Life expectancy in individuals with type 2 diabetes: implications for annuities.
BACKGROUND
Insurance companies often offer people with diabetes ''enhanced impaired life annuity'' at preferential rates, in view of their reduced life expectancy.


OBJECTIVE
To assess the appropriateness of ''enhanced impaired life annuity'' rates for individuals with type 2 diabetes. Patients. There were 4026 subjects with established type 2 diabetes (but not known cardiovascular or other life-threatening diseases) enrolled into the UK Lipids in Diabetes Study. Measurements. Estimated individual life expectancy using the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model.


RESULTS
Subjects were a mean (SD) age of 60.7 (8.6) years, had a blood pressure of 141/83 (17/10) mm Hg, total cholesterol level of 4.5 (0.75) mmol/L, HDL cholesterol level of 1.2 (0.29) mmol/L, with median (interquartile range [IQR]) known diabetes duration of 6 (3-11) years, and HbA(1c) of 8.0% (7.2-9.0). Sixty-five percent were male, 91% white, 4% Afro-Caribbean, 5% Indian-Asian, and 15% current smokers. The UKPDS Outcomes Model median (IQR) estimated age at death was 76.6 (73.8-79.5) years compared with 81.6 (79.4-83.2) years, estimated using the UK Government Actuary's Department data for a general population of the same age and gender structure. The median (IQR) difference was 4.3 (2.8-6.1) years, a remaining life expectancy reduction of almost one quarter. The highest value annuity identified, which commences payments immediately for a 60-year-old man with insulin-treated type 2 diabetes investing 100,000, did not reflect this difference, offering 7.4K per year compared with 7.0K per year if not diabetic.


CONCLUSIONS
The UK Government Actuary's Department data overestimate likely age at death in individuals with type 2 diabetes, and at present, ''enhanced impaired life annuity'' rates do not provide equity for people with type 2 diabetes. Using a diabetes-specific model to estimate life expectancy could provide valuable information to the annuity industry and permit more equitable annuity rates for those with type 2 diabetes.
Price
Hermione C
HC
Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of Oxford, Oxford, UK. Hermione.Price@dtu.ox.ac.uk
Clarke
Philip M
PM
Gray
Alastair M
AM
Holman
Rury R
RR
D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000191:economics / Q000401:mortality*; D005260:Female; D006801:Humans; D007352:Insurance, Life / Q000191:economics*; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D016016:Proportional Hazards Models; D012737:Sex Factors; D006113:United Kingdom / Q000453:epidemiology
D001786:Blood Glucose