By A. Marx (auth.)
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This is partly due to different dietary habits and inadequacy of medical care as well as the genetic influences and other factors still unknown. The incidence and severity of certain diseases may also be greatly increased in areas where malnutrition, but not necessarily undernutrition, may be rife. This latter statement refers mainly to infective conditions such as tuberculosis, which in underprivileged countries, carries a higher mortality than expected in a Western country. In such cases the usual extra mortality suggested for any specific impairment in rating manuals designed for highly developed European or North American countries would be completely unrealistic and the underwriter cannot work on the same assumptions.
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It is well known that in wine-growing areas such as France, Italy and the Western Cape Province of South Africa, there is an increased incidence of mortality from alcoholism and cirrhosis of the liver. An enlarged liver reported in an applicant for life assurance in such areas may have more significance than in areas where alcoholism is not so common. In Britain for instance, cirrhosis of the liver is not prevalent enough as a cause of death, to rank in the summary tables for causes of death. In the United States this condition appears as a serious "killer" .