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Background Mortality rates have been reduced by half over the last 60 years for nonagenarians, and the progress is continuing. The greater survival might be due to overtreatment of severely physically and cognitively disabled individuals, which is a big concern for societies and individuals. Methods The study population comprised two Danish birth cohorts: the 1905 Cohort and the 1915 Cohort. At age 95, all from the two cohorts who were still alive and living in Denmark were invited to participate in a health survey that used the same assessment instrument. A total of 2,670 (56.8%) persons participated in the two surveys and survival was assessed through a 7.3-year follow-up period during which 2,497 (93.5%) had died, and with virtually no loss to follow-up. Results Despite the increasing chance of surviving to age 95, the 1915 Cohort had significantly better health and functioning than the 1905 Cohort. The survival advantage in the 1915 Cohort continued in the follow-up period after age 95: Median survival length was 2.4 months longer, p = .011. This advantage was not statistically associated with different levels of activities of daily living, physical performance, cognitive functioning, self-rated health and life satisfaction. However, the advantage tended to be more pronounced among people with better health. Conclusions Life span and health increases among the oldest old. The improvement in survival for 95-year olds born in 1915 compared with 1905 was seen across the whole spectrum of health and functioning, with a tendency towards bigger improvement among those in good health.

Aims: During the first wave of the COVID-19 pandemic, Sweden registered a high level of excess deaths. Non-pharmaceutical interventions adopted by Sweden have been milder compared to those implemented in Denmark. Moreover, Sweden might have started the pandemic with a large proportion of vulnerable elderly with a high mortality risk. This study aimed to clarify whether excess mortality in Sweden can be explained by a large stock of ‘dry tinder’ instead of being attributed to faulty lockdown policies. Methods: We analysed weekly death counts in Sweden and Denmark from July 2007 to June 2020. We used a novel method for short-term mortality forecasting to estimate expected and excess deaths during the first COVID-19 wave in Sweden and Denmark. Results: In the first part of the epiyear 2019–2020, deaths were low in both Sweden and Denmark. In the absence of COVID-19, a relatively low level of death would be expected for the later part of the epiyear. The registered deaths were, however, way above the upper bound of the prediction interval in Sweden and within the range in Denmark. Conclusions: ‘Dry tinder’ can only account for a modest fraction of excess Swedish mortality. The risk of death during the first COVID-19 wave rose significantly for Swedish women aged >85 but only slightly for Danish women aged >85. The risk discrepancy seems more likely to result from differences between Sweden and Denmark in how care and housing for the elderly are organised, coupled with a less successful Swedish strategy of shielding the elderly.

Significance Female life expectancy exceeds male life expectancy. Males at ages 15 to 40 die at rates that are often three times female levels, but this excess mortality is not the main cause of the life expectancy gap. Few deaths occur at younger adult ages compared with mortality after age 60 or, historically, among newborns. Our demographic analysis shows that, up through the early decades of the 20th century, the life expectancy gap largely resulted from excess deaths of infant boys. Afterward, higher mortality among men 60+ became crucial. The higher mortality of males at ages 15 to 40 has played a modest role., Why do women live longer than men? Here, we mine rich lodes of demographic data to reveal that lower female mortality at particular ages is decisive—and that the important ages changed around 1950. Earlier, excess mortality among baby boys was crucial; afterward, the gap largely resulted from elevated mortality among men 60+. Young males bear modest responsibility for the sex gap in life expectancy: Depending on the country and time, their mortality accounts for less than a quarter and often less than a 10th of the gap. Understanding the impact on life expectancy of differences between male and female risks of death by age, over time, and across populations yields insights for research on how the lives of men and women differ.

Although Denmark and Sweden have close cultural and historical ties, lifespans for Danes have generally been lower than those of Swedes. Recent improvements in Danish mortality after a period of stagnation have led to the suspicion that there may be positive trends at the very high ages at death within that population and that these trends could be quite different from those observed in Sweden. Although the mean ages at death for Danish and Swedish centenarians have been relatively constant at about 102 years for the cohorts born 1870–1904, the oldest-old in Denmark have been getting older, but no evidence has suggested any increase in lifespan for Swedes. Using quantile regression, we show that Danish centenarian lifespans in the 90th percentile have been lengthening, with those in 94th percentile (6 % longest-lived individuals) having a trend that is statistically significant at the 5 % level. We demonstrate that the increase observed is not due to the increasing sizes of birth cohorts and thus must be due to improving survival among this select top tier. We postulate that this super-select group in Denmark is best able to take advantage of the factors driving mortality reduction, whereas the majority of centenarians are not. Electronic supplementary material The online version of this article (10.1007/s13524-018-0755-7) contains supplementary material, which is available to authorized users.

Background: The male-female life expectancy gap is increasingly driven by mortality differences at older ages. However, the dynamics of the onset of the old age contribution to the sex gap in survival have not been analyzed yet. Objective: We investigate how much of the gender gap in life expectancy is attributable to older ages and when the old-age contribution to the gap started to increase in different countries. Methods: Using data from the Human Mortality Database, we computed age-specific contributions to the sex gap, investigated their rate of increase over time, and identified breakpoints. Results: We found a heterogenous picture in Eastern Europe, while in the other countries the contributions of those aged 65-80 are declining, while the contributions of those aged 80+ are increasing. The pace of increase accelerated after 1950. At the end of the observation some countries show signs of stagnation, but this is not related to the level of life expectancy. Conclusions: The timing and pace of the increasingly old-age-driven sex difference in life expectancy differ among countries. The complexity of the patterns that emerged calls for country-specific, in-depth investigation. Contribution: We analyzed trends, temporal breakpoints, and differences among countries of the increasing contribution of older ages to the sex gap in life expectancy. This provides additional information about health transitions and offers new evidence for the development of policies targeting specific age groups and aimed at reducing the sex gap in survival.

Background: Mortality trends for subpopulations, e.g., countries in a region or provinces in a country, tend to change similarly over time. However, when forecasting subpopulations independently, the forecast mortality trends often diverge. These divergent trends emerge from an inability of different forecast models to offer population-specific forecasts that are consistent with one another. Nondivergent forecasts between similar populations are often referred to as "coherent." Methods: We propose a new forecasting method that addresses the coherence problem for subpopulations, based on Compositional Data Analysis (CoDa) of the life table distribution of deaths. We adapt existing coherent and noncoherent forecasting models to CoDa and compare their results. Results: We apply our coherent method to the female mortality of 15 Western European countries and show that our proposed strategy would have improved the forecast accuracy for many of the selected countries. The results also show that the CoDa adaptation of commonly used models allows the rates of mortality improvements (RMIs) to change over time. Contribution: This study opens a discussion about the use of age-specific mortality indicators other than death rates to forecast mortality. The results show that the use of life table deaths and CoDa leads to less biased forecasts than more commonly used forecasting models based on the extrapolation of death rates. To the authors' knowledge, the present study is the first attempt to forecast coherently the distribution of deaths of many populations.

