title: Obtaining insurance after DNA diagnostics: a survey among hypertrophic cardiomyopathy mutation carriers.
abstract: Hypertrophic cardiomyopathy (HCM) is a common hereditary heart disease associated with increased mortality. Disclosure of DNA test results may have social implications such as low access to insurance. In The Netherlands, insurance companies are restricted in the use of genetic information of their clients by the Medical Examination Act. A cross-sectional survey was used to assess the frequency and type of problems encountered by HCM mutation carriers applying for insurance, and associations with carriers' characteristics. The response rate was 86% (228/264). A total of 66 carriers (29%) applied for insurance of whom 39 reported problems (59%) during an average follow-up of 3 years since the DNA test result. More problems were encountered by carriers with manifest disease (P<0.001) and carriers with symptoms of HCM (P=0.049). Carriers identified after predictive DNA testing less frequently experienced problems (P=0.002). Three carriers without manifest HCM reported problems (5% of applicants). Frequently reported problems were higher premium (72%), grant access to medical records (62%), and complete rejection (33%). In conclusion, HCM mutation carriers frequently encounter problems when applying for insurances, often in the case of manifest disease, but the risk assessment of insurance companies is largely justified. Still, 5% of carriers encounter potentially unjustified problems, indicating the necessity to monitor the application of the existing laws and regulations by insurance companies and to educate counselees on the implications of these laws and regulations.
authors: Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands. i.christiaans@amc.uva.nl
authors: Imke
authors: I
authors: Christiaans
authors: Tjitske M
authors: TM
authors: Kok
authors: Irene M
authors: IM
authors: van Langen
authors: Erwin
authors: E
authors: Birnie
authors: Gouke J
authors: GJ
authors: Bonsel
authors: Arthur A M
authors: AA
authors: Wilde
authors: Ellen M A
authors: EM
authors: Smets
mesh_terms: D000328:Adult; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000191:economics / Q000235:genetics*; D002353:Carrier State / Q000191:economics*; D003430:Cross-Sectional Studies; D003710:Demography; D004522:Educational Status; D005006:Ethnicity / Q000235:genetics; D005190:Family; D005260:Female; D006306:Health Surveys; D006801:Humans; D015273:Insurance Selection Bias; D007348:Insurance, Health; D007352:Insurance, Life; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009426:Netherlands; D010415:Pensions; D011795:Surveys and Questionnaires