Session 083 L - Disabled Mortality and the Impact on Life Expectancy: An LTC Perspective. Moderator: Anthony C. Laudato, FSA, MAAA

Transcription

1 Session 083 L - Disabled Mortality and the Impact on Life Expectancy: An LTC Perspective Moderator: Anthony C. Laudato, FSA, MAAA Presenters: Allen J. Schmitz, FSA, MAAA P. J. Eric Stallard, ASA, FCA, MAAA SOA Antitrust Compliance Guidelines SOA Presentation Disclaimer

2 Mortality of Disabled Persons: Non- Insured Population Experience Based on the National Long Term Care Survey P.J. ERIC STALLARD, ASA, MAAA, FCA Session 83 Lecture Disabled Mortality and the Impact on Life Expectancy: An LTC Perspective 2017 SOA Annual Meeting & Exhibit October 15 18, 2017 Boston, MA

3 Background This presentation builds on results reported in the 2016 LTC Morbidity Improvement Study; see Stallard and Yashin (2016) at: That report evaluated temporal trends in HIPAA ADL and cognitive impairment (CI) disability between 1984 and 2004 using non-insured LTC experience data from the National Long Term Care Survey (NLTCS). The main results of that study are summarized in the following table. 2

4 Percent of Population Meeting Either HIPAA Trigger, United States 1984 and 2004, Unisex, Age 65 and Above, by Age and Totaled Over Age, with Two Modes of Age Standardization Age Change % Change Annual Rate of Decline; 20 yr % % % % % % % Total % 1984 ASDR % 2004 ASDR % Standard Error Total ASDR ASDR t -statistic Total ASDR ASDR NOTE: ASDR denotes age-standardized disability rate; the 1984 ASDR and 2004 ASDR results were age-standardized, respectively, to the 1984 and 2004 NLTCS weighted unisex population. The HIPAA triggers are based on 2+ ADL Impariments or 3+ errors on the SPMSQ. Source: Stallard and Yashin (2016; Table 2.21). 3

5 Objectives The present study evaluates the 5-year mortality experience of disabled persons following the 1984 and 2004 NLTCS in-person visits, presents the survival rates for and , and assesses the changes in those rates between and The disability states were defined by applying the HIPAA ADL and CI criteria to the responses for each study subject in the 1984 and 2004 NLTCS. The survival statistics were stratified by age, sex, and type of residence, i.e., community vs. nursing home or similar LTC institution. 4

6 Survival Statistics for the NLTCS Disabled Sample, by Survey Year and Age Proportion Alive at Each Anniversary of In-Person Visit Survey Year Age Group N SE (1989) Total 3, SE (2009) Total 2, Age-Standardized Survival Fractions for Years 0 5 SE (5) , , Difference Note: Age-standardized survival fractions were computed using the 1984 age-specific N's shown above as the "standard." 5

7 Survival Statistics for the 1984 NLTCS Disabled Sample, by Sex and Age Proportion Alive at Each Anniversary of In-Person Visit Sex Age Group N SE (1989) Female Subtotal 2, Male Subtotal 1, Total 3, Age-Standardized Survival Fractions for Years 0 5 SE (5) Female 2, Male 1, Difference Note: " " denotes sample size < 11 subjects. 6

8 Survival Statistics for the 2004 NLTCS Disabled Sample, by Sex and Age Proportion Alive at Each Anniversary of In-Person Visit Sex Age Group N SE (2009) Female Subtotal 1, Male Subtotal Total 2, Age-Standardized Survival Fractions for Years 0 5 SE (5) Female 1, Male Difference Note: " " denotes sample size < 11 subjects. 7

9 Survival Statistics for the 1984 NLTCS Disabled Sample, by Residence Type and Age Residence Proportion Alive at Each Anniversary of In-Person Visit Type Age Group N SE (1989) Community Subtotal 2, Nursing Home Subtotal 1, Total 3, Age-Standardized Survival Fractions for Years 0 5 SE (5) Community 2, Nursing Home 1, Difference Note: " " denotes sample size < 11 subjects. 8

10 Survival Statistics for the 2004 NLTCS Disabled Sample, by Residence Type and Age Residence Proportion Alive at Each Anniversary of In-Person Visit Type Age Group N SE (2009) Community Subtotal 1, Nursing Home Subtotal Total 2, Age-Standardized Survival Fractions for Years 0 5 SE (5) Community 1, Nursing Home Difference Note: " " denotes sample size < 11 subjects. 9

11 Survival Statistics for the 2004 NLTCS Disabled Sample, by Residence Type and Age, Females Residence Proportion Alive at Each Anniversary of In-Person Visit Type Age Group N SE (2009) Community Subtotal Nursing Home < Subtotal Total 1, Age-Standardized Survival Fractions for Years 0 5 SE (5) Community Nursing Home Difference Note: " " denotes sample size < 11 subjects. 10

12 Survival Statistics for the 2004 NLTCS Disabled Sample, by Residence Type and Age, Males Residence Proportion Alive at Each Anniversary of In-Person Visit Type Age Group N SE (2009) Community Subtotal Nursing Home Subtotal Total Age-Standardized Survival Fractions for Years 0 5 SE (5) Community Nursing Home Difference Note: " " denotes sample size < 11 subjects. 11

13 Summary Large differences were found in survival rates for disabled persons; Age Older ages had significantly lower survival Sex Males had significantly lower survival Residence type NH residents had significantly lower survival Survey year 2004 had significantly lower survival The declines in the 5-year survival rates support the hypothesized compression of LTC morbidity, as described and documented in the 2016 LTC Morbidity Improvement Study, and in Stallard, E., Compression of Morbidity and Mortality: New Perspectives. North American Actuarial Journal, 20(4), pp

14 Age-Standardized Survival Statistics for the 1984 and 2004 NLTCS Disabled Samples, by Calendar Year, Sex, and Residence Status Comparison N 1984/ / / / / /2009 SE (5) , , Difference Female 2, Male 1, Difference Female 1, Male Difference Community 2, Nursing Home 1, Difference Community 1, Nursing Home Difference Female Community Female Nursing Home Difference Male Community Male Nursing Home Difference Note: Age-standardized survival fractions were computed using the 1984 age-specific N's shown on Slide 5 as the "standard." 13

15 Caveats The NLTCS data were sampled from the general non-insured U.S. elderly population. Sampling from insured persons may produce substantially different results. The NLTCS data provided cross-sectional estimates of disability prevalence in the respective survey years. Almost all disability episodes were ongoing at the time of the in-person interview substantially different from insurance applications which typically follow claims from the time of inception to the time of claim termination or death. The means and standard errors of survival statistics were computed assuming simple random sampling within the rows of the tables this may be revised as additional analyses are conducted. 14

16 Thank You! Questions? Discussion 15

17 Acknowledgements Funding for the research in this presentation was provided by the National Institute on Aging through Grants Nos. P01-AG043352, R01-AG007370, R01-AG046860, and R56-AG A1. Funding for the National Long Term Care Survey was provided by the National Institute on Aging, most recently through grant no. U01-AG We gratefully acknowledge use of services and facilities of the Center for Population Health and Aging at Duke University, funded by NIA Center Grant P30-AG

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