Study Reveals Battle Over Tests Used to Determine Mortality Risk.

For life insurance applicants under 49 years old, the testing of urine samples is a better indicator of life expectancy than blood samples, according to a recent study.

The study, by actuary Richard Bergstrom of Milliman & Robertson and Ernie Testa of Atset Consulting Group, was sponsored by Calypte Biomedical Corp., Alameda, Calif., the manufacturer of the only urine HIV antibody tests cleared by the U.S. Food and Drug Administration.

But not everyone in the life industry agrees. Lincoln Re, a subsidiary of the Lincoln National Corp., maintains that blood tests are still the most effective way of evaluating mortality risk. Urine tests rank second and saliva tests third, said Jay Biehl, second vice president and chief actuary.

After looking at lab results of about 3.5 million insurance applicants, the study found that the ability to identify increased mortality risk in young applicants with urine markers, such as glucose and protein, exceeded the ability to identify mortality risk with blood markers, such as cholesterol, high-density lipoprotein and the liver enzyme GGT.

Insurers that require lab testing look for evidence of cocaine and tobacco use as well as antibodies to the human immunodeficiency virus, often through both blood and urine samples. The report looked at the relative value of some of the urine and blood tests that can be performed in addition to those three.

"The biochemical markers in blood that are suggestive of poor eating alcohol and exercise habits may not manifest themselves until later in life. Conversely, some of the tests that are readily available in urine for such conditions as diabetes or kidney damage may be less age-dependent," Testa said.

Blood testing on younger applicants may yield only marginal benefits to insurers in terms of mortality savings, said Kip Whitefield, national sales manager for Calypte. Blood collection is costly to insurers and inconvenient and potentially painful for applicants.

Biehl said he was "kind of surprised" that the authors of the study took the positions they did. Saliva and urine tests can identify the presence of HIV antibodies and use of cocaine or tobacco products, and urine tests also can detect diabetic risk by determining whether glucose is spilling over into a subject's urine. "But it's not very specific," he said. "It actually takes a high level of glucose before it spills into the urine." Blood provides a more accurate view of the risk of diabetes, vascular disease through cholesterol ratios, and liver function, which is particularly relevant to determining alcohol abuse and hepatitis, Biehl said. Alcohol abuse is an important underwriting factor for younger applicants, because motor-vehicle accidents are the leading cause of death in a population under 49 years old and those accidents are predominantly caused by alcohol abuse, he said.

Urine sampling is less expensive than blood testing, but only if an agent or broker--rather than a paramedic--takes the sample, Biehl said.

But few agents or brokers want to collect urine samples, and agent collection raises questions about the "chain of custody," Biehl said. The fluid is not drawn in anyone's presence, and even a legitimate sample could be switched by unscrupulous producers, who have an economic interest in the outcome of the test.