ReCent Medical News

Before the diagnosis: accumulated risk in midlife men

November 2026

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Midlife is often treated as a single stage, yet the health patterns that emerge during these years can differ substantially between women and men.

Our previous article examined health risk in midlife women. Here, we turn to men, for whom serious illness may first present as a heart attack, stroke, advanced cancer diagnosis or mental health crisis - even though the underlying risk factors have been developing for many years. Together, the two articles consider how accumulated risk shapes later health outcomes and the mortality, morbidity and claims risks faced by insurers.

Figure 1: How risk can accumulate before diagnosis

Why midlife matters

Midlife, used here broadly for ages 40–64, is a period in which established lifestyle and metabolic exposures increasingly translate into measurable disease. Men are living longer and healthier lives than previous generations, but important gaps remain. Premature male mortality is shaped not only by biology, but also by social, economic, cultural and gender-related influences on behaviour, healthcare use and health-system responses.[1]

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These influences are reflected in marked social inequalities. Globally, life expectancy remains closely linked to social and economic development, with substantial differences persisting across regions and countries despite overall improvements in longevity.[2] Accumulated health risk is also substantial. The Health Survey for England 2024 reported that 70% of men were overweight or living with obesity, compared with 62% of women. Across adults, 27% were inactive, 48% had raised cholesterol and 46% had at least one longstanding illness or condition.[3]

The consequence of this accumulated risk becomes clear in mortality data. In the EU, the majority of male deaths under age 65 are from non-communicable diseases and external causes, with cancer and circulatory disease among the leading contributors.[4] England and Wales data for 2024 show a comparable pattern, with intentional self-harm prominent at younger midlife ages.[5]

These are population patterns rather than individual predictions, but they underline why the years before diagnosis matter. For insurers, a limited reported medical history may therefore coexist with emerging risk that has not yet produced symptoms or led to investigation or treatment.

Four pathways of accumulated risk

Cardiometabolic risk

Cardiometabolic disease is often a silent driver of future claims. Myocardial infarction, stroke and heart failure may appear suddenly, but their risk usually develops over years. A 2025 analysis of more than two million people found that being free of five classic cardiovascular risk factors at age 50 - hypertension, hyperlipidaemia, abnormal weight (under or overweight), diabetes and smoking - was associated with more than a decade of additional life expectancy compared with having all five.[6] This illustrates the cumulative effect of multiple risk factors, even before clinical disease is diagnosed.

Screening programmes help to identify people in healthy populations who may be at an increased risk of developing health issues. This can improve engagement with health services and provide entry points into appropriate care pathways. The NHS Health Check illustrates an established prevention approach, using measures such as body size, blood pressure, cholesterol and, where appropriate, blood glucose to assess cardiovascular risk in eligible adults aged 40-74.[7] However, participation in screening or preventive care may itself vary, meaning that an apparently limited medical history does not necessarily indicate an absence of emerging risk.

10 + years

difference in life expectancy at age 50 between people free of five major cardiovascular risk factors and those with all five.[6]

Sleep disorders, especially obstructive sleep apnoea (OSA), are common in middle-aged men, with just over a third meeting the diagnostic criteria for OSA. However, it is often underdiagnosed, undertreated and frequently co-exists with other cardiovascular disease. This makes OSA relevant as a comorbidity marker in underwriting, although evidence that treatments such as continuous positive airway pressure (CPAP) improve cardiovascular outcomes is mixed. [8]

A 2026 observational study also reported higher cancer incidence and mortality among people with cardiovascular disease, with the greatest burden in men.[9] This does not demonstrate that cardiovascular disease causes cancer, but it reinforces the value of an integrated assessment where comorbidity may influence both mortality and living-benefit risk.

For insurers, a clear diagnosis history may be reassuring, but it does not always show the full risk trajectory. Underwriting should distinguish isolated, well-controlled findings from clustered or progressive risk. Assessment should consider treatment, control and healthcare engagement, alongside any evidence of complications or end-organ damage. Claims and experience analysis should also consider related conditions that may influence mortality, morbidity, recovery and recurrence.

Cancer

Globally, cancer incidence and mortality are moving in opposite directions. A systematic analysis of the 2021 Global Burden of Disease Study noted that cancer incidence more than doubled between 1990 and 2021, while the age-standardised mortality rate fell by 21.5%. Rising prostate cancer incidence was largely attributed to increased screening and the detection of low risk or early-stage disease. The same analysis identified increases in several less common cancers, including melanoma and liver, oral and kidney cancers, each with links to modifiable lifestyle risks such as ultraviolet radiation, alcohol, smoking or obesity.[10]

Delayed presentations are an important contributor to cancer outcomes. Men may downplay symptoms, defer screening or seek medical advice only once symptoms progress, increasing the likelihood of more advanced disease. Later-stage cancers often require more intensive treatment, with greater potential for long-term morbidity, impaired function and delayed return to work.

