Public Health Aspects of the 1951 Impairment Study

Abstract

This study, made under the auspices of the Society of Actuaries, comprised the experience of 27 large life insurance companies on 625,000 persons with specific medical impairments to whom policies were issued at standard and substandard rates between 1935 and 1949 after medical examination and who were traced to the policy anniversary in 1950. Some 132 groups of impairments were included. The average period of observation was slightly more than 6 years. This paper deals with the long-range outlook for persons with a history of various acute or chronic conditions which are of special interest to the public health profession, namely, personal history of or contact with tuberculosis, acute rheumatism (with and without cardiac impairment), poliomyelitis, syphilis, heart impairments, mental or nervous disorders, caesarean section, glycosuria and family history of heart disease, diabetes, cancer or insanity. Major findings were: (1) Persons who have had minimal tuberculosis and are free of symptoms 5 years after recovery have a virtually normal life expectancy. Underweights with a history of tuberculosis have a better record of longevity than ex-tuberculous persons of heavier build be- cause even though the underweights still experience a relatively high mortality from respiratory diseases, this is more than offset by their low mortality from degenerative diseases of later life, such as heart and circulatory diseases; (2) Several types of heart findings such as inconstant or localized heart murmurs or a rapid pulse rate, but with normal heart findings otherwise, appear to be relatively harmless and without significant effect on longevity. The opposite is likely to be true in the case of murmurs that are not localized, especially if, in addition, there is a history of rheumatic fever or other streptococcal infection or there is some increase in heart size; (3) Among persons with 2 or more close relatives under age 60 with heart or related disorders, the death rate was significantly above normal, primarily because they, too, experienced excessive mortality from these cardiovascular conditions; (4) Among persons with a history of neuroses, the mortality was only slightly higher than normal, but significantly, suicide accounted for the excess mortality.