After a brief introduction to the background, significance and unique features of the centenarian population in China, we describe the Chinese Longitudinal Healthy Longevity Study (CLHLS), which is the world's largest study of centenarians, nonagenarians, octogenarians, and compatible young-old aged 65-79. Based on the CLHLS data and other relevant studies, we summarize demographic and socioeconomic characteristics as well as self-reported and objectively-tested health indicators of centenarians in China, with an emphasis on gender differences and rural/urban disparities. We then compare five-year-age-specific trajectories of physical and cognitive functions, self-reported health, and life satisfactions from ages 65-69 to 100+, concluding that good psychological resilience and optimism are keys to the exceptional longevity enjoyed by centenarians. We discuss recent findings of novel loci and pathways that are significantly associated with longevity based on the genome-wide association study (GWAS) of the CLHLS centenarian sample, which is 2.7 times as large as prior GWAS of longevity. We also highlight colleagues' and our own studies on longevity candidate genes and gene-environment interaction analyses. Finally, we discuss limitations inherent in our studies of centenarians in China and further research perspectives. After a brief introduction to the background, significance and unique features of the centenarian population in China, we describe the Chinese Longitudinal Healthy Longevity Study (CLHLS), which is the world's largest study of centenarians, nonagenarians, octogenarians, and compatible young-old aged 65-79. Based on the CLHLS data and other relevant studies, we summarize demographic and socioeconomic characteristics as well as self-reported and objectively-tested health indicators of centenarians in China, with an emphasis on gender differences and rural/urban disparities. We then compare five-year-age-specific trajectories of physical and cognitive functions, self-reported health, and life satisfactions from ages 65-69 to 100+, concluding that good psychological resilience and optimism are keys to the exceptional longevity enjoyed by centenarians. We discuss recent findings of novel loci and pathways that are significantly associated with longevity based on the genome-wide association study (GWAS) of the CLHLS centenarian sample, which is 2.7 times as large as prior GWAS of longevity. We also highlight colleagues' and our own studies on longevity candidate genes and gene-environment interaction analyses. Finally, we discuss limitations inherent in our studies of centenarians in China and further research perspectives.

Background: The "male-female health-survival paradox" that women live significantly longer, but have lower physical performance and more adverse health outcomes at older ages than men, is a phenomenon observed everywhere in the world. This study aims to provide an understanding of the "male-female health-survival paradox", through investigating whether genetic associations with longevity are stronger in males or females. Methods: We conducted logistic regression and bio-demographic analyses, using the genome-wide association study (GWAS) datasets including 2,178 centenarians and 2,299 middle-aged controls of Chinese Longitudinal Healthy Longevity Study. Findings: We found that averages of probabilities of longevity, associated with each of the six mutually exclusive groups of 11 male-specific and 11 female-specific top loci (P

If life expectancy – also known as the expectation of life, is the mean life-span of a cohort of newborns if current age-specific death rates remain unchanged – in developed countries were close to an ultimate limit, then increases in record life expectancy – the average length of life in the best-practice population – should slow as the ceiling is asymptotically approached.

Background Adult mortality has been postponed over time to increasingly high ages. However, evidence on past and current health trends has been mixed, and little is known about European disability trends. Methods In a cross-sectional setting, we compared cognitive and physical functioning in same-aged Europeans aged 50+ between 2004–05 (wave 1; n = 18 757) and 2013 (wave 5 refresher respondents; n = 16 696), sourced from the Survey of Health, Ageing and Retirement in Europe (SHARE). Results People in 2013 had better cognitive function compared with same-aged persons in 2004–05, with an average difference of approximately one-third standard deviation. The same level of cognitive function in 2004–05 at age 50 was found in 2013 for people who were 8 years older. There was an improvement in cognitive function in all European regions. Mean grip strength showed an improvement in Northern Europe of 1.00 kg [95% confidence interval (CI) 0.65; 1.35] and in Southern Europe of 1.68 kg (95% CI 1.14; 2.22), whereas a decrease was found in Central Europe (-0.80 kg; 95% CI −1.16; −0.44). We found no overall differences in activities of daily living (ADL), but small improvements in instrumental activities of daily living (IADL) in Northern and Southern Europe, with an improvement in both ADL and IADL from age 70 in Northern Europe. Conclusions Our results indicate that later-born Europeans have substantially better cognitive functioning than earlier-born cohorts. For physical functioning, improvements were less clear, but for Northern Europe there was an improvement in ADL and IADL in the oldest age groups.

Significance Women live longer than men in nearly all populations today. Some research focuses on the biological origins of the female advantage; other research stresses the significance of social factors. We studied male–female survival differences in populations of slaves and populations exposed to severe famines and epidemics. We find that even when mortality was very high, women lived longer on average than men. Most of the female advantage was due to differences in mortality among infants: baby girls were able to survive harsh conditions better than baby boys. These results support the view that the female survival advantage is modulated by a complex interaction of biological environmental and social factors., Women in almost all modern populations live longer than men. Research to date provides evidence for both biological and social factors influencing this gender gap. Conditions when both men and women experience extremely high levels of mortality risk are unexplored sources of information. We investigate the survival of both sexes in seven populations under extreme conditions from famines, epidemics, and slavery. Women survived better than men: In all populations, they had lower mortality across almost all ages, and, with the exception of one slave population, they lived longer on average than men. Gender differences in infant mortality contributed the most to the gender gap in life expectancy, indicating that newborn girls were able to survive extreme mortality hazards better than newborn boys. Our results confirm the ubiquity of a female survival advantage even when mortality is extraordinarily high. The hypothesis that the survival advantage of women has fundamental biological underpinnings is supported by the fact that under very harsh conditions females survive better than males even at infant ages when behavioral and social differences may be minimal or favor males. Our findings also indicate that the female advantage differs across environments and is modulated by social factors.

Importance: Sex differences in genetic associations with human longevity remain largely unknown; investigations on this topic are important for individualized health care. Objective: To explore sex differences in genetic associations with longevity. Design, Setting, and Participants: This population-based case-control study used sex-specific genome-wide association study and polygenic risk score (PRS) analyses to examine sex differences in genetic associations with longevity. Five hundred sixty-four male and 1614 female participants older than 100 years were compared with a control group of 773 male and 1526 female individuals aged 40 to 64 years. All were Chinese Longitudinal Healthy Longevity Study participants with Han ethnicity who were recruited in 1998 and 2008 to 2014. Main Outcomes and Measures: Sex-specific loci and pathways associated with longevity and PRS measures of joint effects of sex-specific loci. Results: Eleven male-specific and 11 female-specific longevity loci (P < 10 -5) and 35 male-specific and 25 female-specific longevity loci (10 -5≤ P < 10 -4) were identified. Each of these loci's associations with longevity were replicated in north and south regions of China in one sex but were not significant in the other sex (P =.13-.97), and loci-sex interaction effects were significant (P -5) and US women (P = 4.6 × 10 -5) but not significant in Chinese and US men. The associations of the loci rs2622624 of the ABCG2 gene were replicated in Chinese women (P = 6.8 × 10 -5) and European women (P =.003) but not significant in both Chinese and European men. Eleven male-specific pathways (inflammation and immunity genes) and 34 female-specific pathways (tryptophan metabolism and PGC-1α induced) were significantly associated with longevity (P -5) and 35 male-specific and 25 female-specific loci (10 -5≤P < 10 -4) were jointly replicated across north and south discovery and target samples. Analyses using the combined data set of north and south showed that these 4 groups of sex-specific loci were jointly and significantly associated with longevity in one sex (P = 2.9 × 10 -70to 1.3 × 10 -39) but not jointly significant in the other sex (P =.11 to.70), while interaction effects between PRS and sex were significant (P = 4.8 × 10 -50to 1.2 × 10 -16). Conclusion and Relevance: The sex differences in genetic associations with longevity are remarkable, but have been overlooked by previously published genome-wide association studies on longevity. This study contributes to filling this research gap and provides a scientific basis for further investigating effects of sex-specific genetic variants and their interactions with environment on healthy aging, which may substantially contribute to more effective and targeted individualized health care for male and female elderly individuals.

Many causes of death have a clear seasonal pattern. Circulatory and respiratory diseases, which comprise about half of all deaths, have a peak in winter and lowest mortality during summer. Data by cause of death, age, and calendar time (month and year) provided by the National Center for Health Statistics allow an analysis how seasonality has changed over age and time. Using a two-dimensional decomposition and smoothing approach, we show how the amplitude and the phase of selected causes of death have developed since the late 1950s.

