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Supercentenarians and the oldest-old are concentrated into regions with no birth certificates and short lifespans

July 2019

July 2019

DOI:10.1101/704080

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Saul Newman

University College London

Preprints and early-stage research may not have been peer reviewed yet.

The observation of individuals attaining remarkable ages, and their concentration into geographic sub-regions or 'blue zones', has generated considerable scientific interest. Proposed drivers of remarkable longevity include high vegetable intake, strong social connections, and genetic markers. Here, we reveal new predictors of remarkable longevity and 'supercentenarian' status. In the United States, supercentenarian status is predicted by the absence of vital registration. The state-specific introduction of birth certificates is associated with a 69-82% fall in the number of supercentenarian records. In Italy, which has more uniform vital registration, remarkable longevity is instead predicted by low per capita incomes and a short life expectancy. Finally, the designated 'blue zones' of Sardinia, Okinawa, and Ikaria corresponded to regions with low incomes, low literacy, high crime rate and short life expectancy relative to their national average. As such, relative poverty and short lifespan constitute unexpected predictors of centenarian and supercentenarian status, and support a primary role of fraud and error in generating remarkable human age records.

Number and per capita rate of attaining supercentenarian status across US states, relative to the introduction of complete-area birth registration. Despite the combined effects of rapid population growth and increasing life expectancy during this period the total number of US

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Old-age poverty and the density of remarkable lifespans. A higher percentage of people are centenarians, SSCs and supercentenarians in high-poverty and income-deprived regions of rich countries.

…

Social hardship and the distribution of 105+ year old people in the United Kingdom. Across 128 regions containing at least one semisupercentenarian, the number of SSCs per capita is highest in regions where: (a) people are more deprived overall (r = 0.28; p = 0.001), (b) people over age

…

Relationship between mid-life and late-life survival across Italian provinces. Across Italian provinces (points), probabilities of survival in mid-life are positively correlated with the probability of

…

Figure S1. Poverty and the distribution of Japanese Centenarians. The 47 prefectures of Japan

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Supercentenarian and remarkable age records exhibit patterns indicative of clerical errors

and pension fraud

Saul Justin Newman*1

1Biological Data Science Institute, Australian National University

*Correspondence to: saul.newman@anu.edu.au

Abstract

The observation of individuals attaining remarkable ages, and their concentration into geographic

sub-regions or ‘blue zones’, has generated considerable scientific interest. Proposed drivers of

remarkable longevity include high vegetable intake, strong social connections, and genetic

markers. Here, we reveal new predictors of remarkable longevity and ‘supercentenarian’ status.

In the United States supercentenarian status is predicted by the absence of vital registration. In

the UK, Italy, Japan, and France remarkable longevity is instead predicted by regional poverty,

old-age poverty, material deprivation, low incomes, high crime rates, a remote region of birth,

worse health, and fewer 90+ year old people. In addition, supercentenarian birthdates are

concentrated on the first of the month and days divisible by five: patterns indicative of

widespread fraud and error. As such, relative poverty and missing vital documents constitute

unexpected predictors of centenarian and supercentenarian status, and support a primary role of

fraud and error in generating remarkable human age records.

.CC-BY-NC-ND 4.0 International licensecertified by peer review) is the author/funder. It is made available under a The copyright holder for this preprint (which was notthis version posted May 3, 2020. . https://doi.org/10.1101/704080doi: bioRxiv preprint

Introduction

The concentration of remarkable-aged individuals, within geographic regions or ‘blue zones’ [1]

or within databases of people exceeding extreme age thresholds [2,3], has stimulated diverse

efforts to understand factors driving survival patterns in these populations [4,5]. Populations

within remarkable-age databases and ‘blue zone’ regions have been subject to extensive analysis

of lifestyle patterns [5–8], social connections [4,9], biomarkers [10,11] and genomic variants

[12], under the assumption that these represent potential drivers behind the attainment of

remarkable age.

However, alternative explanations for the distribution of remarkable age records appear to have

been overlooked or downplayed. Previous work has noted the potential of bad data [13],

population illiteracy [14] or population heterogeneity [15] to explain remarkable age patterns.

More recent investigations revealed a potential role of errors [16–19], and potential operator

biases [20] in generating old-age survival patterns and data. In turn, these findings prompted a

response with potentially disruptive implications: that, under such models, the majority if not all

remarkable age records may be errors [21].

Here, we explore this possibility by linking civil registration rates and socioeconomic data to

per-capita rates of remarkable age attainment, using data from every known centenarian

(individuals aged 100 or over), semisupercentenarian (SSCs; aged 105 or over), and

supercentenarian (aged 110 or over) from the USA, France, Japan, the United Kingdom, and

Italy (Fig 1).

These data reveal that remarkable age attainment is predicted by regional indicators of error and

fraud including greater poverty, higher illiteracy, higher crime rates, worse population health,

greater levels of material deprivation, shorter average lifespans, fewer old people, and the

absence of birth certificates. In addition, French and Italian historical data indicate that

supercentenarians are not likely to be born into longer-lived cohorts, but are born into

undifferentiated or shorter-lived populations relative to their contemporary national averages.

Supercentenarian birthdates also exhibit ‘age heaping’ distributional patterns that are strongly

indicative of manufactured birth data. Finally, fewer than 15% of exhaustively validated

supercentenarians are associated with either a birth certificate or a death certificate, even in

populations with over 95% death certificate coverage.

As such, these findings suggest that extreme age data are largely a result of vital statistics errors

and patterns of fraud, raising serious questions about the validity of an extensive body of

research based on the remarkable reported ages of populations and individuals.

