Top athletes - Top risks?
"Faster, higher, stronger!" was the motto for the 10,000 or more athletes who took part in the Olympic Games in London. But what risks are posed by a life that is lived at the very limits of physical performance? There have been repeated media reports on the sudden cardiac deaths of top athletes – are these just tragic individual cases, or an indication of enhanced risk? Munich Re provides the answers.
At first sight, top athletes look like a lucrative target group for life insurers: they are young, fit, receive good medical care and are attractive risks from a financial standpoint. After all, many top athletes are also top earners with a substantial need for financial protection and they frequently take out large life insurance policies. But their employers also need security. Take the example of professional football: a club that invests considerable sums in buying new players needs to insure against the risk of their being unable to play for long periods on health grounds.
The flip side of the coin
There seems to be a particularly high number of unexpected deaths among athletes. In the USA alone, 1,866 active top athletes died suddenly between 1980 and 2006. The majority of these deaths were due to sudden cardiac death rather than accidents. There have already been several tragic cases in the 2012 sporting season. This raises a number of questions: are top athletes really such a favourable target group from a life insurance perspective? How should underwriters tackle the task of identifying athletes with a higher risk of cardiac death, and how can they assess the risk accurately in each case?
The answer to the first of these questions is a definite yes: "Sport is certainly good for you and has been shown to improve life expectancy", says Dr. Karsten Filzmaier, a medical consultant in the Center of Competence for Medical Underwriting & Claims Consulting at Munich Re. "And this is also true for top athletes – studies have shown that life expectancy for top athletes is several years longer than that of the general population." But Dr. Filzmaier has a word of warning: "A difference only becomes apparent if you look at things more closely. Studies, for example, suggest that sudden cardiac death is, generally speaking, a rarity among top athletes, but it does occur more often than in the general population."
Athlete's heart – A challenge for risk assessment
The reason for the higher frequency of sudden cardiac death among top athletes sounds plausible, but is no less astonishing for that: nearly all the athletes concerned had an underlying heart condition which, in most cases, had not been detected. And three-quarters of these conditions were either congenital or of genetic origin. Dr. Filzmaier explains: "Unlike a healthy heart, a diseased heart can no longer compensate for the increased physical strain and after a certain point – in a worst case scenario – it suddenly stops beating." But why are these heart conditions not picked up earlier, given that many athletes are under constant medical supervision?
One reason is a condition known as athlete's heart – an adjustment reaction to constant physical stress, where the cardiac chambers enlarge and the heart muscle becomes thicker than normal. In many top athletes, this can even lead to changes in their ECG readings. And that is precisely the problem, says Dr. Filzmaier: "Many heart diseases produce similar abnormalities in the ECG and changes in the structure of the heart itself. So there is a particular risk with top athletes that pathological changes can be misinterpreted as a healthy athlete's heart." There is also the problem that the changes in the heart resulting from training can vary significantly, depending on the type of sport, the gender and ethnic background of the athlete in question.
Competitive advantage through knowledge
In most cases, however, the assessment can be made relatively straightforward by using MIRA, the Munich Re underwriting manual. The assessment guidelines the manual contains allow top athletes to be assessed quickly and reliably, with just a small number of prognostic criteria. A quick look at the statistics show how important this is – from a financial perspective as well a human one: no more than 0.5% of athletes have heart disease. But the risk of sudden cardiac death is up to 100 times greater in this group!
"For the underwriter, it's like trying to find the proverbial needle in a haystack", says Dr. Filzmaier. "We have therefore developed a strategy for the risk assessment that can meet this challenge at a reasonable cost and with relatively little effort." This is possible thanks to an algorithm derived from the field of sports medicine. "We based the development on the latest medical findings, while also taking efficiency aspects into account", Dr. Filzmaier explains. The result: Well over 90% of top athletes can be accepted as a standard risk for life insurance, based on the information available, without any additional examination being required. In individual cases, if the examination results for a competitive athlete show signification deviations from the norm, expert medical advice is needed for the insurance-medicine assessment. Munich Re can provide its clients with such expertise – for example at the Center of Competence for Medical Underwriting & Claims Consulting.