The Impact of Multifactorial Genetic Disorders on Critical Illness Insurance: A Simulation Study Based on UK Biobank

The UK Biobank project is a proposed large-scale investigation of the combined effects of genotype and environmental exposures on the risk of common diseases. It is intended to recruit 500,000 subjects aged 40-69, to obtain medical histories and blood samples at outset, and to follow them up for at least 10 years. This will have a major impact on our knowledge of multifactorial genetic disorders, rather than the rare but severe single-gene disorders that have been studied to date. What use may insurance companies make of this knowledge, particularly if genetic tests can identify persons at different risk? We describe here a simulation study of the UK Biobank project. We specify a simple hypothetical model of genetic and environmental influences on the risk of heart attack. A single simulation of UK Biobank consists of 500,000 life histories over 10 years; we suppose that case-control studies are carried out to estimate age-specific odds ratios, and that an actuary uses these odds ratios to parameterise a model of critical illness insurance. From a large number of such simulations we obtain sampling distributions of premium rates in different strata defined by genotype and environmental exposure. We conclude that the ability of such a study reliably to discriminate between different underwriting classes is limited, and depends on large numbers of cases being analysed.

Keywords: Case-control Study, Critical Illness Insurance, Gene-environment Interaction, Odds Ratio, Premium Rating, Simulation, UK Biobank