Figure 1. Regional distributions for the density of remarkable longevity. The large majority of SSCs

are concentrated in a few countries, each exhibiting large regional variation in density of remarkable

longevity records. Most supercentenarians are concentrated in the USA (a), with large numbers in France

and the UK (b), and Italy (c; life table estimated rates). Within these countries, there exists marked

variation in the density of remarkable age records: for example, variation in SSC density per capita across

the UK (d) includes a 19-fold difference in SSC abundance within London (e) between Tower Hamlets

(region 7; most) and Barnet (region 10; least), with similar variation in SSC density across the Italian

provinces (f).

Results

After removing countries with incomplete data or inadequate spatial resolution, and omitting

individuals with unknown birth locations, this analysis included all known individuals over age

100 in Japan and Italy, all known SSCs and supercentenarians in the UK, the 99.4% of known

GRG supercentenarians in the USA with documented birth locations (IDL data have had such

data removed or omitted), and all 175 supercentenarians in France with documented birth

locations. In total, over 81% of the total global supercentenarian population were located to their

region of birth.

Between the 1880 and 1900 census, a period covering 79% of US supercentenarian births, the

US population increased by 150% and average life expectancy by twenty per cent [22,23]. The

introduction of complete-coverage vital registration in the USA coincided with this rapid

increase in lifespan and population size, and was expected to result in a large increase in the

number of supercentenarian records per capita.

Instead, the introduction of state-wide birth certification coincides with a sharp reduction in the

number of supercentenarians born in each state. In total, 82% of the GRG supercentenarian

records from the USA predate state-wide birth certification. Forty-two states achieved complete

birth certificate coverage during the survey period. When these states transition to state-wide

birth registration, the number of supercentenarians falls by 80% per year overall (Fig 2a) and

69% per capita (Fig 2b) when adjusted relative to c.1900 state population sizes. The observed

drop in supercentenarian number after birth registration remained after right-censoring the GRG

data by as much as 10 years to allow for the delayed or incomplete reporting of recent deaths (S1

Code).

Figure 2. Number and per capita rate of attaining supercentenarian status across US states, relative

to the introduction of complete-area birth registration. Despite the combined effects of rapid

population growth and increasing life expectancy during this period the total number of US

100

supercentenarians in the GRG database (a) falls dramatically after birth certificates achieve state-wide

coverage (vertical blue line). This trend remains after adjusting for total population size c.1900 (b) within

each state.

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In countries with more complete birth documentation, high poverty rates were the best predictor

remarkable age records. This interaction was unexpectedly positive, with increased poverty

predicting a higher density of centenarians per capita in Japan (Fig S1c), SSCs per capita in the

UK, and supercentenarians per capita in both France and the UK (Fig 3; S2 Code). Old-age

specific measures of poverty, available in France and the UK, increased the strength of this

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relationship. Higher rates of old-age poverty are linked to higher densities of remarkably old

people: the amount of old-age poverty alone predicts up to seventy per cent of the variation in

extreme longevity (Fig 3; S2 Code).

When aggregated into the larger NUTS-3 regions containing at least one SSC, the level of

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income deprivation in older people or IDOP, an indicator of the fraction of people aged 60+

suffering poverty and income stress, predicts around 40% of the variation in SSC abundance per

capita across regions in the UK (r =0.42; p = 0.0000009; 127 regions; Fig 3a). That is,

throughout the UK higher income deprivation rates in older people predict higher numbers of

people surviving past age 105. The accuracy of this basic poverty model improves markedly

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when predicting the number of SSCs as a percentage of all 90+ year old residents, rather than the

number of SSCs per capita (r =0.70; p < 1x10-15; Fig 3d). As such, the highest concentration of

remarkable lifespans in the UK arise in London’s east end boroughs near Stepney and the Isle of

Dogs, followed by urban Manchester, Tyneside, and Liverpool: the UK ‘blue zones’ (Fig 1;

Table S1).

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As in the UK data, the density of French supercentenarians is also predicted by higher poverty

rates in the population age 75 and over (r = 0.42; p = 0.0003). However, this number was

markedly reduced by the three overseas departments (Guadeloupe, Martinique and La Réunion)

included in the regression which were marked outliers for both poverty and supercentenarian

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rates (S2 Code). If these three outliers were trimmed, correlations between over-75 poverty rates

and supercentenarian abundance increased (r = 0.58; p = 3e-07; Fig 3e; S2 Code). Again, like the

UK data, these estimates also improved for predictions of the percentage of 90+ year-olds who

also exceeded age 110. Across the 66 regions of France with sufficient data, the poverty rate over

age 75 predicted half of the variation in supercentenarian abundance per 90+ year old (r=0.51, p=

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0.00001; Fig. 3e).

Figure 3. Old-age poverty and the density of remarkable lifespans. A higher percentage of people are

centenarians, SSCs and supercentenarians in high-poverty and income-deprived regions of rich countries.

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Metrics of poverty and old-age poverty are positively correlated with the density of SSCs per capita in the

United Kingdom (a; r = 0.42; p < 0.000001; 127 regions), supercentenarians in France (b; r = 0.42; p =

0.0004; 66 departments; r = 0.58 in the 63 mainland departments), and centenarians in Japan (c; r = 0.36;

p = 0.01; 47 prefectures). These relationships strengthen if density is instead measured by the fraction of

90+ year old people who exceed age 105 (d, UK; r = 0.71, p < 2e-16), age 110 (e, France; r = 0.51; p =

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0.00001), or age 100 (f, Japan; r = 0.62, p = 0.000004).

In Japan, poverty rates in the general population were also positively correlated with the density

of remarkable lifespans (r = 0.36; p = 0.01; Fig 3c). Again, this interaction strengthens when

poverty rates are used to predict the fraction of 90+ year old people living past age 100 (r = 0.62;

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p = 4e-06; Fig 3f). While old-age specific estimates of poverty in Japan appear to be unavailable,

although language barriers made this uncertain, such estimates are forthcoming. It can be

predicted that these estimates of old-age poverty may provide an even better predictor of

centenarian abundance than overall poverty rates.