Introduction: Why do we visualize data and what is this book about? The introductory chapter describes the three rationales to visualize data: exploration, confirmation and presentation, and discusses the developments in computer hardware, software and connectivity that were instrumental for the recent increased interest in visualizing data.

This chapter shows that ROMI plots, as presented in the previous chapter, can not only be employed for mortality from all-causes but also for cause-specific mortality. They allow us to demonstrate that the slow increase in life expectancy among women in the United States during the 1980s and 1990s can not be attributed to heart diseases or stroke. Instead, mortality from respiratory diseases and from lung cancer, the latter featuring a pronounced cohort effect, suppressed faster gains in life expectancy.

While previous chapters focused only on the event of death, this chapter investigates the dynamics over age and time for the duration between being diagnosed with a specific cancer and death. We use five year survival as our indicator of survival in general, disease-specific survival and relative survival for selected cancer sites such as breast cancer, colorectal cancer, lung cancer or pancreatic cancer. The major impact of the stage of the tumor at the time of diagnosis for survival is illustrated using stage 1 and stage 4 of colorectal cancer as an example.

OBJECTIVEThis article provides an overview of the AKeA2 study, with a particular focus on data collection concerning family genealogies of the Sardinian centenarians and controls, and on the quality of these data. A first analysis of the main characteristics of the survey data is also summarized and selected preliminary results are presented.METHODSWe use descriptive statistics to analyze data collected by the AKeA2 survey on Sardinian centenarians and controls.RESULTSCentenarian women have on average fewer children, and at an older age, particularly for their last child. The mothers of centenarians, especially centenarian women, lived longer on average than those of deceased controls and controls born between 1905 and 1910 but still living at the moment of the survey.1. IntroductionIn Sardinia, male death rates after age 80 are only modestly higher than female death rates, and are lower than female levels in some municipalities. The remarkably low mortality after age 80 has thus yielded a surprisingly large number of centenarian men compared with centenarian women (Robine and Caselli 2005). An area with a large number of centenarians has been identified in the Sardinian province of Nuoro (Deiana et al. 1999; Poulain et al. 2004), as well as a longevity area for men. This latter area comprises municipalities in Oristano as well as Nuoro where the standardized death rate across old ages for men is less than 10% higher than for women, whereas elsewhere in the two provinces the standardized male death rate is more than 30% higher (Caselli and Lipsi 2006). The higher number of centenarians and their more balanced sex ratio have led to considerable interest among demographers, geneticists, gerontologists, and clinicians specializing in genetic mapping (DNA) (Caselli, Robine, and Rasulo 2003).The bio-medical characteristics of Sardinian centenarians was investigated by Luca Deiana and Giovannella Baggio (Deiana et al. 1999) in the AKeA study, an acronym derived from an expression in the Sardinian dialect that means "may you live to 100." A second, larger and cross-disciplinary study, called AKeA2, was launched in 2003, which involved demographers, historians, biologists, geneticists, and gerontologists. The demographic survey was directed by James Vaupel.This article gives a short description of the AKeA2 demographic survey and of the data collection, and provides a preliminary analysis of the data.2. Overview of the AKeA2 study: Sample selection and data collection planThe data collection was time-consuming. Over a six-year period various types of information were gathered: individual demographic characteristics, data on survival rates, and archival data regarding family characteristics and early-life events.The AKeA2 demographic survey was planned to involve Sardinian centenarians (100 men and 100 women) and their controls, by differentiating between living and deceased controls. All the controls were of the same sex as the centenarian, born and still resident in the same place of birth, and their day and month of birth were as close as possible to that of the centenarian. Picking the person with the most similar day and month of birth is a convenient method of selecting a matched individual, and this strategy controls for season-of-birth effects, which are known to affect longevity (Doblhammer 1999; Doblhammer and Vaupel 2001; Gavrilov and Gavrilova 1999).As concerns the living controls, the plan was to identify three younger controls for each centenarian by finding people born around 1907, 1912, and 1922. We also identified, for each centenarian, two deceased controls that were born, as mentioned before, the same year (and around the same day and month) and in the same municipality as the centenarian and to find one who died in his or her late 60s and one who died in his or her late 70s.In choosing both controls it was required that the family names of their mothers and fathers had to be different from the family names of the centenarian's parents. …

Objectives The purpose of this study was to explore the pattern of mortality above the age of 100 years. In particular, we aimed to examine whether Scandinavian data support the theory that mortality reaches a plateau at particularly old ages. Whether the maximum length of life increases with time was also investigated. Methods The analyses were based on individual level data on all Swedish and Danish centenarians born from 1870 to 1901; in total 3006 men and 10 963 women were included. Birth cohort-specific probabilities of dying were calculated. Exact ages were used for calculations of maximum length of life. Whether maximum age changed over time was analysed taking into account increases in cohort size. Results The results confirm that there has not been any improvement in mortality among centenarians in the past 30 years and that the current rise in life expectancy is driven by reductions in mortality below the age of 100 years. The death risks seem to reach a plateau of around 50% at the age 103 years for men and 107 years for women. Despite the rising life expectancy, the maximum age does not appear to increase, in particular after accounting for the increasing number of individuals of advanced age. Conclusion Mortality among centenarians is not changing despite improvements at younger ages. An extension of the maximum life span and a sizeable extension of life expectancy both require reductions in mortality above the age of 100 years. This article is protected by copyright. All rights reserved.

BACKGROUND: The oldest-old (those aged ≥80 years) are the most rapidly growing age group globally, and are most in need of health care and assistance. We aimed to assess changes in mortality, disability in activities of daily living, and physical and cognitive functioning among oldest-old individuals between 1998 and 2008.METHODS: We used data from the Chinese Longitudinal Healthy Longevity Study. Three pairs of cohorts aged 80-89 years, 90-99 years, and 100-105 years (in total, 19 528 oldest-old participants) were examined; the two cohorts in each pair were born 10 years apart, with the same age at the time of the assessment in the 1998 and 2008 surveys. Four health outcomes were investigated: annual death rate, Activities of Daily Living (ADL), physical performance in three tests and cognitive function measured by Mini-Mental State Examination (MMSE). We used different tests and multivariate regression analyses to examine the cohort differences.FINDINGS: Controlling for various confounding factors, we noted that annual mortality among oldest-old individuals was substantially reduced between 0·2% and 1·3% in 1998-2008 compared with individuals of the same age born 10 years previously, and that disability according to activities of daily living had significantly reduced annually between 0·8% and 2·8%. However, cognitive impairment in the later cohorts increased annually between 0·7% and 2·2% and objective physical performance capacity (standing up from a chair, picking up a book from the floor, and turning around 360°) decreased anually between 0·4% and 3·8%. We also noted that female mortality was substantially lower than male mortality among the oldest-old, but that women's functional capacities in activities of daily living, cognition, and physical performance were worse than their male counterparts.INTERPRETATION: Advances in medications, lifestyle, and socioeconomics might compress activities of daily living disability, that is, benefits of success, but lifespan extension might expand disability of physical and cognitive functioning as more frail, elderly individuals survive with health problems, that is, costs of success.FUNDING: National Natural Science Foundation of China, National Institute on Aging/National Institutes of Health, United Nations Funds for Population Activities. BACKGROUND: The oldest-old (those aged ≥80 years) are the most rapidly growing age group globally, and are most in need of health care and assistance. We aimed to assess changes in mortality, disability in activities of daily living, and physical and cognitive functioning among oldest-old individuals between 1998 and 2008.METHODS: We used data from the Chinese Longitudinal Healthy Longevity Study. Three pairs of cohorts aged 80-89 years, 90-99 years, and 100-105 years (in total, 19 528 oldest-old participants) were examined; the two cohorts in each pair were born 10 years apart, with the same age at the time of the assessment in the 1998 and 2008 surveys. Four health outcomes were investigated: annual death rate, Activities of Daily Living (ADL), physical performance in three tests and cognitive function measured by Mini-Mental State Examination (MMSE). We used different tests and multivariate regression analyses to examine the cohort differences.FINDINGS: Controlling for various confounding factors, we noted that annual mortality among oldest-old individuals was substantially reduced between 0·2% and 1·3% in 1998-2008 compared with individuals of the same age born 10 years previously, and that disability according to activities of daily living had significantly reduced annually between 0·8% and 2·8%. However, cognitive impairment in the later cohorts increased annually between 0·7% and 2·2% and objective physical performance capacity (standing up from a chair, picking up a book from the floor, and turning around 360°) decreased anually between 0·4% and 3·8%. We also noted that female mortality was substantially lower than male mortality among the oldest-old, but that women's functional capacities in activities of daily living, cognition, and physical performance were worse than their male counterparts.INTERPRETATION: Advances in medications, lifestyle, and socioeconomics might compress activities of daily living disability, that is, benefits of success, but lifespan extension might expand disability of physical and cognitive functioning as more frail, elderly individuals survive with health problems, that is, costs of success.FUNDING: National Natural Science Foundation of China, National Institute on Aging/National Institutes of Health, United Nations Funds for Population Activities.