For insurers, the implications vary by benefit type. Improving survival may reduce some mortality risk, but higher diagnosis volumes can increase critical illness and living-benefit claims. Later-stage presentations may worsen outcomes and prolong treatment, follow-up and recovery. Cancer stage, treatment intensity, recurrence risk and functional impact are therefore more informative than diagnosis alone.

Mental health and alcohol

The prevalence of common mental health conditions among people aged 16–64 in England increased from 18% in 2007 to 23% in 2023/24.[11] Financial strain, job loss, relationship breakdown and bereavement can trigger or exacerbate mental health problems. For men, stigma around mental health, social isolation, lower treatment engagement and use of alcohol or other risk-taking behaviours as coping mechanisms may delay support and compound risk. The pathway is not exclusively psychiatric. Mental distress can affect physical health, treatment adherence, employment and recovery from other conditions.

The consequences can be severe even though suicide remains uncommon in absolute terms. More than 6,000 suicides were registered in England and Wales in 2024. The male suicide rate was approximately three times the female rate and was highest among men aged 50–54.[12] Similar patterns can be seen in Canada and Australia, with highest rates in midlife males. [13][14]

Alcohol also links mental health with physical disease, with alcohol exposure and metabolic dysfunction contributing to liver disorders that may remain unrecognised until fibrosis, cirrhosis or liver cancer appears.[15]

For insurers, this pathway can affect mortality through suicide and alcohol-related disease, critical illness through serious physical complications, and other living-benefits through relapse, impaired function, inconsistent treatment use, work absence and prolonged recovery. Underwriting and claims pathways should therefore support accurate, non-stigmatising disclosure and early, sensitive engagement where mental illness, substance use, debt, employment strain and physical comorbidity overlap.

Multimorbidity and functional outcomes

Multimorbidity, commonly defined as two or more long-term conditions, is central to midlife risk. A global systematic review and meta-analysis estimated adult prevalence at 37%, with an increase over the previous two decades.[16] A UK Biobank analysis of adults aged 40-69 found that 19% had at least two chronic conditions. Diabetes, hypertension, asthma, anxiety and depression appeared within common clusters.[17]

Insurers have developed guidelines and tools that are good at making recommendations for related conditions within a single body system. The challenge comes with those that cut across systems. Hypertension with obesity is not equivalent to hypertension with diabetes, depression or harmful alcohol use. Cancer with cardiovascular disease may complicate treatment and recovery, while chronic pain, depression and metabolic disease together may be more relevant to work absence than any single diagnosis. Multimorbidity can therefore drive mortality, morbidity and disability duration. Underwriting, claims assessment and experience studies should examine condition clusters and their interactions, not only the primary diagnosis or recorded cause of claim.

What does this mean for insurers?

Most evidence cited here comes from population studies and is observational. These findings are useful for portfolio thinking and product design but should not be treated as proof of causation or as direct predictors for individual applicants or claimants. This distinction is particularly important when applying evidence to underwriting and claims.

Underwriting

The practical shift is from diagnosis-first to trajectory-aware assessment, but this should not be interpreted as automatic rating action. Established clinical information – metabolic health, lifestyle, mental health history, family history, healthcare engagement, treatment and evidence of stability – remains the foundation. Any further underwriting action should recognise that age-related mortality and morbidity are already reflected to some extent in pricing assumptions. The issue is whether there is hidden risk beyond that already allowed for by age, product design and existing rating structures. Where substandard terms are considered, particularly for emerging or clustered risk factors, they should be supported by reliable evidence and clear underwriting rationale. Additionally, new data sources may have future value, but near-term underwriting benefits are more likely to come from transparent questions and consistent application of validated risk factors.

Claims

Claims pathways differ by condition and benefit. For living-benefits, cancer and cardiovascular claims may require support through treatment, rehabilitation, recurrence prevention and psychological recovery rather than a single interaction at payment. Mental health claims call for early, non-stigmatising and crisis-aware pathways, with attention to associated physical illness, alcohol or substance use and employment strain. The aim is not to assume that support changes insured outcomes, but to recognise the complexity and duration of recovery.

