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Exceptional longevity does not result in excessive levels of disability. Proc Natl Acad Sci U S A 2008; 105:13274-9. [PMID: 18711139 DOI: 10.1073/pnas.0804931105] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
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.
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Alter G, Dribe M, Van Poppel F. Widowhood, family size, and post-reproductive mortality: a comparative analysis of three populations in nineteenth-century Europe. Demography 2008; 44:785-806. [PMID: 18232211 DOI: 10.1353/dem.2007.0037] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Researchers from a number of disciplines have offered competing theories about the effects oJ childbearing on parents 'postreproductive longevity. The "disposable soma theory" argues that investments in somatic maintenance increase longevity but reduce childbearing. "Maternal depletion" models suggest that the rigors of childrearing increase mortality in later years. Other researchers consider continued childbearing a sign of healthy aging and a predictor of future longevity. Empirical studies have produced inconsistent and contradictory results. Our focus is on the experience of widowhood, which has been ignored in previous studies. We hypothesize that the death of a spouse is a stressful event with long-term consequences for health, especially for women with small children. Data are drawn from historical sources in Sweden, Belgium, and the Netherlands from 1766 to 1980. Postreproductive mortality was highest among young widows with larger families in all three samples. Age at last birth had little or no effect. We conclude that raising children under adverse circumstances can have long-lasting, harmful effects on a mother's health.
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Affiliation(s)
- George Alter
- Inter-university Consortium for Political and Social Research and Population Studies Center, University of Michigan, P.O. Box 1248, Ann Arbor, MI 48106-1248, USA.
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Yi Z, Gu D, Land KC. The association of childhood socioeconomic conditions with healthy longevity at the oldest-old ages in China. Demography 2008; 44:497-518. [PMID: 17913008 DOI: 10.1353/dem.2007.0033] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Based on unique data from the largest-ever sample of the Chinese oldest-old aged 80 and older, our multivariate logistic regression analyses show that either receiving adequate medical service during sickness in childhood or never/rarely suffering from serious illness during childhood significantly reduces the risk of being ADL (activities of daily living) impaired, being cognitively impaired, and self-reporting poor health by 18%-33% at the oldest-old ages. Estimates of effects for five other indicators of childhood conditions are similarly positive but mostly not statistically significant. Multivariate survival analysis shows that better childhood socioeconomic conditions in general tend to reduce the four-year period mortality risk among the oldest-old. But after additional controls for 14 covariates are put into the model, the effects are not statistically significant, thus suggesting that most of the effects of childhood conditions on oldest-old mortality are indirect-at least to the point of affecting current health status at the oldest-old ages, which itself is strongly associated with mortality. While acknowledging limitations of the present analyses due to a lack of information on childhood illness, the oldest-olds'recollection errors, and other data problems, we conclude, based on this and other studies, that policies that enhance childhood health care and children's socioeconomic well-being can have large and long-lasting benefits up to the oldest-old ages.
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Affiliation(s)
- Zeng Yi
- Center for Study of Aging and Human Development, Duke University, Durham, NC 27710, USA.
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Gu D, Xu Q. Sociodemographic Effects on the Dynamics of Task-specific ADL Functioning at the Oldest-old Ages: The Case of China. J Cross Cult Gerontol 2006; 22:61-81. [PMID: 17123154 DOI: 10.1007/s10823-006-9024-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Accepted: 10/31/2006] [Indexed: 10/23/2022]
Abstract
Studies that systematically examine the dynamics of task-specific ADL functioning and its associates are very rare. Using the first three waves of the Chinese Longitudinal Healthy Longevity Survey, this study examines the dynamics of each of the six ADL tasks (bathing, dressing, toileting, indoor transferring, eating, and continence) and their sociodemographic correlates among the oldest-old by including the ADL information both at the follow-up wave for survivors and at the time prior to death for those who died during survey intervals. Effects of age, gender, urban/rural residence, ethnicity, education, primary lifetime occupation, primary source of daily expenses, living alone, and marital status are examined in both the absence and presence of other various confounders. Our results show that each sociodemographic factor still plays some limited role in the dynamics of ADL functioning across tasks.