The general health status of a population changes over time, generally in a positive direction. Some generations experience more unfavourable conditions than others. The health of Danish women in the interwar generations is an example of such a phenomenon. The stagnation in their life expectancy between 1977 and 1995 is thought to be related to their smoking behaviour. So far, no study has measured the absolute effect of smoking on the mortality of the interwar generations of Danish women and thus the stagnation in Danish women's life expectancy. We applied a method to estimate age-specific smoking-attributable number of deaths to examine the effect of smoking on the trends in partial life expectancy of Danish women between age 50 and 85 from 1950 to 2012. We compared these trends to those for women in Sweden, where there was no similar stagnation in life expectancy. When smoking-attributable mortality was excluded, the gap in partial life expectancy at age 50 between Swedish and Danish women diminished substantially. The effect was most pronounced in the interwar generations. The major reason for the stagnation in Danish women's partial life expectancy at age 50 was found to be smoking-related mortality in the interwar generations.

Background A rapidly increasing proportion of people in high-income countries are surviving into their tenth decade. Concern is widespread that the basis for this development is the survival of frail and disabled elderly people into very old age. To investigate this issue, we compared the cognitive and physical functioning of two cohorts of Danish nonagenarians, born 10 years apart. Methods People in the first cohort were born in 1905 and assessed at age 93 years (n=2262); those in the second cohort were born in 1915 and assessed at age 95 years (n=1584). All cohort members were eligible irrespective of type of residence. Both cohorts were assessed by surveys that used the same design and assessment instrument, and had almost identical response rates (63%). Cognitive functioning was assessed by mini-mental state examination and a composite of five cognitive tests that are sensitive to age-related changes. Physical functioning was assessed by an activities of daily living score and by physical performance tests (grip strength, chair stand, and gait speed). Findings The chance of surviving from birth to age 93 years was 28% higher in the 1915 cohort than in the 1905 cohort (6·50% vs 5·06%), and the chance of reaching 95 years was 32% higher in 1915 cohort (3·93% vs 2·98%). The 1915 cohort scored significantly better on the mini-mental state examination than did the 1905 cohort (22·8 [SD 5·6] vs 21·4 [6·0]; p

The chance of surviving to the age of 90 has increased markedly over the last 50 years in high-income countries, and will probably continue to rise with successive cohorts.1,2 In the United States, the number of nonagenarians has increased from approximately 230,000 in 1960 to approximately 1.8 million in 2010, and in the five biggest countries in the European Union (Germany, France, the United Kingdom, Italy, Spain) the number has increased from approximately 250,000 to 1.6 million, which is almost 7 times as many nonagenarians, compared with 1.5 times as many people in the total population of these countries in 1960 as in 2010. With this growing number of oldest old adults, ageism has been decreasing in recent decades, and it has now become generally unacceptable to deny medical procedures to people aged 80 and older using advanced age as the sole argument.3 Research has also emerged that investigates medical procedures for very old adults,4–6 but life expectancy for very old adults is still short in most high-income countries, ranging from around 8 to 10 years for 80-year-olds to 4 to 5 years for 90-year-olds (online Table S1).7 Hence, overtreatment of very old adults is still a general concern, and potential side effects of treatment have to be balanced with the overall survival prognosis, which is generally based on the overall chance of survival to a given age or overall life expectancy.8 It has been argued that clinicians should offer to discuss the overall survival prognosis with patients aged 85 and older.8 There is large varivariation in health and life expectancy in very old adults, which also should be taken into consideration before treatment is provided. Comprehensive geriatric assessments exist, but they are generally time-consuming and mostly validated in people aged 70 to 80.9-11 Simple, easy-to-use tools that can help predict the chance of individual survival in very old adults would be useful in clinical decision-making for general practitioners, but only a few studies have investigated factors that predict mortality in very old adults. In a study of 186 Spanish nonagenarians, comorbidity and cognition assessed over a 5-year follow-up period were found to be the best predictors of mortality.12 In a study of 888 Finnish people aged 90 and older, activities of daily living (ADLs), self-rated health, and being institutionalized over a 9-year period were found to be associated with mortality.13 A study of 19,340 Americans, 335 of whom were nonagenarians, showed that functional limitation in nonagenarians was a better predictor of mortality than chronic conditions.14 In a study of 335 Italian people aged 80 and older, walking speed and five-time chair stand test were found to be associated with mortality.15 Walking speed and chair stands has also been shown to predict subsequent disability and mortality in people aged 70 and older.16,17 Unfortunately, most of these studies presented hazard ratios, which can be difficult to use in clinical decision-making and to communicate to people. This study comprised a Danish birth cohort followed from age 92 or 93 until the cohort was almost extinct. The aim was to identify measures that predict remaining lifespan and chance of surviving to 100 years and that can be easily administered in a primary care setting without specialized equipment.

The goal of this study is to estimate the prevalence of MetS, together with its components and correlates, among elderly Russians. Our population-based sample included randomly selected residents of Moscow aged 55 and older: 955 women with an average age of 67.6, and 833 men with an average age of 68.9. MetS was defined according to National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII). The prevalence of MetS was found to be 41.7% in women and 26.8% in men. It tended to decrease with age in men, but not in women. MetS was inversely related to education in women, but not in men. The most prevalent individual components of MetS were as follows: hypertension (64.4%), abdominal obesity (55%), and decreased high density lipoprotein cholesterol (HDL C) (46%) for women; and hypertension (71%) and fasting hyperglycemia (35.2%) for men. An elevated level of triglycerides (TG) was the rarest MetS component, affecting 23.5% of women and 22.1% of men. The higher female prevalence of MetS was attributable to abdominal obesity. MetS was found to be associated with markers of insulin resistance (IR), low-grade inflammation, and insufficient fibrinolysis. Although the metabolic burden is an important contributor to high levels of ill-health and cardiovascular mortality among elderly Russians (especially women), it does not explain why cardiovascular mortality is much higher in Russia than in other industrialized countries.