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In addition to the unexpected relationship with poverty rates, the number of centenarians in

Japan is also negatively correlated with income per capita (r = -0.44, p=0.001), the minimum

wage (r = -0.64; p = 1e-09), and the Japanese financial strength index (r = -0.70; p = 3e-08)

across all 47 Japanese prefectures. Prefectures that spend more money on old-age welfare per

capita, a disincentive for welfare fraud, also produce fewer centenarians per capita (r = -0.49; p=

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0.0004). These factors share latent drivers and are highly autocorrelated: prediction models for

centenarians per capita based solely on poverty (R2 = 0.37; p= 0.0001; S2 Code) approach the

accuracy of linear mixed models containing all available socioeconomic variables (R2 = 0.43; p =

3e-06) yet have a lower Akaike’s information Criteria (S2 Code).

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In the UK, which had the most abundant granular data available at the NUTS-3 regional level,

socioeconomic indicators collectively predicted half of the regional variation in SSC density

when fitted as interactive effects in a linear mixed model (Fig 4; adjusted R2 = 0.0.39; p = 6.09e-

05; S2 Code). Under a one-way analysis of variance, the best predictors of SSC density per capita

were the Indices of Multiple Deprivation or IMD, a multidimensional indicator of area-level

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hardship and poverty (Fig 4a; F value = 20.3; p = 2e-05), the IDOP indicator of old-age poverty

(Fig 5b; F value = 16.5; p = 9e-05), and purchase-power standard adjusted gross domestic

product or PPS-adjusted GDP (F value = 10.3; p = 0.002; S2 Code). When predicting the number

of SSCs per 90+ year old across the UK, this socioeconomic model captures 80% of the variance

in SSC abundance (adjusted R2 = 0.80; p < 2.2e-16; S2 Code), again largely through the effect of

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IMD (F value = 61.8; p = 6e-12), IDOP (F value = 326.4; p < 2.2e-16), and the interaction

between IDOP and the UK crime index (F value = 29.7; p = 4e-07), all of which predict higher

SSC density under worse conditions.

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Figure 4. Social hardship and the distribution of 105+ year old people in the United Kingdom.

Across 128 regions containing at least one semisupercentenarian, the number of SSCs per capita is

highest in regions where: (a) people are more deprived overall (r = 0.28; p = 0.001), (b) people over age

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60 are more income-deprived (r = 0.42; p < 0.000001), (c) multidimensional health indices are worse (r =

0.23; p =0.01), and (d) crime rates are higher (r = 0.22; p= 0.01). In contrast, regions with a higher

fraction of people surviving past 90 years of age (e), have significantly fewer SSCs per capita (r = -0.18, p

= 0.04). A simple linear mixed model (f) fit to these five variables, PPS-adjusted GDP, and employment

rates (S2 Code), accurately predicts the regional density of SSCs across the UK (r = 0.74; adjusted R2 =

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0.39; p = 1e-06).

Fitted as interactive effects in a linear mixed model, general and old-age poverty rates predicted

46% of the variance in supercentenarian density across France (overseas territories included,

adjusted R2 = 0.44; p = 1e-08; S2 Code). When PPS-adjusted GDP per capita, unemployment

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and murder rates per capita were also included as fixed effects, these inputs collectively captured

46% of the variance in supercentenarian density across France, an increase caused by

interactions of PPS-adjusted GDP with both overall and old-age poverty rates (adjusted R2 =

0.56; p = 1e-08; S2 Code).

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Direct measurements of provincial poverty rate were not available for Italy at the NUTS-3

regional level. Instead, the attainment of remarkable age in Italy is predicted by worse early- and

mid-life health. While survival to age 55 is positively correlated with life expectancy at all ages

at all ages from 60 to 95, higher early- and mid-life survival are inversely correlated with

mortality rates after age 95 (Fig 5a). Cohort survival to age 55 is increasingly negatively

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correlated with survival to ages 100 (Fig 5b), 105 (Fig 5c) and 110 years (Fig 5d), and with life

expectancy at age 100 (r = -0.4; p=0.00001; S2 Code). That is, autocorrelation between age-

specific survival breaks down and inverts at advanced ages, such that better survival to mid-life

is linked to worse survival in advanced age. Contrary to expectations yet again, both a lower

probability of survival to age 55, and higher probability of death at age 55, are linked to a higher

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density of remarkable age records (S2 Code).

Figure 5. Relationship between mid-life and late-life survival across Italian provinces. Across Italian

provinces (points), probabilities of survival in mid-life are positively correlated with the probability of

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survival at older ages until around age 95 (a; r = 0.15; p=0.1; N=116). However, this relationship inverts

at advances ages: better mid-life and early-life probabilities of survival, and higher average longevity, are

linked to significantly lower probabilities of survival at 100 years (b), 105 years (c), or 110 years (d) of

age. Sardinian provinces shown in blue.

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Population sizes, GDP per capita, PPS-adjusted GDP per capita and employment rates were

available at a sufficiently granular level across Italy for basic analysis. Individuals across Italy

were more likely to attain supercentenarian ages if their province has a worse economy (Fig S2a-

c), higher unemployment rates (Fig S2d-f), and fewer people over the age of 90 (Fig S2g-I; S2

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Code). However, a linear mixed model with cohort life expectancy to age 55 had a significantly

lower Akaike’s information criteria, compared to a linear mixed model containing these basic

economic indicators as interactive effects (S2 Code).

As in Italy, French historical data did not reveal the expected positive relationship between life

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expectancy and supercentenarian status. There are 143 French supercentenarians whose region of

birth had a corresponding local and national estimate of life expectancy at birth. For these

individuals, cohort life expectancy for the region and year of birth was lower than, but not

significantly different from, the contemporary national average (p = 0.52; N = 143; Fig S3). That

is, supercentenarians were not, on average, born into regions with either significantly longer or

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shorter than expected life expectancy across metropolitan France. It seems unusual that modern

economic conditions and poverty rates are predictive of reaching age 110, yet life expectancy at

birth is not (Fig S3).