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Affiliation(s)
- Danan Gu
- Center for Study of Aging and Human Development, Medical Center, Duke University, 200 Trent Dr. Busse BLDG RM 1506, Durham, NC 27710, USA.
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McArdle PF, Pollin TI, O'Connell JR, Sorkin JD, Agarwala R, Schäffer AA, Streeten EA, King TM, Shuldiner AR, Mitchell BD. Does having children extend life span? A genealogical study of parity and longevity in the Amish. J Gerontol A Biol Sci Med Sci 2006; 61:190-5. [PMID: 16510865 DOI: 10.1093/gerona/61.2.190] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The relationship between parity and life span is uncertain, with evidence of both positive and negative relationships being reported previously. We evaluated this issue by using genealogical data from an Old Order Amish community in Lancaster, Pennsylvania, a population characterized by large nuclear families, homogeneous lifestyle, and extensive genealogical records. METHODS The analysis was restricted to the set of 2,015 individuals who had children, were born between 1749 and 1912, and survived until at least age 50 years. Pedigree structures and birth and death dates were extracted from Amish genealogies, and the relationship between parity and longevity was examined using a variance component framework. RESULTS Life span of fathers increased in linear fashion with increasing number of children (0.23 years per additional child; p =.01), while life span of mothers increased linearly up to 14 children (0.32 years per additional child; p =.004) but decreased with each additional child beyond 14 (p =.0004). Among women, but not men, a later age at last birth was associated with longer life span (p =.001). Adjusting for age at last birth obliterated the correlation between maternal life span and number of children, except among mothers with ultrahigh (>14 children) parity. CONCLUSIONS We conclude that high parity among men and later menopause among women may be markers for increased life span. Understanding the biological and/or social factors mediating these relationships may provide insights into mechanisms underlying successful aging.
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Affiliation(s)
- Patrick F McArdle
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Abstract
A lost less is known about the morbidity and mortality consequences of male infertility. It was the aim of our study to analyse the association between sperm concentration and individual lifetime mortality in men. The data sources included medical records of 601 men who attended the andrological service at the Marburg University Hospital between 1949 and 1985, and vital data gathered from public registration offices and a statutory health insurance. A Cox regression model estimated a two-fold higher mortality risk for oligozoospermic men as compared to the normozoospermic group for cohorts born between 1892 and 1931. Since a selection bias could not be found, we assume there to be a connection between poor fertility status and a shorter lifespan in men. Possible explanations for the variation in mortality risk are: (i) Lifestyle and health behaviour in adulthood, (ii) conditions in utero, and (iii) genetic dispositions.
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Affiliation(s)
- Sabine Groos
- Department of Medical Sociology and Social Medicine, University Hospital of Marburg, Bunsenstrasse, Marburg, Germany.
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57
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Grundy E, Tomassini C. Fertility history and health in later life: a record linkage study in England and Wales. Soc Sci Med 2005; 61:217-28. [PMID: 15847974 DOI: 10.1016/j.socscimed.2004.11.046] [Citation(s) in RCA: 124] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2004] [Accepted: 11/18/2004] [Indexed: 11/27/2022]
Abstract
Women born at different periods within the 20th century in England and Wales have followed varying fertility pathways with large changes in, for example, proportions having no children or only one child. Among the consequences of these changes may be effects on women's health later in life. Links between fertility histories and later health and mortality have been investigated in several studies, but in many of these socio-economic characteristics have not been allowed for, even though there are socio-economic differences in both fertility and mortality patterns and results are conflicting. Here we analyse associations between the fertility histories of women born 1911-1940 in England and Wales and their mortality and health status after age 50. We used data from the Office for National Statistics Longitudinal Study; a record linkage study of approximately 1% of the population initially based on those enumerated in the 1971 Census of England and Wales. We used survival analysis to investigate the effects of parity, short birth intervals, and timing of fertility on mortality from age 50 to the end of 2000, controlling for a range of relevant socio-demographic characteristics. For survivors to 1991, we additionally used logistic regression to model probability of having a limiting long-term illness in 1991. We found that nulliparous women and women with five or more children had significantly higher mortality than other women, and that in the oldest groups women with just one child also had raised mortality. Women who had been teenage mothers had higher mortality and higher odds of poor health than other parous women. Mothers with short birth intervals, including mothers of twins, also had elevated risks in some cohorts. Late childbearing (after age 39) was associated with lower mortality. Personal demographic history is an important factor to consider in analyses of health and mortality variations in later life. More research is needed to further elucidate causal pathways.