Background. The study aimed to examine sex differences in healthcare use before and after widowhood to investigate whether reduced healthcare use among widowers compared with widows may partially explain excess mortality and more adverse health outcomes among men than women after spousal loss. Methods. All individuals alive and aged at least 60 years in 1996 and who became widowed in the period from 1996 to 2003 were selected from the 5% sample of the total Danish population and all Danish twins. The healthcare use was assessed as the average daily all-cause and major system-specific medication use and the average annual number of visits to general physicians (GPs). Results. The average daily use of all-cause and major system-specific medications, as well as the number of GP visits increased over the period from 1 year before and up to 5 years after a spouse's death, but there were no sex-specific patterns in the trajectories of medication use and number of GP visits after conjugal loss. Conclusion. We found little support for the hypothesis that reduced healthcare use contributes to the explanation of more adverse health outcomes after conjugal loss in men compared with women in Denmark. Background. The study aimed to examine sex differences in healthcare use before and after widowhood to investigate whether reduced healthcare use among widowers compared with widows may partially explain excess mortality and more adverse health outcomes among men than women after spousal loss. Methods. All individuals alive and aged at least 60 years in 1996 and who became widowed in the period from 1996 to 2003 were selected from the 5% sample of the total Danish population and all Danish twins. The healthcare use was assessed as the average daily all-cause and major system-specific medication use and the average annual number of visits to general physicians (GPs). Results. The average daily use of all-cause and major system-specific medications, as well as the number of GP visits increased over the period from 1 year before and up to 5 years after a spouse's death, but there were no sex-specific patterns in the trajectories of medication use and number of GP visits after conjugal loss. Conclusion. We found little support for the hypothesis that reduced healthcare use contributes to the explanation of more adverse health outcomes after conjugal loss in men compared with women in Denmark.

Studies of Nordic twins suggest an increased genetic influence on mortality with age. Contrary to this, the heterogeneity hypothesis predicts that the mortality of individuals carrying a 'frail' or 'risky' genotype in a population will approach that of noncarriers with age because of selection pressure. The ApoE e4 allele is associated with an increased mortality risk, and its effect has been suggested to decrease with age. Here, we investigated the effect of ApoE e4 allele on survival in a sample of the healthiest and long-lived Danes. The study population comprised Danes born in 1905 and a replicate sample of the 1895 cohort. For the 1905 cohort, a total of 350 carriers and 1256 noncarriers of the ApoE e4 allele were followed from 1998 until death or end of follow-up. Cox regression models were used for the analysis. Of the 1606 persons with known ApoE e4 status in 1998, 1546 had died at the end of the 10-year follow-up. Carriers of the ApoE e4 allele had an increased mortality compared to noncarriers, and the influence of ApoE status on mortality increased in the age interval 92-103. For the covariates sex and independency status, the difference in relative risk of death between groups decreased with advancing age. Our findings of increasing influence of ApoE e4 allele on mortality with age do not support previous findings of decreased influence ApoE e4 allele on mortality with age, and alternative models such as the multifactorial threshold models should be considered for understanding the genetic effects on mortality at advanced age.

In a heterogeneous cohort, the change with age in the force of mortality or some other kind of hazard or intensity of attrition depends on how the hazard changes with age for the individuals in the cohort and on how the composition of the cohort changes due to the loss of those most vulnerable to attrition. Here we prove that the change with age for the cohort equals the average of the change in the hazard for the individuals in the cohort minus the variance in the hazard across individuals. The variance captures the compositional change. This very general and remarkably elegant relationship can be applied to understand and to analyze changes with age in many kinds of demographic hazards, including, e.g., the lifetable aging rate or the intensity of first births.

There is a unique threshold age separating early deaths from late deaths such that averting an early death decreases life disparity, but averting a late death increases inequality in lifespans.

Centenarians surpass the current human life expectancy with about 20-25 years. However, whether centenarians represent healthy aging still remains an open question. Previous studies have been hampered by a number of methodological shortcomings such as a cross-sectional design and lack of an appropriate control group. In a longitudinal population-based cohort, it was examined whether the centenarian phenotype may be a useful model for healthy aging. The study was based on a complete follow up of 39,945 individuals alive in the Danish 1905 birth cohort on January 1, 1977 identified through the Danish Civil Registration System (DCRS). Data from the Danish Demographic Database and The Danish National Patient Register (in existence since 1977) were used. The 1905 cohort was followed up from 1977 through 2004 with respect to hospitalizations and number of hospital days. Survival status was available until December 2006. Danish centenarians from the 1905 cohort were hospitalized substantially less than their shorter-lived contemporaries at the same point in time during the years 1977 through 2004. For example, at age 71-74, the proportion of nonhospitalized centenarians was 80.5% compared with 68.4% among individuals who died in their early 80s. This trend was evident in both sexes. As a result of their lower hospitalization rates and length of stay in hospital compared with their contemporaries, who died at younger ages, Danish centenarians represent healthy agers. Centenarians constitute a useful study population in the search for fixed traits associated with exceptional longevity, such as genotype.

It is well known that life expectancy can be expressed as an integral of the survival curve. The reverse - that the survival function can be expressed as an integral of life expectancy - is also true.

Mortality data for 30 mostly developed countries available in the Kannisto–Thatcher Database on Old-Age Mortality (KTDB) are drawn on to assess the pace of decline in death rates at ages 80 years and above. As of 2004 this database recorded 37 million persons at these ages, including 130,000 centenarians (more than double the number in 1990). For men, the probability of surviving from age 80 to age 90 has risen from 12 percent in 1950 to 26 percent in 2002; for women, the increase has been from 16 percent to 38 percent. In the lowest-mortality country, Japan, life expectancy at age 80 in 2006 is estimated to be 6.5 years for men and 11.3 years for women. For selected countries, average annual percent declines in age-specific death rates over the preceding ten years are calculated for single-year age groups 80 to 99 and the years 1970 to 2004. The results are presented in Lexis maps showing the patterns of change in old-age mortality by cohort and period, and separately for men and women. The trends are not favorable in all countries: for example, old-age mortality in the United States has stagnated since 1980. But countries with exceptionally low mortality, like Japan and France, do not show a deceleration in death rate declines. It is argued that life expectancy at advanced ages may continue to increase at the same pace as in the past.

Udgivelsesdato: 2008-Sep-9 Late-life loss of independence in daily living is a central concern for the aging individual and for society. The implications of increased survival to advanced age may be different at the population level than at the individual level. Here we used a longitudinal multi-assessment survey of the entire Danish 1905 cohort from 1998 to 2005 to assess the loss of physical and cognitive independence in the age range of 92 to 100 years. Multiple functional outcomes were studied, including independence, which was defined as being able to perform basic activities of daily living without assistance from other persons and having a MiniMental State Examination (MMSE) score of 23 or higher. In the aggregate, the 1905 cohort had only a modest decline in the proportion of independent individuals at the 4 assessments between age 92 and 100 years: 39%, 36%, 32%, and 33%, with a difference between first and last assessment of 6% [95% confidence interval (CI), -1-14%]. For participants who survived until 2005, however, the prevalence of independence was reduced by more than a factor of 2, from 70% in 1998 to 33% in 2005 (difference, 37%; 95% CI, 28-46%). Similar results were obtained for the other functional outcomes. Analyses of missing data resulting from nonresponse and death suggest that the discrepancy between the population trajectory and the individual trajectory is caused by increased mortality among dependent individuals. For the individual, long life brings an increasing risk of loss of independence. For society, mortality reductions are not expected to result in exceptional levels of disability in cohorts of the very old.

PURPOSE: Familial clustering of longevity is well documented and includes both genetic and other familial factors, but the specific underlying mechanisms are largely unknown. We examined whether low incidence of specific cancers is a mechanism for familial clustering of longevity.METHODS: The study population of individuals from longevity-enriched families consisted of 3267 offspring from 610 Danish long-lived families defined by two siblings attaining an age of 90 years or more. The offspring of the long-lived siblings were followed from 1968 to 2009. Using high-quality registry data, observed numbers of cancers were compared with expected numbers based on gender-, calendar period-, and age-specific incidence rates in the general population.RESULTS: During the 41-year-follow-up period, a total of 423 cancers occurred in 397 individuals. The standardized incidence ratios (95% confidence interval) for offspring of long-lived individuals were 0.78 (0.70-0.86) for overall cancer; 0.66 (0.56-0.77) for tobacco-related cancer; 0.34 (0.22-0.51) for lung cancer; 0.88 (0.71-1.10) for breast cancer; 0.91 (0.62-1.34) for colon cancer.CONCLUSIONS: The low incidence of tobacco-related cancers in long-lived families compared with non-tobacco-related cancers suggests that health behavior plays a central role in lower early cancer incidence in offspring of long-lived siblings in Denmark.