Experience analysis

Improving mortality does not necessarily mean reducing morbidity. Rising diagnosis volumes, persistent cardiometabolic risk, mental health burden and multimorbidity can affect claim incidence, severity, duration and recurrence in different ways. Experience monitoring should therefore distinguish deaths from living-benefit claims and examine product, diagnosis, stage or severity, comorbidity, recovery duration and repeat claims if the data is available.

Product development

Prevention services may strengthen the value proposition through earlier engagement but claims of improved health or insurance outcomes require evidence. Emerging tools should therefore be considered through evidence-led pilots with clear clinical pathways and evaluation of benefits, harms, customer acceptance and cost-effectiveness.

For insurers, the key is to understand health risk as dynamic rather than static. This calls for an evidence-led approach that considers how risks evolve, interact and affect different parts of the insurance lifecycle.

Conclusions

Insurers should understand that risk in midlife men rarely reflects one factor. It is more often the result of accumulating and interacting pressures from multiple pathways before diagnosis. The challenge for insurers is to assess clustered risk consistently across products, monitor morbidity as well as mortality, and focus on earlier action only where evidence and customer value are clear.

Look beyond diagnosis to the pathway that precedes it.

Author

Stuart Crichton

FALU, FLMI | Head of Underwriting & Claims

Hannover Re (Ireland) DAC

References

World Health Organization Regional Office for Europe: The health and well-being of men in the WHO European Region: better health through a gender approach, Copenhagen: WHO Regional Office for Europe; 2018. Available from: https://www.who.int/europe/publications/i/item/9789289053532, (viewed on 10 August 2026).
Taherian, R., Karimi Ghahfarokhi, M., and Zayeri, F. A study of trends and projection of life expectancy and its association with socio-demographic index: Results from GBD study 2023. 3 June 2026.
NHS England. Health Survey for England, 2024. 27 January 2026. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2024, (viewed on 25 July 2026).
Eurostat. Causes of death statistics by age group. March 2026. Available from: https://ec.europa.eu/eurostat/statistics-explained/SEPDF/cache/13480.pdf, (viewed on 10 August 2026).
Office for National Statistics. Deaths registered in England and Wales: 2024. 9 October 2025. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregistrationsummarytables/2024, (viewed on 25 July 2026).
Global Cardiovascular Risk Consortium, Magnussen C, Alegre-Diaz J, et al. Global Effect of Cardiovascular Risk Factors on Lifetime Estimates. N Engl J Med. 2025;393(2):125-138. doi:10.1056/NEJMoa2415879.
NHS. NHS Health Check. Available from: https://www.nhs.uk/tests-and-treatments/nhs-health-check/, (viewed on 10 August 2026).
Yeghiazarians, Y., Jneid, H., Tietjens, J.R., et al. Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association. 21 June 2021.
Thuemmler, R.J., Pana, T.A., Mamas, M.A., and Myint, P.K. Sex differences in cancer incidence and mortality in patients with cardiovascular disease: the European Prospective Investigation into Cancer-Norfolk study. 5 August 2026.
Zhu, L., Zhu, J., Wang, Q., et al. Global, regional, and national burden of 34 cancer groups across 204 countries and territories, 1990–2021, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. 21 October 2025.
Morris, S., Hill, S., Brugha, T., et al. Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4. 27 November 2025. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/survey-of-mental-health-and-wellbeing-england-2023-24, (viewed on 25 July 2026).
Office for National Statistics. Suicides in England and Wales: 1981 to 2024. 3 October 2025. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/suicidesintheunitedkingdom/2024registrations, (viewed on 26 August 2026).
Public Health Agency of Canada. Suicide Surveillance Indicator Framework: Suicide, self-harm, and suicide-related behaviours in Canada: Data tool. 29 April 2026. Available from: https://health-infobase.canada.ca/ssif/, (viewed on 26 August 2026).
Australian Bureau of Statistics. Causes of Death, Australia, 2023. 10 October 2024. Available from: https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/2023, (viewed on 26 August 2026).
Åberg, F., Jiang, Z.G., Cortez-Pinto, H., and Männistö, V. Alcohol-associated liver disease—Global epidemiology. 19 April 2024.
Chowdhury, S.R., Das, D.C., Sunna, T.C., Beyene, J., and Hossain, A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. 16 February 2023.
Zemedikun, D.T., Gray, L.J., Khunti, K., Davies, M.J., and Dhalwani, N.N. Patterns of Multimorbidity in Middle-Aged and Older Adults: An Analysis of the UK Biobank Data. 22 May 2018.