmol/l resulted in a substantial excess (median 135%, range 50-200%). A smaller but more variable excess was applied to an applicant with possible familial hypercholesterolaemia (median 75%, range 0-200%).
  
  
  CONCLUSIONS
  Despite considerable differences among companies in the excess mortality ratings applied, increases in term life assurance premiums are likely to be restricted to patients with severe hypercholesterolaemia, in particular those with familial hypercholesterolaemia. In the absence of other cardiovascular risk factors milder hypercholesterolaemia is unlikely to result in higher premiums.
authors.affiliation: Department of Public Health and Primary Care, University of Oxford, Radcliffe Infirmary.
authors.forename: H A
authors.initials: HA
authors.lastname: Neil
authors.forename: D
authors.initials: D
authors.lastname: Mant
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality; D002784:Cholesterol / Q000097:blood*; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000401:mortality; D007343:Insurance Carriers; D007352:Insurance, Life / Q000191:economics; D008297:Male; D012307:Risk Factors; D006113:United Kingdom
chemical_list: D002784:Cholesterol