Vol 46: Issue 3 | September 2023
Globally, stroke is considered to be the second-leading cause of death, and the third-leading cause of death and disability combined. Clearly, it is an important concern for insurers providing life insurance, income protection cover, and total and permanent disability (TPD) cover.
A stroke occurs when a vessel supplying blood to the brain either becomes blocked (ischaemic stroke) or ruptures and bleeds (haemorrhagic stroke). Both types of stroke cause the death of brain cells, and the outcome depends on the number and position of the cells affected.
“Diseases of the circulatory, respiratory or nervous system are in the top five causes of claim we see at MetLife,” says Lina Saliba, MetLife Australia’s chief customer and marketing officer.
At TAL, conditions of the circulatory system, including heart attack and stroke, accounted for 10 per cent of all claims paid in the 12 months to 31 March 2023. “This is consistent with the same period in 2022 and 2021,” says TAL general manager of Health Services, Dr Priya Chagan.
Advances and trends
While the annual number of strokes and associated deaths increased globally between 1990 and 2019, deaths in Australia declined by 30 per cent. New Zealand reported a similar trend, with stroke volumes predicted to grow by around 40 per cent in the next decade and mortality rates similarly on the decline.
This is largely due to advances in emergency treatments, including medication and catheterisation to either dissolve or retrieve blood clots responsible for ischaemic strokes.
However, as the Australian Stroke Foundation points out, this isn’t the end of the story. Those who survive may have to live with challenges such as limited movement and communication, difficulty with balance, ongoing fatigue, loss of concentration, depression and anxiety.
“Recovery time is influenced by the severity of the stroke and the risk factors of the individual,” says Saliba. “Given this complexity and that risk factors also relate to other health conditions, we don’t single out stroke for exclusion. Having said that, we do apply a health loading for risk factors such as smoking, where appropriate.”
There is also uncertainty around employment for stroke survivors.
“The amount of time a stroke victim would need to take off work can range from a few weeks to indefinitely, if there is severe and permanent damage to key areas of the brain,”
says Sally Phillips, head of Health Services, Zurich Australia and New Zealand. “We continue to cover stroke under income protection and, as with any claim, claimants who have had a stroke are treated with an individual and personalised focus.”
Around the world, there are 12.2 million new strokes per year. The highest rates are in the World Bank low-income group, where relatively few of those affected would have access to life-saving preventive or emergency treatment.
Incidence varies from country to country and also within countries. In Australia, for example, in 2018 there were more than twice as many strokes in the lowest socioeconomic areas than in the highest, and Aboriginal and Torres Strait Islander peoples had approximately double the incidence of ischaemic stroke compared with the total Australian population.
Similarly, a 2022 New Zealand study published in The Lancet identified significant ethnic inequality in stroke care access, with Māori and Pacific people reporting a much slower decline in stroke incidences and mortality rates than people of European backgrounds.
Asia has a higher average mortality rate than Europe, the United States and Australia, with 70 per cent of all strokes and 87 per cent of stroke-related deaths occurring in low- and lower-middle-income countries. The number of strokes and stroke-related deaths are lowest in Japan and Singapore, and highest in Indonesia and Mongolia.
Stroke is a complex health event with a wide range of risk factors. “These include hypertension [high blood pressure], coronary heart disease, obesity and smoking — and this is not an exhaustive list,” says Saliba.
Globally, high systolic blood pressure — the force the heart exerts on the walls of the arteries when it beats — is the largest single risk for stroke, while high body-mass index was the fastest-growing risk factor between 1990 and 2019.
The incidence of stroke also increases with age. People aged 85 and over experience more than twice as many strokes as those aged 75 to 84 and almost six times as many as those in the 65–74 age group.
However, while the overall incidence has been falling, the number of younger people having strokes has been rising. In 2020, 6,535 strokes (24 per cent) occurred in people aged under 55 years, up from 18 per cent in 2001.
This trend is particularly worrying because stroke is a major cause of long-term disability, which has a profound effect on quality of life as well as associated costs and productivity.
A team of researchers led by Deakin University’s Elise Tan and Lan Gao estimated that the economic burden of stroke among younger adults in Australia was A$2 billion over five years — an average of A$149,180 per stroke patient. Over 30 years, this rose to A$3.4 billion, with a mean of A$249,780 per case.
“There are some specific causative factors that may lead younger individuals to suffer a stroke, including increased neck pressure due to sports or exercise, or the impact of recreational drugs,” says Phillips. “However, the greatest cause of stroke in any age group is the delay in detection of lifestyle risk factors such as high blood pressure, increased alcohol consumption, diabetes and obesity.”
Encouraging proactive health
Governments, medical practitioners and many insurers are sharpening their focus on preventive health to help reduce the human and financial burden of diseases like stroke.
“Effective preventive health care not only ensures Australians have a healthier future, it also helps to support sustainable and affordable life insurance products,” says Chagan.
TAL Health Sense Plus combines education with lump sum discounts on policy premiums for customers who undergo screening for serious diseases. These tests are recommended by the Royal Australian College of General Practitioners on the basis of age, gender and any underlying risks.
“We don’t ask our customers to share their results; we just want them to take the tests and engage with their own health,” says Chagan. “Last year, more than 5,000 customers completed a Health Sense Plus preventive health test, saving them an estimated $600,000 in total first-year premiums.”
Zurich’s whole health offering, Zurich Evolve, also focuses on educating customers on the importance of regular health checks, while MetLife’s 360Health provides access to preventive services through to recovery and rehabilitation support.
“There are many conditions that can be prevented, or the severity reduced, with proactive health management, and early treatment has a significant positive impact on a customer’s return to health,” says Saliba.
“We believe we have a role to play in ensuring customers get support as quickly as possible. Our aim is to help our customers live healthier for longer.”
How can you tell if someone is having a stroke?
The F.A.S.T. acronym is an easy way to remember the most common signs of stroke
- FACE has the mouth drooped?
- ARMS can they lift them both?
- SPEECH is it slurred?
- TIME is critical — if you see any of these signs, call emergency services immediately
What to do while you’re waiting for an ambulance:
- Lie the person on their side, with their head slightly raised and supported.
- Don’t give them anything to eat or drink.
- Loosen any restrictive clothing.
- Support an obviously weak limb.
- If the person is unconscious and doesn’t have a pulse or is not breathing, start CPR right away. If you’re not sure how, the emergency services representative will give you instructions over the phone.
Source: The Stroke Foundation — Australia
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