title: Predictors of extraordinary survival in the Iowa established populations for epidemiologic study of the elderly: cohort follow-up to "extinction".
abstract: OBJECTIVE
  To identify predictors of extraordinary survival.
  
  
  METHODS
  Longitudinal study of a cohort of elderly people followed up until almost all have died.
  
  
  METHODS
  Two counties in Iowa; a part of the Established Populations for Epidemiologic Study of the Elderly.
  
  
  METHODS
  Two thousand eight hundred ninety community-dwelling citizens aged 65 to 85 at baseline and surviving at least 3 years.
  
  
  METHODS
  Data relating to age, sex, birth order, parental longevity, marital status, education, family income, social support, self-reported health, chronic diseases, blood pressure, body mass index, physical ability, exercise, life attitude and mental health were obtained. Extraordinary survivors (ESs) were defined to include approximately 10% of the longest survivors in their sex group.
  
  
  RESULTS
  The 253 ESs were far more likely never to have smoked. In models adjusted for age, sex, and smoking, the earlier-life factors such as parental longevity, being earlier in the birth order (in women only), and body mass index at age 50 were associated with extraordinary survival. In similar models for predictors at age 65 to 85, extraordinary survival was associated with excellent self-reported health, fewer chronic diseases, better physical mobility and memory, and positive attitude toward life, but it was not associated with depression, anxiety, or sleep quality. In multivariable models, attitude toward life was not an independent predictor. Women in the top third of a cumulative score of independent predictors were 9.3 (95% confidence interval=4.4-19.6, P<.001) times as likely to reach extraordinary survival as those in the bottom third.
  
  
  CONCLUSIONS
  ESs had fewer "classical" risk factors and were in better health than their contemporaneous controls. Possibly genetic factors such as parental longevity and birth order appear to be less predictive in men than in women.
authors.affiliation: Epidemiology and Public Health Group, Peninsula Medical School, University of Exeter, Exeter, United Kingdom.
authors.forename: Ambarish
authors.initials: A
authors.lastname: Dutta
authors.forename: William
authors.initials: W
authors.lastname: Henley
authors.forename: Iain
authors.initials: I
authors.lastname: Lang
authors.forename: David
authors.initials: D
authors.lastname: Llewellyn
authors.forename: Jack
authors.initials: J
authors.lastname: Guralnik
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wallace
authors.forename: David
authors.initials: D
authors.lastname: Melzer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001290:Attitude; D001722:Birth Order; D015992:Body Mass Index; D005260:Female; D015577:Geriatric Assessment; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008019:Life Style; D008136:Longevity / Q000235:genetics; D008297:Male; D008568:Memory; D009043:Motor Activity; D011159:Population Surveillance; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D014481:United States