title: Coronary heart disease in the elderly--underwriting and pricing issues.
abstract: OBJECTIVE
  The purpose of this analysis was to estimate the degree of excess mortality in elderly people with coronary heart disease.
  
  
  METHODS
  Pertinent studies were found via an Internet search of English language articles in the National Library of Medicine. Excess mortality was estimated by the traditional calculations used in mortality methodology.
  
  
  RESULTS
  Mortality ratios for coronary heart disease were very high at young ages and tapered with advancing age, reaching levels at ages 80 and older of 130% to 180%. Comparison with other mortality studies indicated that this pattern was typical for most impairments. Present value calculations showed that relative risk (mortality ratio) was lower at older ages, but absolute risk (mortality cost) was much higher.
  
  
  CONCLUSIONS
  Mortality ratios for coronary heart disease and most common impairments are generally lower in elderly people. This has important underwriting and pricing implications. Disregarding what might be considered "low" mortality ratios in the elderly means that large additional risks are accepted with no additional premium.
authors.affiliation: Gen Re LifeHealth, Financial Centre, PO Box 300, 695 East Main Street, Stamford, CT 06904-0300, USA. pokorski@genre.com
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Pokorski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003324:Coronary Artery Disease / Q000191:economics / Q000401:mortality; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D020379:Risk Adjustment; D014481:United States / Q000453:epidemiology