Risk Adviser
No Smoking, Please

• Julianne Callaway
• January 2019
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It's no newsflash that spending too much time sitting in front of a computer or on a couch isn't good for you. Physical inactivity is pervasive in modern culture and continues to drive worrying levels of non-communicable diseases such as diabetes and heart disease. The connection between a sedentary lifestyle and unfavorable mortality and morbidity outcomes is clear, proven, and indisputable.

Recently, a flurry of attention-grabbing headlines in mainstream media announcing “Sitting is the New Smoking” have taken this connection a step further, boldly claiming that inactivity impacts mortality even more than smoking.

As you might expect, refutations of this claim have generated headlines of their own, as well as responses in peer-reviewed research journals.

The current push to accelerate underwriting decisions is driving innovation across all aspects of our business. New forms of data and new tools to analyze that data are providing a more complete view of insurance applicant risk. Against a backdrop of mounting non-traditional underwriting evidence, life insurers may be tempted to replace the slow, costly screenings required to detect smoking status with new data-driven variables—particularly those reflecting physical activity that are seemingly as predictive of mortality.

It's time to set the record straight from a life insurance perspective: While a sedentary lifestyle is clearly linked to higher mortality risks, smoking remains far more deadly. We must not lose sight of this truth. Physical activity has a significant impact on longevity, but no amount of exercise can negate the profoundly elevated mortality risk associated with smoking.

We must also remind ourselves that smoking is not yesterday's problem. Despite decades of warnings from health authorities, approximately 15.5% of U.S. residents age 18 and above are current smokers as defined by the U.S. Centers for Disease Control and Prevention (CDC). Cigarette use remains the leading cause of preventable disease and death in the United States, killing nearly half a million Americans annually, according to the CDC.

Data analysis from a recent RGA white paper, “Lifestyle-Related Behaviors and Mortality: A Comparison of Physical Inactivity and Smoking,” clearly shows that all-cause mortality experience for current smokers is 2.3 times higher than individuals who have never smoked when controlling for other key health variables, and the more you smoke, the higher the mortality risk. Analysis derived from a multivariate model that adjusts for age, sex, smoking, disease history, health status, and income using data from the National Health Interview Survey (NHIS). Ultimately, the data analysis finds that smokers' mortality expectation is worse than non-smokers, regardless of activity level.

It is an exciting time for our industry. However, life insurers would do well to critically consider counterintuitive and sometimes conflicting reports and ground risk assessment in statistically significant, reproducible analysis. Accelerated underwriting should not require absorbing excessive risk. Let's move forward together responsibly.