title: Stratifying long-term care risk by cardiovascular risk factors--an analysis of claims experience with atrial fibrillation.
abstract: OBJECTIVE
  The objective of this study is to stratify all-cause disability experience by stroke risk factors in a large cohort of individuals who have been underwritten and successfully enrolled in a long- term care insurance (LTCI) program.
  
  
  METHODS
  A large database of over 120,000 underwritten insured lives for LTCI between 1994 and 2002 allowed classification of claims risk for atrial fibrillation, hypertension, diabetes, and combinations of these cardiovascular risks. The mean duration of policy was over 5.7 years. A simple model utilizing the mean amount per covered life paid as a claim per year of coverage allowed for stratification of these risks for all-cause long-term care claims. Data analysis produced relative risks for these categories compared to individuals without any cardiovascular risks.
  
  
  RESULTS
  There was a significantly increased relative risk of 2.5 and 2.6 for atrial fibrillation and diabetes in individuals underwritten at ages 65-74, but not in ages 75 and older. This study also shows the relative risk of hypertension and diabetes to be less than diabetes alone at ages 65-74.
  
  
  CONCLUSIONS
  The current study is considered preliminary and establishes the foundation for future relative risk or "LTC morbidity ratio" studies for long-term care insurance.
authors.affiliation: Long Term Care Group, Inc, 11000 Prairie Lakes Drive, Suite 300, Eden Prairie, MN 55344, USA. sholland@ltcg.com
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Holland
authors.forename: Wayne F
authors.initials: WF
authors.lastname: Heidenreich
authors.forename: Igor F
authors.initials: IF
authors.lastname: Itskovich
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation; D002318:Cardiovascular Diseases; D015331:Cohort Studies; D006801:Humans; D007345:Insurance Claim Review; D008134:Long-Term Care; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke; D014481:United States