While informative of general trends, these models mask large regional anomalies in the pattern

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of remarkable age records. Several of these anomalies, particularly those regions with the very

highest number or density of extreme age records, require some comment.

For example, Scotland and Northern Ireland have a combined modern population of seven

million people, yet produced only three known SSCs. In contrast, the 24-fold smaller population

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of Tower Hamlets has produced fifteen SSCs: the most SSCs per capita in the UK (Table S1).

However, Tower Hamlets also has the highest poverty rate, highest child poverty rate, the

shortest disability-free life expectancy, the highest income inequality, [24], and the worst index

of multiple deprivation [25] of all 32 London boroughs. Of all 317 local authority districts in the

UK, Tower Hamlets has the single most income-deprived population of older people [25]. Of

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these 317 local area districts, Tower Hamlets also has the smallest percentage of people aged 90

and over [25]. This is a notable discrepancy.

Adjacent to Tower Hamlets, the borough of Southwark & Lewisham ranks second for SSCs per

capita, and first for SSCs overall (N= 31) across the 175 NUTS-3 regions of the UK (Table S1).

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Southwark & Lewisham is also the eighth most income-deprived district for older people in the

UK, and has the fifth-fewest 90+ year old people per capita [25]. Outside of London, Tyneside

and Greater Manchester are strongly represented. For example, Manchester produced 18 SSCs

overall (equal sixth) and ranks 14th for SSCs per capita (Table S1), yet is the third most income-

deprived district for older people in the UK, and has the highest crime index, third-worst

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population health index, fourth-worst index of multiple deprivation, and sixth smallest

percentage of 90+ year old people of any region (Table S1). These rankings are not a recent shift:

Manchester is the second most-persistently deprived of the 317 local-authority districts in the

UK [25].

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As in the UK, French regions illustrate a concordance between regions with the highest poverty

and the regions with the most remarkable age records. The mainland region of Creuse has the

highest per capita rank of supercentenarians under the IDL rankings (Table S2), potentially due

to the combined effects of having a 60% reduction in population size since 1901, the fourth-

highest old-age poverty rate, the 16th worst poverty rate overall, and the fourth-lowest GDP per

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capita (Table S2).

Guadeloupe and Martinique rank equal second for total supercentenarians after Paris, and second

and third for supercentenarians per capita, with at least eight supercentenarians each (Table S2).

Martinique has the second-highest poverty rate, both overall (29%) and for people aged 75 and

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over (31%), in all of the 101 NUTS-3 coded provinces. While not monitored by Eurostat, third-

ranked Guadeloupe has a 24% unemployment rate [26]. Of the Eurostat regions only Réunion

has higher poverty rates, with 39% of citizens falling below the poverty line. Again, these

rankings seem inconsistent with the general drivers of population health.

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French supercentenarians are over-represented in the overseas departments, former colonial

holdings, and Corsica (which is included in metropolitan France; Table S2): regions that

historically constitute some of the most neglected, least well-documented, and shortest-lived

administrative regions of France. As a result, many of these regions are absent from the above

models due to absent or insufficient population data and reporting.

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At the first reliable estimate of population size in 1950, overseas departments and colonial

holdings contained around 1.7% of French citizens. However, at least 11% (N=16) of the French

supercentenarians in the GRG database originate there: a 6.5-fold over-representation. This

number increases when integrating deidentified IDL data, which only includes regions monitored

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by Eurostat (Réunion, Guadeloupe, and Martinique), to establish a minimum numbers of

supercentenarians born in each region. Under these estimates, the overseas and former colonial

regions of France contain a minimum of twenty-four (15.5%) of the total 155 supercentenarians

with known birth locations. Guadeloupe and Martinique each contain eight supercentenarians,

and French Algeria contains four, Saint Barthélemy, Réunion, French Guiana, and New

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Caledonia at least one each.

If this minimum count across the IDL and GRG databases is used, the overseas and colonial

holdings of France contain eight times as many supercentenarians per capita (1.5 per 100,000),

and more supercentenarians overall (N=24), than the region of Île-de-France (0.16 per 100,000;

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N=19). This is despite Île-de-France earning more than double the income per capita, being the

longest-lived region in mainland France, and containing seven times as many citizens c.1900

when these supercentenarians were born.

Similar anomalies occurred in Japan and Italy. Of 114 total regions, the Italian province of

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Olbia-Tempio ranked as the best province for survival to ages 100,105 and 110, yet somehow

was also the seventh-worst ranked province for survival to age 55, and according to Eurostat had

the eighth-fewest residents surviving over the age of 90 (Table S3). The first and second ranked

Japanese prefectures for centenarians per capita, Shimane and Kochi, had the worst and second-

worst regional economic rankings, while extensive anomalies in third-ranked ‘blue zone’

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Okinawa are detailed below (Table S4).

Overall patterns observed in the IDL and GRG database also provided indications of widespread

error. Contemporary US births have a near-uniform distribution of births with minimal deviation

from random sampling (Fig S4a), driven by the aseasonal and approximately equal distribution

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of days of the month (e.g. the 1st or 2nd of each month) throughout the year. Even after the

widespread uptake of induced births and surgical births, which avoid weekends and public

holidays, birthdays generally varying by less than two per cent across different days of the

month. In contrast with this uniform distribution, supercentenarians in the GRG database are

142% more likely to be born on the first day of the month and 1.2-fold as likely to be born on a

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day that is divisible by five (Fig S4b). The number of supercentenarians born on the first day of

the month is 150% higher than on the preceding calendar day (S1 Code). Given the near-

complete absence of caesarean sections in these population, this age-heaping pattern can be

explained if a large percentage of people are non-randomly choosing their birthday.

