Health and Care Conference 2001Warwick University, 22 October 2001

Trends in Causes of Sickness for IP Policies

A D Wilkie

InQA Limitedand CMI IP Subcommittee

IP (PHI) Claims 1975-98

Individual (not Group)UK (not Ireland)Not medically ratedA few others excluded: inconsistent data, commuted for

lump sum, ex gratia payment, etc

Claim record: a part (or all) of a sickness claim that falls into one calendar year.

A claim record may be for all or part of one calendar year.

Claims terminate (mostly) by recovery, death, expiry, or continuation to next calendar year.

Subdivided by:

Year or Quadrennium (four years)SexDeferred PeriodAge (at start of sickness)Occupation (two ways).

Cause of Sickness (73 detailed Causes; 41 Cause Groups)

Claims 1975-98

Total records 181,663

Inceptions 89,430Recoveries 74,865Deaths 3,132Expiries 6,180

Most claims end in recoveryRelatively few deathsRather few expiries; not analysed further

Years Records Inceptions Recoveries Deaths1975 4,050 3,027 2,832 711976 4,494 3,320 3,096 771977 4,482 3,204 2,891 721978 4,709 3,336 3,094 831979 4,642 3,169 2,996 871980 4,848 3,191 2,862 1121981 4,166 2,384 2,437 671982 4,689 2,805 2,888 881983 5,747 3,576 3,215 941984 6,558 3,936 3,487 1301985 7,602 4,336 3,864 1181986 8,125 4,333 3,779 1571987 8,710 4,582 3,761 1741988 9,389 4,787 3,962 1671989 8,778 4,291 3,677 1571990 8,822 4,079 3,362 1221991 10,189 4,878 3,827 1751992 10,464 4,472 3,516 1771993 9,377 3,995 3,170 1681994 9,347 3,552 2,657 1861995 9,843 3,740 2,594 1761996 9,858 3,331 2,330 1731997 11,171 3,498 2,329 1221998 11,603 3,608 2,239 179Total 181,663 89,430 74,865 3,132Numbers are generally rising, but irregularlyChanges also because of offices coming in and out

Quadrennia: Records Inceptions Recoveries Deaths

1975-78 17,735 12,887 11,913 3031979-82 18,345 11,549 11,183 3541983-86 28,032 16,181 14,345 4991987-90 35,699 17,739 14,762 6201991-94 39,377 16,897 13,170 7061995-98 42,475 14,177 9,492 650Total 181,663 89,430 74,865 3,132

Recoveries falling off in last quadrennium

Sex: Records Inceptions Recoveries Deaths

Males 158,084 78,177 65,641 2,877Females 23,579 11,253 9,224 255Total 181,663 89,430 74,865 3,132% Female 12.98 12.58 12.32 8.14

Many more males than femalesProportionately fewer female deaths

Deferred Period: Records Inceptions Recoveries Deaths

1 week 57,066 43,313 42,629 4604 weeks 49,855 26,104 22,429 81613 weeks 36,110 11,525 7,109 92326 weeks 28,254 6,254 2,264 71952 weeks 10,378 2,234 434 214Total 181,663 89,430 74,865 3,132

Many more claims in DP1 and DP4Recoveries/Inceptions lower for high DPs

Age: Records Inceptions Recoveries Deathsup to 19 88 66 58 020-24 2,749 1,902 1,815 725-29 10,467 7,296 7,031 5430-34 15,911 10,070 9,506 10535-39 21,398 12,327 11,473 19240-44 26,308 13,114 11,628 35845-49 30,286 13,598 11,375 49950-54 32,484 13,189 9,928 72055-59 29,713 11,453 7,659 83060-64 12,226 6,382 4,368 36765 and over 33 33 24 0Total 181,663 89,430 74,865 3,132

Peak at ages 45-59Very few outside range 20-64

Occupational Rating:RecordsInceptions Recoveries Deaths

Not rated (Standard) 138,445 68,819 58,525 2,567Rated (Star) 43,218 20,611 16,340 565Total (Standard *) 181,663 89,430 74,865 3,132%Rated 23.79 23.05 21.83 18.04

Two rating codes. Very few in code 2

Occupation Code: Records Inceptions Recoveries Deaths

0 12,478 6,112 4,934 2281 96,073 53,469 47,653 1,4522 8,782 3,107 1,761 1523 11,041 4,028 2,722 1474 7,496 2,698 1,868 825 45,793 20,016 15,927 1,071Total 181,663 89,430 74,865 3,132

