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The Actuary The magazine of the Institute & Faculty of Actuaries

The chronic disease burden

After nearly two years in the making,
the Chronic Disease Working
Party (CDWP) presented its
paper ‘The chronic disease burden an analysis of health risks and healthcare usage’ at a SIAS meeting on 25 October 2005. Around 50 people attended the meeting at Staple Inn, including representatives from medical insurers, local NHS primary care trusts, and public health officials.
The meeting was chaired by Fiona Adshead, deputy chief medical officer at the Department of Health, who welcomed the paper in the context of the recent debate about the workplace smoking ban in England. She reiterated the importance of innovative research into the risk factors for chronic diseases and the ways in which different chronic diseases are related to one another.

The Chronic Disease Working Party is a collaborative effort between actuaries, public health officials, academics, and other researchers. Four of its members, Simon Moody, Richard Morris, Rajeev Shah, and Joanne Alder, are actuaries, with interests across all the different types of healthcare insurance. The fifth member is Les Mayhew, who works at Cass Business School and is an honorary FIA, as well as a former senior civil servant with extensive experience in health and social security. By drawing its membership from actuaries and non-actuaries with different types of healthcare expertise, the CDWP hoped to avoid the silo mentality that besets and constrains research in this area. The other aims of the CDWP were listed as:
– learning about chronic diseases, their prevalence, and progression, including their impact on healthcare services;
– furthering actuarial knowledge in this area using new techniques to evaluate comorbidity and risk; and
– providing new results and practical tools that can be applied locally and nationally.

Risk ladders
The paper looks at five chronic diseases: coronary heart disease, stroke, type II diabetes, hypertension, and chronic obstructive pulmonary disease (COPD). The results were presented in three stages. First, Les Mayhew presented the findings from work carried out on a local primary care trust’s GP data. This work was partially funded by the Institute of Actuaries and involved linking GP data to local registries of housing and other social indicators. Les presented results showing the prevalence and co-prevalence of groups of chronic diseases and risk ladders giving the relative risk of developing a specified chronic disease given certain combinations of different risk factors.
Les also presented some pathways to different combinations of chronic diseases, which show in which order different chronic diseases are likely to be diagnosed for people with more than one of the five diseases studied. The CDWP also looked at mapping risks of developing chronic diseases by geographical area in local primary care trusts.
The second set of results demonstrated the use of survival curves applied to people diagnosed with COPD, showing the proportions of people surviving a specified number of years after diagnosis. These results were based on a national sample of GP data called the Health Improvement Network (THIN) data and supplied by an organisation called EPIC. The third set of results, showing the relative usage of GP services for people with chronic diseases, was also based on THIN data.

Ask the audience
In conclusion, the CDWP gave a summary of some of the possible uses of its research and asked the audience for some feedback on where it should concentrate its efforts for further areas of detailed research. The audience came up with some interesting ideas, including building a projection model of future prevalence based on current trends and the implications of these levels of prevalence for the resourcing of primary care facilities. The audience was also keen that the CDWP extend its research to include cancer diagnoses and depression.
Mike Pomery thanked the CDWP for producing work that was so clearly in the public interest and fulfilled a stated aim of the Institute of extending research by actuaries into wider fields. He did express some personal dismay at the graphs showing the high levels of prevalence of chronic diseases among men of his age!
Following some comments by the chair about the impact of smoking on the chance of developing a number of chronic diseases, one member of the audience raised the issue of trying to calculate the true cost impact of smoking on the economy versus the taxes paid by smokers over a lifetime. The CDWP agreed that this was an important consideration, but expressed concern about the difficulty of finding a robust methodology.
After a lively discussion, the CDWP thanked SIAS for giving it the opportunity to present its paper at this forum. The working party also reiterated that it was able to share only a very tiny proportion of its results in a 30-minute presentation and urged people to read the full paper for all the detailed results and discussion of methodologies.