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The first day of the month was not over-represented amongst the IDL data, and the 5-day

enrichment was less pronounced (Fig S4c). This was initially difficult to reconcile, given these

databases overlap considerably and ideally contain the same set of individuals. However, this

differential appears to be a result of dates of birth being removed for 48% (N=797) of the IDL

supercentenarians.

330

These patterns can be explained because most of the signal for age heaping in the GRG data

arises in Japanese and US birthdates (S2 Code): Japanese supercentenarians were 2.77 times

more likely and US supercentenarians were 1.57 times more likely to be born on the first day of

the month. The IDL does not document Japan and unusually, despite comprehensive US birth

335

dates being known and available, every US supercentenarian in the IDL database has had their

day and month of birth removed. No other country received a similar treatment. With these dates

excised from the database, evidence of heaping in the IDL data is reduced (Fig S4c; S1 Code).

340

Discussion

Basic economic and social indicators in the modern economy, such as GDP per capita and

poverty rates, provide adequate predictors of the distribution of extreme age records. Despite

constraints on model construction and accuracy, such as unavoidable differences in per capita

345

adjustments, these basic models approached reasonable accuracy. However, the direction of

these interactions is the opposite of rational expectations.

Diverse social and economic indicators normally linked to worse health outcomes, such as

income deprivation, poverty, and high unemployment, are all positively associated with a higher

350

probability of reaching an extreme age. These factors are linked to a lower probability of survival

and worse health outcomes at every age below 90, for every population included in this study.

However, these factors exhibit a consistent positive association with extreme longevity. In the

UK, which contains the only national data with sufficiently granular regional health measures,

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even poor health itself is positively associated with attaining a remarkable lifespan (Fig 4c).

Viewed in isolation such a question may, perhaps, be explained away by reference to unknown

lifestyle factors. However, these findings should be considered in the context of other diverse

and incongruous patterns observed in extreme old age studies.

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Indicators of error and fraud in national data

Data used in this study raise simple questions as to why basic socioeconomic indicators of poor

health, and positive correlates of crime and government neglect, are linked to higher per capita

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numbers of remarkable longevity. For example, the UK has produced 1075 SSCs overall, and

Italy 3,638 SSCs overall, across an approximately equivalent timeframe [27]. However, Italy is a

historically smaller, poorer, less well-educated, and shorter-lived country. In 1900 the UK had

eight million more inhabitants than Italy, a 1.22-fold larger population [28]. Citizens of the UK

also enjoyed 2.5 times the GDP per capita, earned 3.5 times higher wages in real terms, had 1.25

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times lower income inequality, received 2.2 times the average education (with just 5.3 years of

schooling), were four times less likely to be murdered, were 3.8cm taller, and lived 5.3 years

longer on average than people in Italy [28]. Given these indicators and the long history of birth

records in both countries, it is difficult to reconcile why the healthier, wealthier, better-educated,

taller, and longer-lived population of the UK produced roughly a quarter as many SSCs per

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capita. One explanation is that remarkable age records result, not from better health or greater

longevity, but from the historical accumulation of illiteracy-driven errors and the modern

dynamics of poverty-driven fraud.

Relative to the global average, states containing remarkable age records generally constitute rich,

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literate, long-lived and well-documented populations, usually with an extensive history of vital

statistics documentation. As a result, the existence of widespread errors and pension fraud is

often assumed to be unlikely or impossible in these countries. However, such national

advantages are no guarantee of data quality.

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High-quality universal registration systems often contain undetected high-frequency errors.

Contrary to previous assertions that “Japan has…among the highest quality data for the oldest-

old” [29], a 2010 investigation of Japanese records revealed that 238,000 centenarians were

actually missing or dead[30]. The Japanese Ministry of Health and Welfare [31,32] now estimate

there were 43,882 Japanese centenarians alive in 2010: an 82% reduction, and a notable contrast

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to the idea that “Japanese demographic data have always been considered extremely reliable”

[33].

Similar instances have occurred elsewhere. In 1997 Italy discovered it was paying 30,000

pensions to dead people [30]. In the USA, a recent analysis cross-checking census and death

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records found at least 17% of centenarians and 35% of 109+ year-olds were actually errors

[16,34]. In 2011, just one of several Greek social insurance institutes was caught paying the

pensions of 1,473 dead people who had ‘survived’ past the age of 90. A subsequent 2012

investigation by the Greek labor ministry was triggered by the “unusually high number of 9,000

Greek centenarians drawing old-age benefits” [35], a notable figure given the 2011 Greek

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census found only 2,488 living centenarians [36]. Assuming the census contains no type I errors,

which is unlikely given the high rate of active pension fraud, at least 72% of Greek centenarians

had been collecting their pensions whilst dead.

Despite the Greek labor ministry paying a fraction of all Greek pensions, its investigation

405

revealed over 200,000 pensions were being paid to fraudulent claimants including ‘blind’ taxi

drivers and dead people [35]. An estimated two per cent of Greeks were engaged in benefits

fraud at the time of the ‘blue zone’ surveys, and thousands of these dead pensions were still

being paid in 2013.

410

These examples refute claims that the suggested existence of widespread pension fraud or errors

in databases of SSCs and supercentenarians is “not credible” [21]. Unlike academics seeking to

generate old-age databases, governments have both a direct financial incentive to detect pension

fraud, and the considerable resources required to do so: and yet, developed-world governments

routinely fail to detect thousands of cases of document-based pension fraud.

415

Indicators of error and fraud in blue zones

Results presented in this study may reflect a general neglect of error processes as a potential

generative factor in remarkable age records, and the omission of evidence from national

420

statistical bodies. This potential for disregarding important context and national statistical data

may be most evident when considering the case of ‘blue zones’: proposed regions of remarkable

longevity [37].

The ‘blue zone’ of Okinawa has the highest number of centenarians per 90-99-year-old of any

425

Japanese prefecture and remains world-famous for remarkable longevity[37]. However,

according to the statistics bureau of Japan, Okinawa also has the fewest senior citizens per

capita, the highest murder rate per capita, the worst over-65 dependency ratio, the second-lowest

median income, and the highest unemployment rate of some 47 Japanese prefectures [32].