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Affiliation(s)
- Emily Grundy
- Centre for Population Studies, London School of Hygiene and Tropical Medicine, 49-51 Bedford Square, London WC1B 3DP, UK.
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Helle S, Lummaa V, Jokela J. Are reproductive and somatic senescence coupled in humans? Late, but not early, reproduction correlated with longevity in historical Sami women. Proc Biol Sci 2005; 272:29-37. [PMID: 15875567 PMCID: PMC1634941 DOI: 10.1098/rspb.2004.2944] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Evolutionary theory of senescence emphasizes the importance of intense selection on early reproduction owing to the declining force of natural selection with age that constrains lifespan. In humans, recent studies have, however, suggested that late-life mortality might be more closely related to late rather than early reproduction, although the role of late reproduction on fitness remains unclear. We examined the association between early and late reproduction with longevity in historical post-reproductive Sami women. We also estimated the strength of natural selection on early and late reproduction using path analysis, and the effect of reproductive timing on offspring survival to adulthood and maternal risk of dying at childbirth. We found that natural selection favoured both earlier start and later cessation of reproduction, and higher total fecundity. Maternal age at childbirth was not related to offspring or maternal survival. Interestingly, females who produced their last offspring at advanced age also lived longest, while age at first reproduction and total fecundity were unrelated to female longevity. Our results thus suggest that reproductive and somatic senescence may have been coupled in these human populations, and that selection could have favoured late reproduction. We discuss alternative hypotheses for the mechanisms which might have promoted the association between late reproduction and longevity.
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Affiliation(s)
- Samuli Helle
- Section of Ecology, Department of Biology, University of Turku, FIN-20014 Turku, Finland.
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Dribe M. Long-term effects of childbearing on mortality: evidence from pre-industrial Sweden. Population Studies 2005; 58:297-310. [PMID: 15513285 DOI: 10.1080/0032472042000272357] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This paper presents an analysis of the impact of childbearing history on later-life mortality for ever-married men and women using historical micro-level data of high quality for southern Sweden. The analysis uses a Cox proportional hazards model, estimating the effects on old-age mortality of number of births and timing of first and last births. By studying the effects of previous childbearing on mortality by sex and social status, we also gain important insights into the mechanisms relating childbearing to mortality in old age. The results show that number of children ever born had a statistically significant negative impact on longevity after age 50 for females but not for males. Analysis by social group shows that only landless women experienced higher mortality from having more children, which seems to indicate that the main explanations are to be found in social or economic conditions specific to females, rather than in the strictly biological or physiological effects of childbearing.
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Affiliation(s)
- Martin Dribe
- Department of Economic History, Lund University, Lund, Sweden.
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Zeng Y, Gu D, Land KC. A new method for correcting under-estimation of disabled life expectancy and an application to the Chinese oldest-old. Demography 2004; 41:335-61. [PMID: 15209044 DOI: 10.1353/dem.2004.0018] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article demonstrates that disabled life expectancies that are based on conventional multistate life-table methods are significantly underestimated because of the assumption of no changes in functional status between age x and death. We present a new method to correct the bias and apply it to data from a longitudinal survey of about 9,000 oldest-old Chinese aged 80-105 collected in 1998 and 2000. In our application, the age trajectories of disability (activities of daily living--ADL), status-specific death rates, and the probabilities of transitions between ADL states of the oldest-old were investigated for the first time in a developing country. In this article, we report estimates of bias-corrected disabled and active life expectancies of the Chinese oldest-old and demonstrate patterns of large differences associated with initial status, gender, and advances in ages. Using combined information on ADL disabilities and length of having been bedridden before dying, we analyze gender and age patterns of the extent of morbidity before dying among the oldest-old and their implications for debates on the hypothesis of compression of morbidity.
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Affiliation(s)
- Yi Zeng
- Center for Demographic Studies, Department of Sociology, Duke University, Campus Drive, Box 90408, Durham, NC 27708, USA.
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