OBJECTIVES: To evaluate the extent to which relationships between apolipoprotein E, cognitive functioning, and survival in people aged 60 to 80 persist into advanced old age. DESIGN: Examine the effect of apolipoprotein E genotypes on baseline cognitive functioning, cognitive decline over 5 years, and survival in a cohort of 1,551 nonagenarians. SETTING: The Danish 1905 birth cohort. PARTICIPANTS: One thousand five hundred fifty-one nonagenarians from the Danish 1905 birth cohort. MEASUREMENTS: Cognitive functioning was assessed using the Mini-Mental State Examination (MMSE) and five brief cognitive tests (cognitive composite). RESULTS: The subjects were stratified into four groups by occurrence of a protective (epsilon2) or a risk (epsilon4) apo E allele (epsilon22 and epsilon23, epsilon33, epsilon24 and epsilon34, epsilon44). At intake, the mean scores for the three genotype groups were 22.1, 21.8, 21.4, and 21.0 for MMSE and 0.10, 0.07, -0.02, and 0.30 for the cognitive composite, respectively. Growth-curve analyses showed that, although individuals carrying at least one epsilon4 allele had slightly lower MMSE scores and declined slightly more rapidly over time, this effect was not statistically significant and was not apparent in scores on the cognitive composite. In subjects whose functioning was relatively well preserved (those still living and able to participate in the assessment, and whose cognitive functioning had declined less than 4 points on the MMSE), epsilon4 frequencies tended to decline at subsequent waves (P=.03, chi-square test for trend), but epsilon4 had no significant survival disadvantage (hazard ratio=1.11 (95% confidence interval=0.99-1.25; P=.07). CONCLUSION: Apo E genotype has a small effect on the probability of remaining a well-functioning nonagenarian but no separately detectable effect on cognitive functioning, cognitive decline, or survival.

Statistical analysis of a large and unique longitudinal data-set demonstrates that childbearing after age 35 or 40 is associated with survival and healthy survival among very old Chinese women and men. The association is stronger for women than for men. The estimates are adjusted for a variety of confounding factors: demographic characteristics, family support, social connections, health practices, and health conditions. Further analysis based on an extension of the Fixed-Attributes Dynamics method shows that late childbearing is positively associated with long-term survival and healthy survival from ages 80-85 to 90-95 and 100-105. This association exists among oldest-old women and men, but, again, the effects are substantially stronger for women than for men. We discuss four possible factors that may explain why late childbearing affects healthy longevity at advanced ages: (1) social factors; (2) biological changes caused by late pregnancy and delivery; (3) genetic and other biological characteristics; and (4) selection.

OBJECTIVES: To elucidate whether well-known predictions of mortality are reduced or even reversed, or whether mortality is a stochastic process in the oldest old. DESIGN: A multidimensional survey of the Danish 1905 cohort conducted in 1998 with follow-up of vital status after 15 months. SETTING: Denmark. PARTICIPANTS: All Danes born in 1905, irrespective of physical and mental status were approached. Two thousand two hundred sixty-two persons of 3,600 participated in this survey. MEASUREMENTS: Professional interviewers collected data concerning sociodemographic factors, smoking, alcohol consumption, body mass index, physical and cognitive performance, and health during a visit at the participant’s residency. Cox regression models were used to evaluate predictors of mortality. RESULTS: Five hundred seventy-nine (25.7%) of the 2,249 participants eligible for the analysis died during the 15 months follow-up. Multivariate analyses showed that marital status, education, smoking, obesity, consumption of alcohol, and number of self-reported diseases were not associated with mortality. Disability and cognitive impairment were significant risk factors in men and women. In addition poor self-rated health was associated with an increase in mortality in women. CONCLUSION: In the oldest old, several known predictors of mortality, such as sociodemographic factors, smoking, and obesity, have lost their importance, but a high disability level, poor physical and cognitive performance, and self-rated health (women only), predict mortality, which shows that mortality in the oldest old is not a stochastic process. J Am Geriatr Soc 51:1365–1373, 2003.

Background. Although several genetic determinants (mutations or polymorphisms) have been associated with increasedrisk of venous thromboembolism, the overall influence of genetic factors on this disease is unknown.Methods. We linked the Danish Twin Registry, which includes twins born 1870–1953, with the Danish National Registry of Patients, comprising all hospitalizations in Denmarksince 1977. We then determined the risk of venous thromboembolism as determined from discharge diagnosis.Results. We identified 26,982 twins who were alive on 1January 1977, and computed measures of familial and geneticassociation of venous thrombotic disorders. Individuals wereclassified according to zygosity and hospitalization with venousthromboembolism. Since 1977, 678 twins were hospitalizedwith an episode of venous thromboembolism. Of these, only545 pairs (281 male pairs and 264 female pairs) were alive in1977. For men, the concordance rates for mono- and dizygotictwin pairs, respectively, were 0.22 (95% confidence interval 0.14 to 0.30) and 0.08 (0.04–0.12). The odds ratio (interpreted as the relative risk of venous thromboembolism for onetwin, given venous thromboembolism in the partner twin) was13.5 (7.3–24.8) among monozygotic twins and 3.8 (1.8–8.3)among dizygotic twins. The respective correlations for venousthromboembolism were 0.55 (0.38–0.70) and 0.26 (0.09–0.42). The proportion of the variance attributable to geneticeffects on venous thromboembolism in males was 55% (39%–68%). The remaining variation could be attributed to men’snonfamilial environments. In contrast, for women there wasno intra–twin pair similarity for venous thromboembolism.Conclusions. We found differences in genetic susceptibility tovenous thromboembolism between the sexes, with geneticfactors playing a substantially stronger role in males than infemales

THE NUMBER OF oldest old persons in China, defined here as aged 80 and older, is calculated by the United Nations to climb from about 11.5 million in the year 2000 to 27 million in 2020, 39 million in 2030, 64 million in 2040, and 99 million in 2050. 1 Under the UN’s medium fertility assumption, 2 the percent aged 65 and older is expected to increase from 6.9 in 2000 to 15.7 in 2030 and 22.7 in 2050, while the share of the oldest old which in 2000 is 13 percent of the elderly population will be some 30 percent in 2050. The main reason the number of oldest old will climb so quickly after 2030 is that China’s “baby boomers,” who were born in the 1950s and 1960s, will fall into the category of “oldest old” at that time. During 2000‐50 the population of the oldest old will grow faster than any other age group in China. This phenomenon is not limited to China. The average annual rates of increase of oldest old persons between 2000 and 2050 are expected to be around 4.3 percent in China, India, and Mexico and 2.2‐2.8 percent in Canada, Japan, the United States, Germany, and France (UN 2001b). The rate of increase of the Chinese oldest old subpopulation is much faster (4.4 percent vs. 2.7 percent) than that of the entire elderly population aged 65 and older. The oldest old are much more likely to need help in daily living than the younger elderly. The oldest old consume medical care and other services and benefits of government and private transfers far out of proportion to their numbers. As evidenced later in this article, the proportion of individuals leading active daily lives declines and the disability rate increases dramatically with age among the Chinese oldest old. Torrey (1992: 382) estimated that in the United States, the Medicare costs of those aged 80 and older are 77, 60, and 36 percent higher than those of the younger elderly aged 65‐69, 70‐74, and