Despite prior claims of dietary benefits based on vegetable and sweet potato consumption [37],

430

Okinawa has the single lowest per capita intake of sweet potato, at 64% of the Japanese average

intake. Okinawa also has the single lowest consumption per capita of fruit, vegetables, seafood,

taro, shellfish, root vegetables, pickled vegetables, and oily fish such as sardines and yellowtail

[32]. Okinawa has the second-highest per capita intake of beer, the fourth-highest alcohol

consumption, the most ‘flophouses’, the most ‘shotgun’ weddings, the highest per-capita intake

435

of Kentucky Fried Chicken [32], and according to USDA estimates Okinawans consume an

average 14 cans of spam per year each [38]. Okinawa has a 36% child poverty rate, 15% higher

any other prefecture [39]. Mortality rates in Okinawa ‘cross over’ after age 50, such that older

individuals and cohorts have age-specific mortality rates far below the national average [33]: a

pattern indicative of unreliable data and misreported ages [13]. Okinawa also has the second-

440

lowest minimum wage (by one yen), the lowest household savings, the highest percentage of

over-65s on income assistance, the highest poverty rate [39], and the worst average body mass

index of all 47 prefectures [32]. These rankings have not changed substantially since the blue

zone surveys and do not represent a recent sudden shift away from traditional lifestyles. Again, it

seems unusual that so few of these issues have been raised by an extensive body of

445

demographers, epidemiologists, and public health scientists familiar with the ‘blue zones’

concept.

There are other well-known drivers of error in the Japanese vital registration system. Birth and

marriage records in Japan are not generated by a central bureaucracy, but instead are hand-

450

recorded by family members as ‘Koseki’ documents, which are then filed in local town halls and

government offices. This combination of citizen self-reporting and government filing allows the

propagation of errors without requiring fraud. In Okinawa, this broad potential for error

generation has also been compounded by a different class of error processes.

455

The large-scale US bombing and invasion of Okinawa involved the destruction of entire cities

and towns, obliterating around 90% of the Koseki birth and death records [33] with almost

universal losses outside of Miyako and the Yaeyama archipelago [40]. Post-war Okinawans

subsequently requested replacement documents, using dates recalled from memory in different

calendars [40], from a US-led military government that largely spoke no Japanese. The number

460

of these replacement Koseki documents issued, a proxy measure of American bombing and

shelling intensity, predicts 79% of the variation in centenarian status in Okinawa [33].

Like the ‘blue zone’ islands of Sardinia and Ikaria, Okinawa represents deprived regions of rich,

high-welfare states. These regions may have higher social connections, and arguably may have

465

had higher vegetable intakes in the past, but they also rank amongst the least educated, poorest,

highest-crime and least healthy regions of their respective countries.

These patterns were reflected in this study’s findings on the ‘blue zone’ provinces of Sardinia,

which during the ‘blue zone’ surveys had the highest murder rate in Italy [41]. The primary ‘blue

470

zone’ province of Ogliastra has the single lowest survival rate to age 55 and the highest

unemployment rate of 116 regions in Italy (Table S3), while potential issues in the Greek data

may be clear from the previous discussion.

The two remaining blue zones, Loma Linda and the Nicoya Peninsula, are considered

475

exceptional due to their high average longevity rather than the presence of extreme outliers for

longevity. As such, these claims are not relevant to assessments of supercentenarian status, yet

their analysis also raises serious questions and broader issues in extreme longevity research. For

example, Loma Linda is a Californian suburb containing just 23,000 people, designated as a

‘blue zone’ because of an estimated average lifespan of 86 years for females and 83 years for

480

males. This average lifespan is matched or exceeded by the 125 million citizens of Japan, the

seven million citizens of Hong Kong, and the seven and a half million citizens of Singapore [42].

When assessed independently by the Centers for Disease Control (CDC) the five small-area

survey tracts covering Loma Linda instead have an average life expectancy of 76 to 81 years

[43]: the 27th to 75th percentiles of US life expectancy (Fig S5). At best, the independent CDC

485

estimates rank Loma Linda as the 16,102nd most long-lived neighborhood in the USA (Fig S5;

S1 code).

Loma Linda is not a standard census tract but a custom-selected region within a larger

geographic area, the largest US county of San Bernadino, with an average lifespan of 78 years

490

[43,44]. The Nicoya peninsula in Costa Rica, where independent estimates are currently not

available, is also a non-standard region cut from several independent census units of moderate

life expectancy by proponents of the ‘blue zone’ concept. The first ‘blue zone’ was described by

drawing circles on a map with a blue pen [45] across two standard, independently surveyed

regions of Italy with the lowest and sixth-lowest probability of survival to age 55 [46]. As such,

495

it seems somewhat debatable that these regions should be regarded valid outliers for human

longevity.

Indicators of error and fraud in health studies

500

Like anomalous population-scale patterns, indicators of poverty and fraud and contra-indications

of health are regularly ignored or downplayed in studies of extreme age. For example, smoking

rates of e.g. 17-50% and illiteracy rates of 50-80% are often observed in samples of the oldest-

old [7,8]. Surveying the ‘blue zone’ of Ikaria, Chrysohoou et al. observed that the oldest-old

have: a below-median wage in over 95-98% of cases, moderate to high alcohol consumption

505

(5.1-8.0 L/ year), a 10% illiteracy rate, an average 7.4 years of education, and a 99% rate of

smoking in men [4].

In the Tokyo study of exceptional longevity 15.4% of centenarians were current smokers [47].

However, according to the national statistics bureau of Japan, above the age of 80 only 3.9% of

510

Japanese women (78% of the Tokyo sample were women) and 19.3% of men are smokers [48].

