Exceptional Longevity in Men: Modifiable Factors Associated With Survival and Function to Age 90 Years

Data from twin studies suggest that modifiable factors are largely responsible for variation in life span, but it is unclear what modifiable factors earlier in life might potentiate survival in a few men to age 90 (exceptional longevity) and are associated with good health and function at an advanced age. This prospective cohort study evaluated modifiable risk factors in 2357 healthy men (mean age, 72) enrolled in the Physicians’ Health Study (PHS) between 1981 to 1984 who had the potential to live to or beyond age 90 years during a 25-year follow-up. Participants were born on or before 1915 and were followed until 2006. Self-reported questionnaires provided baseline and annual data on biological and lifestyle factors, and history of co-morbid conditions. Review of medical records confirmed death (the primary study outcome) and major age-related diseases (the secondary outcome). Late-life physical and mental health function were assessed by the Medical Outcomes Study 36-Item Short-Form Health Survey at 16 years after baseline. Of the 2357 men, 970 (41%), survived to or beyond age 90 years. Mean ages at death of nonsurvivors and survivors were 83 and 93 years, respectively (P < .001). The risk of mortality before 90 years of age was significantly increased by major modifiable adverse factors: smoking (hazard ratio (HR), 2.10; 95% confidence interval (Cl), 1.75–2.51); diabetes (HR, 1.86; 95% CI, 1.52–2.26); obesity (HR, 1.44; 95% CI, 1.10–1.90); and hypertension (HR, 1.28; 95% CI, 1.15–1.43). In contrast, regular exercise was associated with almost a 30% decrease in mortality risk (HR, 0.72; 95% CI, 0.62–0.83). The age-adjusted odds of survival to age 90 years with four or more adverse risk factors were reduced by 88%. At age 70, a male with no adverse risk factors had a 54% probability of living an additional 20 years. Exceptional longevity was associated with lower incidence and later onset of major age-related diseases, as well as significantly higher physical function (P < .001) and mental health scores (P < .03). These findings demonstrate that adoption of a healthy lifestyle during the early elderly years is associated with a significantly enhanced life span and provides substantial improvements in mental and physical function in men with exceptional longevity.