Deferred Period/Duration

Inceptions @ 1 day @ 4 wks @ 13 wks @ 26 wks @ 52 wksDP1 43,313 43,194 11,934 3,957 2,437 1,863DP4 26,104 24,874 12,968 7,161 4,545DP13 11,525 10,529 8,006 5,513DP26 6,254 5,414 4,935DP52 2,234 1,967

DP1 diminishes with durationDP4, DP13, DP26 important at higher durations

Inceptions

Quadrennium by Occupational Rating:

Standard Star (rated) Total% Star

1975-78 10,599 2,288 12,887 17.751979-82 9,310 2,239 11,549 19.391983-86 12,243 3,938 16,181 24.341987-90 13,395 4,344 17,739 24.491991-94 12,400 4,497 16,897 26.611995-98 10,872 3,305 14,177 23.31Total 68,819 20,611 89,430 23.05

Rated cases generally increasing

Quadrennium by Occupation Code:

0 1 2 3 4 5 (= " ") Total

1975-78 792 7,746 0 0 0 4,349 12,8871979-82 827 6,735 0 0 0 3,987 11,5491983-86 1,785 8,648 0 0 0 5,748 16,1811987-90 2,708 10,192 183 364 169 4,123 17,7391991-94 0 10,521 1,345 2,154 1,492 1,385 16,8971995-98 0 9,627 1,579 1,510 1,037 424 14,177Total 6,112 53,469 3,107 4,028 2,698 20,016 89,430

Cases coded irregularly 0,1 or 5 in early yearsSince 1991 most coded 1, 2, 3 or 4Still a few coded 5 in latest years

Occupation Code by Occupational Rating:

Standard Star (rated) Total% Star0 2,725 3,387 6,112 55.421 53,228 241 53,469 0.452 850 2,257 3,107 72.643 758 3,270 4,028 81.184 323 2,375 2,698 88.035 (= " ") 10,935 9,081 20,016 45.37Total 68,819 20,611 89,430 23.05

Code 1 mostly not rated (but a few are)Codes 2, 3 and 4 mostly treated as rated (but not all)Codes 0 and 5 mixedBest division is 0, 1, 5 standard versus 2, 3, 4 and star

Quadrennium by Occupation Group:

0,1,5 Standard 2, 3, 4 and rated Total % 2, 3, 4 + rated

1975-78 10,599 2,288 12,887 17.751979-82 9,310 2,239 11,549 19.391983-86 12,243 3,938 16,181 24.341987-90 13,375 4,364 17,739 24.601991-94 11,513 5,384 16,897 31.861995-98 9,848 4,329 14,177 30.54Total 66,888 22,542 89,430 25.21

Rising proportions of 2, 3, 4 and rated

Quadrennium by Sex:

Males Females Total % females

1975-78 11,960 927 12,887 7.191979-82 10,455 1,094 11,549 9.471983-86 14,383 1,798 16,181 11.111987-90 15,320 2,419 17,739 13.641991-94 14,382 2,515 16,897 14.881995-98 11,677 2,500 14,177 17.63Total 78,177 11,253 89,430 12.58

Steadily rising proportion of females

Quadrennium by Deferred Period:1 week 4 weeks 13 weeks 26 weeks 52 weeks Total

1975-78 8,546 3,057 796 425 63 12,8871979-82 6,832 3,104 1,023 483 107 11,5491983-86 8,239 4,994 1,851 871 226 16,1811987-90 8,199 5,840 2,193 1,161 346 17,7391991-94 6,383 5,514 2,927 1,514 559 16,8971995-98 5,114 3,595 2,735 1,800 933 14,177Total 43,313 26,104 11,525 6,254 2,234 89,430

DP1 losing groundDP4 fluctuatingDP13 rising up to 1991-94DP26 and DP52 rising steadily

Sex by Deferred Period

Male Female Total % female

DP1 38,277 5,036 43,313 11.63DP4 23,119 2,985 26,104 11.44DP13 10,047 1,478 11,525 12.82DP26 5,011 1,243 6,254 19.88DP52 1,723 511 2,234 22.87Total 78,177 11,253 89,430 12.58

Lower proportion of females in DP1 and DP2Higher proportion of females in DP26 and DP52

