EXPLORING THE IMPACT OF LIFESTYLE
FACTORS ON MORTALITY AND MORBIDITY
USING UK BIOBANK DATAABOUT THE AUTHORS

Abstract
When underwriting life and health insurance, determining how
multiple rating factors, such as lifestyle, comorbidities, and mortality,
can interact with and impact one another remains challenging. To
unravel this, RGA is collaborating with world-renowned researchers
from the University of Leicester (U.K.) to enable scientists as well asinsurers to realize the potential and limits of lifestyle information fordisease and death prognostication. The research aims to bring directand significant value to insurance medical directors and underwriters
by generating critical and novel insights that will enhance
medical knowledge and support the development of underwriting
philosophies and strategies.

Introduction
Insurers have long understood that lifestyle factors thought of as“unhealthy,” such as smoking, sedentary behaviors, poor eating
habits, and excessive (or inadequate) sleep, can contribute tochronic health conditions and adverse outcomes. What insurers havelargely lacked, however, is the ability to quantify the influences andinteractions of these activities on the health and longevity of life andliving benefits insurance applicants.
Improved risk assessment, for example, could enable premium
pricing that reflects individual applicant risks more precisely andultimately strengthens insurer underwriting practices. For customers,a better understanding of how lifestyle factors can affect health, life
expectancy, and quality of life (possibly coupled with financial or otherincentives) could lead to behavior changes and, through insurancelinked wellness programs, greater engagement with their insurance

Kishan Bakrania, Ph.D.
Kishan.Bakrania@rgare.com
Kishan Bakrania, Ph.D., is a Senior Health Data
Scientist in RGA’s Global Data and Analytics(GDA) department. His doctorate in epidemiology,
Master of Science (M.Sc.) in medical statistics,and Bachelor of Science (B.Sc.) in mathematics,
are from the University of Leicester.
Richard Russell, Ph.D.
rrussell@rgare.com
Richard Russell, Ph.D., is Vice President, Headof Health Data Analytics in RGA’s Global Dataand Analytics department. Previously, he was a
Postdoctoral Research Fellow at City, Universityof London for two years, and at Moorfields Eye
Hospital, London. His Bachelor of Science (B.Sc.)in biotechnology, Master of Science (M.Sc.) inbioinformatics (with distinction), and Ph.D. instatistics are from Imperial College London. He
has authored more than 30 peer-reviewed articles
for journals such as The Lancet, BMJ Open, PLoS
One, and Annals of Actuarial Science.
Dr. Kevin Somerville, D.M.
kevin.somerville@rgare.com
Kevin Somerville MbCHb, DM, FRCP, FRACP is
Medical Consultant to RGA’s Global Underwriting
Manuals, Research and Development team.
He graduated in Medicine from Auckland
University, New Zealand and his Doctorate inMedicine is from Nottingham University. Since
1997 he has worked in Insurance Medicine
with a particular and evolving interest inevidence-based risk assessment.

providers as partners in health.
This research study, sponsored by RGA and conducted by theUniversity of Leicester, a leading university in the U.K., has as its
objective making enhanced risk knowledge a risk assessment reality.
Using some of the best data available, from the UK Biobank, thisresearch will help quantify how everyday life factors such as physicalactivity, diet, and hours of sleep, can impact chronic health conditionssuch as cancer, diabetes, and cardiovascular disease, and refine
industry data on related mortality outcomes.

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The database used for this research is the UK Biobank,Wellness’ Unexplored Potential

a large prospective study that provides accredited

The incorporation of wellness, as an initiative and a

researchers direct access to a comprehensive databasegoal, into life and living benefits insurance first emergedof health metrics from half a million middle-aged

more than 20 years ago. Although it has been anparticipants. These data have been and are being used

accelerating trend ever since, our industry has yet toby researchers to conduct a variety of studies about

either realize the full potential of or understand the limits

topics related to health and longevity.1

of wellness initiatives.

Findings from this research, which are expected

Strategically implementing wellness programs andby 2023’s fourth quarter, are anticipated toinitiatives in our products requires a deep understanding

enhance underwriting considerations, pricing, andof the associations between lifestyle behaviors andrecommendations for insurer life and living benefits

health outcomes. New and more inclusive data sources,

wellness programs.

ongoing developments in technology, and advanced

This article provides a brief background to the concept

approaches to integrating biometric information intoof wellness as it is conceived of and utilized in the life
insurance industry, introduces and highlights RGA’s goals
for our collaborative UK Biobank database research,and demonstrates how the findings might be utilized

insurance products are all moving such initiatives beyond
mere engagement and marketing schemes. Insurers
now see them not only as tools for gathering additional
underwriting evidence but also, importantly, as tools thatto enhance underwriting philosophies and pricing

can improve customer health and wellbeing.

estimates. Lastly, it will showcase the wider industry

In 2021, RGA and RGAX surveyed more than 100 life andvalue from this project.

health insurers from around the world about current andReFlections September 2023

| 15future wellness-related products, initiatives, and strategies as well as challenges and potential
opportunities.2 The survey found that insurers see great potential for wellness initiatives tosupport their policyholders’ overall physical, mental, and financial health:y 85% of insurers globally indicated wellness is a top priority, particularly after the onset of
COVID-19.
y Wellness program implementations among insurers are increasing globally, with 57% of
respondents offering wellness-related products, digital tools and services, mental healthsupport, and/or financial planning tools.
y Top areas for growth in wellness-related products, strategies, and initiatives are in chronic
disease management, mental health, and financial welfare.
Data-driven evidence will be needed to help insurers achieve the full potential of theirwellness initiatives.