Tokyo centenarians smoke at around twice the rate that could be expected in a younger 80+ year

old cohort with an identical sex ratio. Likewise, 80% of the ‘exceptional’ health-status

centenarians in Tokyo drank alcohol every day, followed by 49% of the ‘normal’ and less than

40% of the ‘frail or fragile’ centenarians, which resulted in “a [significant] positive relationship

515

between drinking habits and functional status” [47]. In contrast, in the general population only

2.8% of women and 23% of men aged 80+ drink every day [48]. In men aged 60-69, the

heaviest-drinking cohort in Japan, daily drinking rates peak at 36.7%: less than half the rate of

the exceptionally healthy centenarians [48]. Tokyo centenarians drink at higher rates than any

other age group, and smoke at rates equal to a population 45 years younger [48].

520

In the USA only 8.4% of general population over the age of 65 smoke, and in Europe 4.1%

population over the age of 75 smoke: figures that continue to fall with age due to two-fold higher

mortality rates in smokers [49,50]. However, in the US and Europe individuals over the age of

100 smoke and drink at much higher rates [4]: in one US centenarian study [6] 60% of people

525

over age of 95 were former smokers, compared to just 25% of individuals over the age of 65 in

the broader USA.

Anomalies where harmful health behaviors become more prevalent with age is common in

centenarian studies. For example, comparisons of lifestyle factors in centenarians to earlier

530

surveys of the same cohort [6], revealed that centenarians have a similar or worse body mass

index, and worse rates of physical activity, smoking, and alcohol consumption, than younger

representatives of their birth cohort. Rajpathak et al. concluded that these similar or worse

lifestyle indicators meant centenarians were representative of the baseline population,

documented by the NHANES I survey, from which they were drawn [6]. However, this

535

comparison was made between a population who were on average 97.5 years old [6], and

individuals who were aged 35 years younger.

Longitudinal follow-up surveys of the NHANES I comparison cohort reveal a linear decrease in

the number of smokers and drinkers with age until age 85 that is typical of almost all

540

populations. This reduction is caused by increased all-cause mortality, at all ages below 95, in

individuals who smoke and drink [51,52]. After just 9.2 years, over 33% of people who were

current smokers in the NHANES I cohort had quit smoking, 8.9% remained current smokers, and

13% were either current or former smokers: the rest were deceased. Therefore, the observation of

60% smoking rates in centenarians [6], who are older representatives of the same cohort,

545

presents some difficulty.

The increasing frequency of past harmful behavior with age also occurs in longitudinal studies of

the oldest-old, suggesting these patterns do not result from ascertainment biases or population

differences. For example, in the Leisure World Cohort Study of over 11,000 retirees 78% of men

550

and 72% of women in the initial 71-year-old population were moderate to heavy drinkers [53].

Individuals who drank daily throughout the 23-year follow-up period of this study had a

significantly lower mortality risk, even those drinking 2-4 times over the CDC clinical threshold

for ‘excessive’ drinking [54]. In contrast with normal clinical patterns, abstaining from alcohol

significantly increased mortality risk while drinking at the most dangerous levels, 28 or more

555

alcoholic beverages a week, was associated with an unexplained 9-16% reduction in the risk of

death [54].

It is unclear why clinically excessive drinkers or daily smokers should survive at equal or higher

rates, and increase in population frequency at extreme ages, unless these lifestyle factors are

560

positively correlated with committing fraud or having an incorrect age.

The frequency of birth and death certification, indicators that are linked to data quality but not

health outcomes, are suggestive of the latter. In the benchmark New England Centenarian Study,

only 30% of enrolled centenarians have an official birth document of any description [55]. This

565

rate of documentation is lower than the background population, with every state in New England

achieving state-wide birth certificate coverage by 1897 [22]. For the remaining 70% of

centenarians without birth documents, age validation was carried out using US census data, as a

best-case scenario, or documents including “military certificates, an old passport, school report

card, family bible, and baptismal or other church certificate” [56]. Twenty-two years after the

570

New England study used US census data for validation and study enrolment, and after the

publication of extensive research findings, at least 17% of centenarians in the US census data

were discovered to be errors [16,34].

Birth certificates are also rare in databases of remarkable age records. Just 19% of all

575

supercentenarians and 20% of the ‘exhaustively’ validated supercentenarians are listed as having

either an original or copied birth certificate by the IDL [57]. Overall only 6.6% of

supercentenarians have an original birth certificate, and 74% of cases have no reported birth

documents of any kind: not even parish register data is recorded. None of the 797 SSCs from the

USA is listed as having a birth certificate, and 41% of these cases have the possibility of a birth

580

certificate explicitly ruled out [57].

These high rates of missing data may be due in part to low reporting or incomplete monitoring in

some countries: death and birth certificates may exist, but have not been entered into the

database. However, a low rate of reporting does not explain the absence of birth certificates in

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countries with near-complete reporting of evidence. The 241 French supercentenarians in the

IDL all have the field code for birth documents completed, but not one supercentenarian has a

birth certificate (S1 Code). Likewise, the IDL explicitly lists the evidence available in support

98% of remarkable-age claimants in the UK (S1 Code). Of the 1116 oldest people in the UK, all

but three were born after the introduction of compulsory, nation-wide birth certificates in 1864.

590

However, only eighteen (1.6%) have a birth certificate. Furthermore, these rates do not increase

markedly in the 1,587 ‘exhaustively’ validated UK, French and US-born SSCs: in total only 24

have a birth certificate listed in support of their case, and all of these documents are re-issued

copies.

595

While birth certificates were produced more than a century in the past, death certificates are

issued by modern bureaucracies: over 96% of listed SSCs died after the year 1990, during a

period of unprecedented death certificate coverage (S1 Code). However, like birth certificates,

death certificates are completely absent or severely under-represented relative to their respective

birth cohort amongst individuals in remarkable age databases. This inconsistency is difficult to

600

explain.

