Mortality in Adults With Sickle Cell Disease and Pulmonary Hypertension

To the Editor: Dr Olshansky's research letter on the accelerated aging of US presidents concluded that presidents do not age faster than other men. 1 That may be true, but this study cannot demonstrate it due to a faulty comparison.Olshansky compared presidents' actual age at death (adjusted for aging by subtracting 2 days for every day in office) against average life expectancy for men matched to the date of inauguration.However, the correct comparison is with men who have the same profile of risk factors for premature death.For example, as Olshansky notes, education, wealth, and access to medical care strongly influence life expectancy, and these factors undoubtedly contributed to longer lives for many presidents.The real question is if, despite these advantages, presidents' lives were shortened.That requires comparison with other men of similar education, wealth, and access to medical care, and possibly with similar risk factors, such as smoking and alcohol consumption.Absent data permitting proper restriction, stratification, or control for confounding, the only conclusion that can be drawn is that presidents tend to be blessed with certain advantages that allow them to outlive men without those advantages.