Why UK Biobank Data?
The UK Biobank is a large biomedical database containing both broad and in-depth information
about the health of its participants, which comprise more than half a million U.K. adults
between ages 37 and 73 at baseline (2006 to 2010). The database includes not only participant
routinely linked mortality and morbidity outcome data, but also comprehensive lifestyle andwellness metrics. Participants provided a broad range of biological, cognitive, demographic,health, lifestyle, mental, social, and wellbeing data, and continue to do so today (Figure 1).
Figure 1: Breadth and Depth of UK Biobank

Adapted from UK Biobank

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When compiling the database, several steps were taken to ensure ethnic, geographical, andsocioeconomic heterogeneity, as well as broad distribution across as many exposures aspossible. This was done to allow reliable detection of generalizable relationships between
demographic characteristics and health outcomes. Participant recruitment was via invitations
mailed to people in the targeted age cohort – those registered with the U.K.’s National HealthService (NHS) who lived within 25 miles of one of the 22 study assessment centers locatedthroughout England, Scotland, and Wales.
Although the UK Biobank is not necessarily representative of the general population, as it
has already been shown to have “healthy volunteer” selection bias – that is, participants, who
are self-selected from the overall database, are healthier than the general U.K. population.3
Still, it is sufficiently illustrative of standard insured lives, making studies of this population ofparticular interest and relevance to insurers.

Research Goals
Life and health underwriting philosophies typically contain criteria relating to several different
aspects of health, including biological, physical, mental, and lifestyle. As the UK Biobank is asizable data resource that permits research into many of these aspects of human health, thishas given RGA’s underwriters, with input from our chief medical officers, the opportunity toformulate a broad range of research questions they considered to be of highest importance for
the UK Biobank to be used to investigate.
Tackling these questions will help strengthen and expand RGA’s underwriting philosophies
and wellness strategies. A baseline normative wellness dataset, as well as other easily
measured attributes within the conventional standard risk pool, is a prerequisite for assessing
substandard risks. Table 1 shows some examples of how the deliverables from this study may
impact the different functions of RGA’s underwriting methodology.

Table 1: Translating Potential Findings
ExamplePotential action

Guidelines

In comparison to BMI, waist circumference
is observed to be a better predictor of inferior
health outcomes in overweight males

Revise the guidelines
accordingly

Rating tables

After controlling for traditional rating factors,
resting heart rate shows novel relationships
with the outcomes of interest in certain
subpopulations

Understand the evidence
and update the appropriate
rating tableCalculators

Simple, easy-to-collect metrics such as selfreported walking pace is observed to be astrong differentiator of mortality risk in older
adultsFittingly incorporate
walking pace into therelevant calculator

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| 17Wider Value
This collaborative research will enable insurers to focus on the utility of current and future
underwriting factors such as lifestyle (including physical activity) and easily measured variables
such as heart rate. The hope and expectations are that these items can complement more
traditional rating factors such as age and sex, and comorbidities such as high blood pressure,
to predict mortality and morbidity outcomes. There is even the potential for incorporating
lifestyle factors in underwriting in ways that can supplement traditional approaches to risk.
Data-driven research can help insurers identify and segment risk more effectively, calculate
the impact wellness factors can have on life and health experience, and potentially optimize
underwriting decisions. It will also enable us to justify, through trusted data, our approaches torisk assessment.

Summary
Can new evidence from the UK Biobank make an impact on insurance underwriting? Theanswer, we trust, will be yes. The goals of this research are:y Improve the underwriting philosophy and best-estimates for pricing
y Enhance wellness product developmenty Generate additional critical insights into health and wellness, further supporting the resultsof the recent RGA & RGAX Global Wellness Survey Reporty Publish peer-reviewed articles on this research in medical, actuarial, and insurance
journals for public interest and benefity Create a pool of knowledge that has sizable benefit to clinical researchers that could lead
to better interventions in primary care (e.g., support healthcare providers in encouraging
people to engage in healthier lifestyle choices) and significant public health implicationsy Make a positive impact on societyConclusion
As people are living longer, more will assuredly live with multiple diseases and conditions
that impair health, making a deeper understanding of how combinations of risk factors affectmortality and morbidity extremely valuable. With interest in wellness rising rapidly across theinsurance industry, the output from this project has the potential to create and provide criticalinsights to enhance underwriting and pricing for wellness products, as well as to informconsumers on ways to improve their health and longevity.

References1.

https://www.ukbiobank.ac.uk/

2.

https://www.rgare.com/knowledge-center/article/redefining-wellness-global-surveysheds-new-light-on-opportunities-for-insurers

3.

https://pubmed.ncbi.nlm.nih.gov/28641372/

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September 2023 ReFlections