Logistic regression analysis based on data from 822 Han Chinese oldest old aged 92+ demonstrated that interactions between carrying FOXO1A-266 or FOXO3-310 or FOXO3-292 and tea drinking at around age 60 or at present time were significantly associated with lower risk of cognitive disability at advanced ages. Associations between tea drinking and reduced cognitive disability were much stronger among carriers of the genotypes of FOXO1A-266 or FOXO3-310 or FOXO3-292 compared with noncarriers, and it was reconfirmed by analysis of three-way interactions across FOXO genotypes, tea drinking at around age 60, and at present time. Based on prior findings from animal and human cell models, we postulate that intake of tea compounds may activate FOXO gene expression, which in turn may positively affect cognitive function in the oldest old population. Our empirical findings imply that the health benefits of particular nutritional interventions, including tea drinking, may, in part, depend upon individual genetic profiles. Logistic regression analysis based on data from 822 Han Chinese oldest old aged 92+ demonstrated that interactions between carrying FOXO1A-266 or FOXO3-310 or FOXO3-292 and tea drinking at around age 60 or at present time were significantly associated with lower risk of cognitive disability at advanced ages. Associations between tea drinking and reduced cognitive disability were much stronger among carriers of the genotypes of FOXO1A-266 or FOXO3-310 or FOXO3-292 compared with noncarriers, and it was reconfirmed by analysis of three-way interactions across FOXO genotypes, tea drinking at around age 60, and at present time. Based on prior findings from animal and human cell models, we postulate that intake of tea compounds may activate FOXO gene expression, which in turn may positively affect cognitive function in the oldest old population. Our empirical findings imply that the health benefits of particular nutritional interventions, including tea drinking, may, in part, depend upon individual genetic profiles.

In high income countries females outlive men, although they generally report worse health, the so-called male-female health-survival paradox. Russia has one of the world's largest sex difference in life expectancy with a male disadvantage of more than 10 years. We compare components of the paradox between Denmark and Moscow by examining sex differences in mortality and several health measures. The Human Mortality Database and the Russian Fertility and Mortality Database were used to examine sex differences in all-cause death rates in Denmark, Russia, and Moscow in 2007-2008. Self-reported health data were obtained from the Study of Middle-Aged Danish Twins (n = 4,314), the Longitudinal Study of Aging Danish Twins (n = 4,731), and the study of Stress, Aging, and Health in Russia (n = 1,800). In both Moscow and Denmark there was a consistent female advantage at ages 55-89 years in survival and a male advantage in self-rated health, physical functioning, and depression symptomatology. Only on cognitive tests males performed similarly to or worse than women. Nevertheless, Muscovite males had more than twice higher mortality at ages 55-69 years compared to Muscovite women, almost double the ratio in Denmark. The present study showed that despite similar directions of sex differences in health and mortality in Moscow and Denmark, the male-female health-survival paradox is very pronounced in Moscow suggesting a stronger sex-specific disconnect between health indicators and mortality among middle-aged and young-old Muscovites. In high income countries females outlive men, although they generally report worse health, the so-called male-female health-survival paradox. Russia has one of the world's largest sex difference in life expectancy with a male disadvantage of more than 10 years. We compare components of the paradox between Denmark and Moscow by examining sex differences in mortality and several health measures. The Human Mortality Database and the Russian Fertility and Mortality Database were used to examine sex differences in all-cause death rates in Denmark, Russia, and Moscow in 2007-2008. Self-reported health data were obtained from the Study of Middle-Aged Danish Twins (n = 4,314), the Longitudinal Study of Aging Danish Twins (n = 4,731), and the study of Stress, Aging, and Health in Russia (n = 1,800). In both Moscow and Denmark there was a consistent female advantage at ages 55-89 years in survival and a male advantage in self-rated health, physical functioning, and depression symptomatology. Only on cognitive tests males performed similarly to or worse than women. Nevertheless, Muscovite males had more than twice higher mortality at ages 55-69 years compared to Muscovite women, almost double the ratio in Denmark. The present study showed that despite similar directions of sex differences in health and mortality in Moscow and Denmark, the male-female health-survival paradox is very pronounced in Moscow suggesting a stronger sex-specific disconnect between health indicators and mortality among middle-aged and young-old Muscovites.

OBJECTIVE Referring to the multidisciplinary and multipurpose survey AKeA2, and focusing on family genealogy data on centenarian women and controls, this paper aims to verify the hypothesis that maternal longevity is associated with lower infant mortality in offspring, after having controlled for fertility characteristics, familial longevity and some contextual variables. METHODS The association between the longevity of a mother and her children's infant mortality level was assessed using a multivariate Poisson Regression Model with robust estimates, which is suitable for estimating consistently and efficiently the relative risk when binary data are used. RESULTS Our results show an association between longevity and infant mortality among the children of the Sardinians who survived to become centenarians. Infant mortality is significantly lower for children belonging to a mother born and living in Sassari and Oristano than Nuoro, close to each other and both located on the Western coast.

Although the increase in the number of centenarians is well documented today, at least in some countries, this is still not the case for people having reached the age of 110 years or more: the supercentenarians. The supercentenarians emerged in the mid-1960s. Their numbers have regularly increased since the mid-1970s. The current prevalence of known supercentenarians in countries involved in the database is approximately five to six times more than in the mid-1970s. In roughly 20 years the maximum age observed has increased by about 10 years from 112 to 122 years. The annual probability of death at age 110 is as low as 0.52 with the validated data (n=106) or with the exhaustive and validated data (n=73). The probabilities of death stagnate between 110 and 115 years, and all the computed probabilities fall below the ceiling of 0.6. Our results are compatible with the last extrapolations of mortality trajectories using a logistic or a quadratic model.

Udgivelsesdato: 2001-Feb OBJECTIVES. The authors studied nonagenarians, a rapidly growing age group whose cognitive and physical abilities have yet to be investigated systematically. METHODS. All Danes born in 1905 were invited to participate in a home-based 2-hour multidimensional interview, including cognitive and physical performance tests and collection of DNA, carried out by lay interviewers. Population-based registers were used to evaluate representativeness. RESULTS. There were 2,262 participants. A total of 1,632 (72%) gave a DNA sample. Participants and nonparticipants were highly comparable with regard to marital status, institutionalization, and hospitalization patterns, but men and rural area residents were more likely to participate. Six months after the survey began, 7.2% of the participants and 11.8% of the nonparticipants had died. DISCUSSION. Despite the known difficulties of conducting surveys among the extremely old, it was possible to conduct a nationwide survey, including collection of DNA, among more than 2,000 fairly nonselected nonagenarians using lay interviewers.

Objectives: To study the relative influence of genetic and environmental factors on self-rated health and hospitalization patterns in the elderly. Methods: Asurvey among all 3,099 Danish twins ages 75 years and older identified in the Danish Twin Registry. An interviewwas conducted with 77% of the twins. The number of hospitalizations in the previous 18 years was obtained through register linkage, thereby obtaining health information on 96% of the study population, including all nonresponders. Results: Structural equation modeling suggested that approximately a quarter of the variation in the liability to self-reported health and the number of hospitalizations could be attributed to genetic factors. The remaining variationwas most likely due to nonfamilial environment. Analyses of the hospitalization patterns of proxy responders and nonresponders suggest that the estimates of the genetic influence on health outcomes in the study are conservative. Discussion: The present study indicates that variation in general health among the elderly is partly explained by genetic factors.