Sex by Age group:Males Females Total % female

up to 19 57 9 66 13.6420-24 1,476 426 1,902 22.4025-29 5,843 1,453 7,296 19.9230-34 8,636 1,434 10,070 14.2435-39 10,587 1,740 12,327 14.1240-44 11,279 1,835 13,114 13.9945-49 11,780 1,818 13,598 13.3750-54 11,708 1,481 13,189 11.2355-59 10,520 933 11,453 8.1560-64 6,260 122 6,382 1.9165 and over 31 2 33 6.06Total 78,177 11,253 89,430 12.58

High proportion of females at lowest ages, up to 29Low proportion of females at higher ages, especially after 59

Sex by Occupation Group

Males Females Total % female

0, 1, 5 Standard 57,208 20,969 78,177 26.822, 3, 4 and rated 9,680 1,573 11,253 13.98Total 66,888 22,542 89,430 25.21% 2, 3, 4 and rated 14.47 6.98 12.58

Lower proportion of females are rated

Sex by Occupation Code:

Males Females Total % female

0 5,368 744 6,112 12.171 45,555 7,914 53,469 14.802 2,319 788 3,107 25.363 3,826 202 4,028 5.014 2,665 33 2,698 1.225 18,444 1,572 20,016 7.85Total 78,177 11,253 89,430 12.58

If females are rated they are commonly Code 2

Deferred period by Occupation Group:

0,1,5 Standard 2, 3, 4 and rated Total % 2, 3, 4 + rated

DP1 41,801 1,512 43,313 3.49DP4 11,422 14,682 26,104 56.24DP13 6,994 4,531 11,525 39.31DP26 4,925 1,329 6,254 21.25DP52 1,746 488 2,234 21.84Total 66,888 22,542 89,430 25.21

Very low proportion of rated cases in DP1Very high proportion of rated cases in DP4Quite high proportion of rated cases in DP13

Age group by Occupation Group:0,1,5 Standard 2, 3, 4 and rated Total % 2, 3, 4 + rated

up to 19 13 53 66 80.3020-24 1,084 818 1,902 43.0125-29 5,030 2,266 7,296 31.0630-34 6,945 3,125 10,070 31.0335-39 8,583 3,744 12,327 30.3740-44 9,452 3,662 13,114 27.9245-49 10,140 3,458 13,598 25.4350-54 10,340 2,849 13,189 21.6055-59 9,603 1,850 11,453 16.1560-64 5,667 715 6,382 11.2065 + 31 2 33 6.06Total 66,888 22,542 89,430 25.21

High proportions of rated cases at young agesLow proportions of rated cases at high ages

Year:Influenza high 1976 and 1989

Quadrennium:Increasing: 1995-98 much bigger than 1975-78

Tonsils and adenoids × 6.5Malignant neoplasms × 3.0

Decreasing: 1975-78 much bigger than 1995-98Hyperplasia of Prostate × 8.1Other respiratory × 5.6Calculus of urinary system × 5.1Appendicitis × 5.1Cholelithiasis and cholecystitis × 3.1

Sex:Males much bigger than Females:

Hyperplasia of Prostate × 37.5Ischaemic heart disease × 9.0Intestinal obstruction and hernia × 8.7Peptic ulcer × 2.5Cerebrovascular disease × 2.5

Females much bigger than Males:Other genitourinary × 4.2All other causes (includes pregnancy) × 3.2Benign neoplasms × 2.2

Deferred Period:DP1 much bigger than DP52:

Influenza × ∞Appendicitis × ∞Diseases of teeth × ∞Acute respiratory infections × 39.1Enteritis and diahorreal × 32.6Tonsils and adenoids × 21.2All other infective × 17.9Intestinal obstruction and hernia × 13.2

DP52 much bigger than DP1:Cerebrovascular disease × 6.9Malignant neoplasms × 6.1Mental disorders × 5.8

Age:Ages 60+ much bigger than ages up to 29:

Hyperplasia of Prostate × ∞Ischaemic heart disease × 105.9Cataract × 66.7Hypertensive disease × 44.1Cerebrovascular disease × 11.4

Ages up to 29 much bigger than ages 60 +:Tonsils and adenoids × 7.6Appendicitis × 6.6

Occupation Group:Standard 015 much bigger than Rated:

Influenza × 10.4Enteritis and diahorreal × 9.1Acute respiratory infections × 6.4

Rated much bigger than Standard 015:All other accidents × 3.0

Full linear model analysis desirable; not yet done