2007 Annual Meeting ● Assemblée annuelle 2007

Vancouver

2007 Annual Meeting ● Assemblée annuelle 2007

Vancouver

Mortality ImprovementMortality Improvement

Mortality Improvement

• Agenda• Historical improvement Canada-Hardy’s paper

• Difference with the USA

• Improvement by cause of deaths

• Future improvement

Hardy Study

• Population data: 1921-2002

• Insured data: 1982-2001 (Ultimate only)

• No smoking status before 1992

• Insured data less reliable as influenced by underwriting requirements changes over the period covered.

Hardy Study

Hardy Study

• Improvement rates are ultimate and aggregate– Lack of data does not permit select rates, nor

smoker distinct rates.– Projection of mortality improvement for

periods longer than 25 years should be regarded with great caution.

– Cohort effect may exist but impact is mild.

Historical Mortality Improvement Rates: Hardy Study (1921-2002)

Historical Mortality Improvement Rates: Hardy Study (1921-2002)

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

0 10 20 30 40 50 60 70 80 90

Attained Age

Imp

rove

men

t

Male

Female

Mortality Improvement Canada

0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+ All ages 25+1950-1960 4.4% 1.0% 1.4% 1.5% 0.8% 0.2% 0.1% -0.2% 0.4% 0.1%1960-1970 4.6% -1.0% 0.0% 0.1% 0.4% 0.2% 0.0% 1.0% 0.7% 0.5%1970-1980 3.1% 0.2% 0.6% 1.7% 1.2% 1.5% 1.3% 0.9% 1.1% 1.1%1980-1990 4.9% 3.2% 0.6% 1.6% 3.2% 2.2% 1.7% 0.8% 1.5% 1.4%1990-2000 4.2% 3.1% 4.0% 2.5% 2.8% 2.9% 2.4% 1.4% 2.1% 2.0%Total 1950-2000 4.3% 1.3% 1.3% 1.5% 1.7% 1.4% 1.1% 0.8% 1.1% 1.0%Total 1970-2000 4.1% 2.2% 1.8% 1.9% 2.4% 2.2% 1.8% 1.0% 1.6% 1.5%

0-14 15-24 25-34 35-44 45-54 55-64 65-74 75+ All ages 25+1950-1960 4.7% 5.2% 5.0% 4.1% 2.4% 2.0% 1.9% 0.5% 1.5% 1.3%1960-1970 4.6% -0.2% 0.0% 0.6% 0.9% 1.2% 1.7% 2.1% 1.8% 1.7%1970-1980 3.1% 0.6% 2.3% 2.1% 1.6% 1.6% 1.8% 2.0% 1.9% 1.9%1980-1990 4.4% 3.3% 1.5% 2.5% 2.3% 1.6% 1.5% 0.9% 1.3% 1.2%1990-2000 4.1% 0.5% 2.6% 1.4% 1.7% 1.7% 1.5% 0.9% 1.2% 1.2%Total 1950-2000 4.2% 1.9% 2.3% 2.2% 1.8% 1.6% 1.6% 1.2% 1.6% 1.5%Total 1970-2000 3.9% 1.5% 2.2% 2.0% 1.9% 1.6% 1.6% 1.2% 1.5% 1.4%

Male Population

Female Population

US vs Canada

50

55

60

65

70

75

80

85

1929 1934 1939 1944 1949 1954 1959 1964 1969 1974 1979 1984 1989 1994 1999

Canada

US

Post Medicare- CanadaPre Medicare- Canada

1957: Canada passed legislation to allow the federal government to share in the cost of provincial hospital insurance plans. 1961: All 10 provinces and tw o territories had public insurance plans that provided comprehensive coverage for in-hospital care

Smoking cessation

Source: Pampel, F. (2002). Cigarette use and narrowing sex differential in mortality. Population and Devleopment Review, v28 n1, pp77-104

Improvement-Causes of Death

5-10% of deaths at key ages

1979-1998 improvementRespiratory

-1.0%

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79

Age

% I

mp

rove

men

t

US

Canada

Improvement-Causes of Death

35-50% of deaths at key ages

Improvement 1979-1998CHD

-2.0%

0.0%

2.0%

4.0%

6.0%

8.0%

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79

Age

% I

mp

rove

men

t

US

Canada

Improvement-Causes of Death

5-10% of deaths at key ages

Improvement 1979-1998CVD

0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%9.0%

20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79

Age

% I

mp

rove

men

t

US

Canada

CHD-drugs

• RX:– Statins

• Decrease cholesterol levels

– Anti angina• Calcium channel Inhibitors,

nytro,...

– Beta blockers• Cardiac arrhythmia,

hypertension

Improvement-Causes of Death

Source: Ford & al. (2007): Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980–2000, NEJM vol 356, June 7,2007

% deaths prevented by change in risk factors

Smoking

BP

TC

Inactivity

BMIDiabetes

-40%

-20%

0%

20%

40%

60%

80%

1

Improvement-Causes of Death% of deaths prevented by treatment

Drugs as primary

prevention25%

Drugs as secondary prevention

19%

Drugs as treatment

31%

Non-drug treatment

25%

Source: Ford & al. (2007): Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980–2000, NEJM vol 356, June 7,2007

Future

• Mortality improvement vs death rate– No correlation

Future-Smoking• Proportion of smokers seems to have reach a plateau

Proportion smokerMales-Canada

0

10

20

30

40

50

60

70

1965 1974 1979 1983 1985 1990 1994 1995 1997 1998 1999 2000

Year

% S

mo

ker

18-24

25-34

35-44

45-64

65+

Proportion smokersFemales-Canada

0

10

20

30

40

50

1965 1974 1979 1983 1985 1990 1994 1995 1997 1998 1999 2000

Year

% S

mo

ker

18-24

25-34

35-44

45-64

65+

Future-Obesity

• Obesity– Potentially big impact– However only a secondary

risk factor– Indirect impact on mortality

Future-Obesity

Future-Obesity

Future-Obesity

Future-Obesity

• Impact on life insurance– Will probably keep increasing unless major

changes in behaviors.• Government campaigns?• Research?

– Risk factors for CVD have decreases over the last 40 years, except for diabetes, and this for all levels of BMI *.

* JAMA, April 20, 2005 – Vol 293, No. 15

Future- Advanced Medical Research

• Stem cell Research

• Cellular rejuvenation– Repair broken telomeres

• Cancer

Update on Mortality Improvement Sub-committee

• Goal: Propose mortality improvement basis for annuity and life insurance valuation

• Current draft of proposal:– Best estimate improvement scales would be the

same for life insurance and for annuity business – Mortality Improvement assumption would have

it’s own PfAD (insurance and annuity PfADs would be in opposite directions)

– Mortality improvement rates based on Hardy’s paper (Data from 1921 to 2002)

Questions