Danes are unrivalled in satisfaction with life. The University of Leicester recently published the World Map of Happiness (http://news.bbc.co.uk/2/shared/bsp/hi/pdfs/28\_07\_06\_happiness\_map.pdf) with Denmark as number one. For more than 30 years this country with five million inhabitants has ranked first in Eurobarometer surveys (europa.eu.int/comm/public\_opinion/index\_en.htm). More than two thirds of Danes are “very satisfied” with their lives according to these surveys. In no other Eurobarometer country has this proportion exceeded a half, and for most of the countries the proportion is less than a third (figure)⇓. To explain Danish contentment we sifted through literature, statistics, and common knowledge. Proportion who report to be very satisfied in 15 EU countries according to Eurobarometers (europa.eu.int/comm/public\_opinion/index\_en.htm) We focused on accounting for why life satisfaction in Denmark substantially exceeds that in Sweden and Finland, the two Eurobarometer countries most similar to Denmark. We have ordered our hypotheses roughly from most to least implausible. Hair colour —It may indeed be the case that “blondes have more fun.” This hypothesis was launched in the 1950s by a commercial slogan for a hair dye and was cemented in popular culture in 1978 by rock musician Rod Stewart's album of the same title. Sweden, however, has a higher prevalence of blondes than Denmark.1 Genes —Genetic factors might influence differences in life satisfaction within a country,2 and Danes might have a special genetic constitution. Genotypes in Sweden, however, are similar to those in Denmark because most Swedes were Danes until the 17th century. Food— Meals in Denmark can be politely described as unmemorable. “Danish cuisine” is an oxymoron, except perhaps the open faced “butter breads” that accompany the beer and aquavit Danes consume for lunch. Older Danes satisfy their hunger with potatoes, gravy, and a bit of pork, and younger ones devour hotdogs, hamburgers, and Baltic-style pizzas. Danish …

Over the last 60 years, the resources and the research in the Danish Twin Registry (DTR) have periodically been summarized. Here, we give a short overview of the DTR and a more comprehensive description of new developments in the twenty-first century. First, we outline our experience over the last decade of combining questionnaire and survey data with national demographic, social, and health registers in Statistics Denmark. Second, we describe our most recent data collection effort, which was conducted during the period 2008-2011 and included both in-person assessments of 14,000+ twins born 1931-1969 and sampling of biological material, hereby expanding and consolidating the DTR biobank. Third, two examples of intensively studied twin cohorts are given. The new developments in the DTR in the last decade have facilitated the ongoing research and laid the groundwork for new research directions. Over the last 60 years, the resources and the research in the Danish Twin Registry (DTR) have periodically been summarized. Here, we give a short overview of the DTR and a more comprehensive description of new developments in the twenty-first century. First, we outline our experience over the last decade of combining questionnaire and survey data with national demographic, social, and health registers in Statistics Denmark. Second, we describe our most recent data collection effort, which was conducted during the period 2008-2011 and included both in-person assessments of 14,000+ twins born 1931-1969 and sampling of biological material, hereby expanding and consolidating the DTR biobank. Third, two examples of intensively studied twin cohorts are given. The new developments in the DTR in the last decade have facilitated the ongoing research and laid the groundwork for new research directions.

OBJECTIVE: to examine whether the Danish 1905 cohort members had more active hospital treatment than the 1895 cohort members from ages 85 to 99 years and whether it results in higher in-hospital and post-operative mortality.METHODS: in the present register-based follow-up study the complete Danish birth cohorts born in 1895 (n = 12,326) and 1905 (n = 15,477) alive and residing in Denmark at the age of 85 were followed from ages 85 to 99 years with regard to hospitalisations and all-cause and cause-specific surgical procedures, as well as in-hospital and post-operative mortality.RESULTS: the 1905 cohort members had more frequent hospital admissions and operations, but they had a shorter length of hospital stay than the 1895 cohort at all ages from 85 to 99 years. The increase in primary prosthetic replacements of hip joint was observed even within the 1895 cohort: no patients were operated at ages 85-89 years versus 2.2-3.6% at ages 95-99 years. Despite increased hospitalisation and operation rates, there was no increase in post-operative and in-hospital mortality rates in the 1905 cohort. These patterns were similar among men and women.CONCLUSIONS: the observed patterns are compatible with more active treatment of the recent cohorts of old-aged persons and reduced age inequalities in the Danish healthcare system. No increase in post-operative mortality suggests that the selection of older patients eligible for a surgical treatment is likely to be based on the health status of old-aged persons and the safety of surgical procedures rather than chronological age.

Objective: To test the validity of the fetal origins hypothesis and the classic twin method. Design: Follow up study of pairs of same sex twins in which both twins survived to age 6. Setting: Denmark. Subjects: 8495 twin individuals born 1870-1900, followed through to 31 December 1991. Main outcome measures: Mortality calculated on a cohort basis. Results: Mortality among twins and the general population was not significantly different except among females aged 60-89, in whom mortality among twins was 1.14 times (SE 0.03) higher than in the general population. Mortality among female dizygotic twins was 1.77 times (0.18) higher than among monozygotic twins at age 30.59. Otherwise, mortality for monozygotic and dizygotic twins did not consistently differ after age 6. Conclusion: According to the fetal origins hypothesis the risk of adult morbidity and mortality is heightened by retardation in intrauterine growth. Twins, and in particular monozygotic twins, experience growth retardation in utero. The findings in the present study suggest that the fetal origins hypothesis is not true for the retardation in intrauterine growth experienced by twins. Furthermore, the data are inconsistent with the underlying assumption of a recent claim that the classic twin method is invalid for studies of adult diseases. The present study is, however, based on the one third of all pairs of twins in which both twins survived to age 6. The possible impact of this selection can be evaluated in future studies of cohorts of younger twins with lower perinatal and infant mortality. Key messages Key messages It has been claimed that twin studies of adult diseases are invalid owing to the link between intrauterine development and adult diseases Contrary to the prediction from the fetal origins hypothesis this study found that mortality among twins and in the general population was similar after age 6 Contrary to the underlying assumption of the claim that the twin method is invalid, this study found that mortality in monozygotic and dizygotic twins was similar after age 6 This study suggests that the fetal origins hypothesis is not true for the retardation in intrauterine growth in these twin cohorts and that the hypothesis is no threat to the validity of the twin method

This study analyzes the unique datasets of the Chinese Longitudinal Healthy Longevity Survey using logistic regression and controlling for various covariates. Our analyses clearly demonstrate that disabled older parents are more satisfied with care provided by daughters than sons and that older parents enjoy greater filial piety from and better relationships with daughters than sons. The daughter-advantages of enjoying greater filial piety from and better relationships with children are stronger among the oldest-old aged 80+ than the young-old aged 65-79, and surprisingly more profound in rural areas than urban areas, while son-preference is much more prevalent among rural residents. We also discuss why China's rigorous fertility policy until October-2015 and much less-developed pension system in rural areas substantially contribute to sustaining traditional son-preference and a high sex ratio at birth (SRB) when fertility is low. We recommend China take integrative public health policy actions of informing the public that having daughter(s) is beneficial for old age care, developing the rural pension system and implementing the universal two-child policy as soon as possible. We believe that these policy actions would help to reduce son-preference, bring down the high SRB, and enable more future elderly parents to enjoy better care from their children and healthier lives.

Patterns of diversity in age at death are examined using e†, a dispersion measure that equals the average expected lifetime lost at death. We apply two methods for decomposing differences in e†. The first method estimates the contributions of average levels of mortality and mortality age structures. The second (and newly developed) method returns components produced by differences between age- and cause-specific mortality rates. The United States is close to England and Wales in mean life expectancy but has higher life expectancy losses and lacks mortality compression. The difference is determined by mortality age structures, whereas the role of mortality levels is minor. This is related to excess mortality at ages under 65 from various causes in the United States. Regression on 17 country-series suggests that e† correlates with income inequality across countries but not across time. This result can be attributed to dissimilarity between the age- and cause-of-death structures of temporal mortality reduction and intercountry mortality variation. It also suggests that factors affecting overall mortality decrease differ from those responsible for excess lifetime losses in the United States compared with other countries. The latter can be related to weaknesses of health system and other factors resulting in premature death from heart diseases, amenable causes, accidents and violence.