The first follow-up survey of the population-representative NHANES I cohort, representative of

the US population, found 3.8% of decedent men and 5.7% of decedent women did not have

death certificates and remained alive on paper while actually dead [51]. While around 95% of the

605

general US population are issued a death certificate, only seven of the 504 supercentenarians

dying in the USA is listed as having a death certificate by the IDL: an over 70-fold lower rate of

death certification. Despite a self-described exhaustive validation effort, just 1.4% of SSCs and

supercentenarians have a death certificate in the USA.

610

The USA is not an isolated case. Across the IDL database only 15% of supercentenarians and

8% of SSCs are listed as having death certificates (S1 Code). These rates are often lower in

countries with more-complete and longer-term death certification histories [58]. For example, of

the 9386 SSCs dying in France, just one has a death certificate [57]. Only 89 of the 1184 SSCs

dying in the UK have an original or copied death certificate listed [57]. Both of these countries

615

and have maintained over 90% death registration rates for several decades, and are now

approaching 100% death certification rates [58]. It is therefore striking that, despite death

certificates being issued to well over 90% of individuals, a substantial majority of validated

remarkable-age individuals in these countries do not seem to have a death certificate.

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Indicators of error and fraud in individuals

The absence of basic birth and death certification and the high prevalence of counter-indicators

of health and longevity stand in contrast to the large number of listed cases of extreme longevity.

In theory each such case is individually assessed and validated, based on the compilation of

625

documents and the judgement of demographers. Assessing the role of opinion during case

validation, and corresponding potential for bias, is therefore of marked importance.

Individual case studies often highlight the role of personal judgement, and the potential for both

conscious and unconscious bias, during age validation. For example, Jiroemon Kimura, the

630

world’s oldest man, is widely considered to be a valid supercentenarian case. However, Kimura

has at least three wedding dates to the same wife [59], has three dates of graduation from the

same school [59], was conscripted to the same military three times in four years [59] despite the

mandatory conscription period being three years long [60], and has at least two birthdays [59].

635

For the first 20 years of his life all of Kimura’s birthdates and school records are actually

recorded for a different name, Kinjiro Miyake, whose connection to Kimura is attested to by a

hand-written note from a Korean mail and telephone company [59] rather than any official

document. The evidence for Kimura’s case validation was initially compiled and vetted by the

relatives who sought to promote his case [59]. Under interview, Kimura then explained one of

640

his extra birthdays in a way that was “not feasible” [59], and Gondo et al. concluded the birth

date had been deliberately forged [59]. However, Gondo et al. resolved the case validation by

assuming any conflicting official records were mistakes and, from the diverse birth, wedding,

conscription, and graduation dates, selecting the dates they felt were accurate. Multiple names,

multiple weddings, and forged birthdates notwithstanding, the study concluded that “no critical

645

discordances were discovered” [59] and the case is considered valid [57,61].

The validity of the Kimura case has been accepted under the assumption that age discrepancies

can be discarded through the qualitative judgement of demographers. Reliance on such

qualitative judgements during case validation is considered acceptable conduct. In addition,

650

concerns surrounding the validity of ages are often met with the response that biographical

inconsistencies, detected during interview by a demographer, will result in cases being removed

from the record.

However, this sentiment can be difficult to reconcile with observed practice. Former smoker and

655

occasional drinker Adele Dunlap, who “ate anything she wanted” and “never went out jogging or

anything” [62] was validated by the GRG and IDL as the oldest woman in the USA, despite

Dunlap consistently maintaining under interview that she was a decade younger: if “asked how it

felt to be 113, Dunlap… looked her questioner in the eye and answered: ‘I’m 104’” [62]. Despite

consistently maintaining until her death that her age was incorrect, Dunlap remains validated as a

660

supercentenarian on the basis of documentary evidence. This documentary evidence has since

lowered her age by two years in just one [61] of the two [57] major supercentenarian databases.

A reliance on this type of opinion, where qualitative judgements are employed to shape public

perceptions of authenticity, seems to be widely considered satisfactory. This seems particularly

665

the case when explaining the otherwise anomalous health habits of supercentenarians. For

example, Maier et al. issued a contradictory statement that Jeanne Calment smoked both one and

two cigarettes a day for an entire century, followed by the justification that this counter-

indication of health could be explained because she “possibly did not inhale at all” [63]. It was

likewise observed that, from age 20 to age 117, the then-oldest man in the world Christian

670

Mortensen smoked “mainly a pipe and later on cigars, but almost never cigarettes… he had also

chewed tobacco…but never inhaled” [63]. Why two people would voluntarily choose to smoke

for an accumulated 190 years, yet never inhale, was never explained.

Such behavior is not atypical. At least three of the ten oldest women drank every day, two

675

smoked every day, and four are of unknown smoking status, while Jeanne Calment smoked

daily, drank daily, and ate around a kilogram of chocolate a week. Of the five oldest men ever

recorded, Kimura and Mortensen are detailed above, Emiliano Del Toro (3rd) smoked for 76

years, Mathew Beard (4th) was busted for drink-driving at age 90, and Walter Breuning (5th)

smoked cigars until he was 108. The oldest man in the UK stated his secret to health as

680

“cigarettes, whiskey and wild, wild women” [64], while the former oldest man in the USA started

every day with coffee and whiskey, drank during the day, ate ice-cream every night, and smoked

from age 18 until his death. Like Calment and Mortensen, he also didn’t inhale some 12 to 18

cigars a day [65].

685

These instances of poor lifestyle choices constitute a substantial fraction of all supercentenarian

cases. As summarized by Coles, the typical supercentenarian lifestyle is characterized by “heavy

smoking, heavy drinking, or both, failure to exercise on a regular basis, and no conscious effort

to eat nutritiously” [66]. Instead of prompting skepticism, under the relatively safe assumption

that smoking, drinking, poverty, lack of exercise, poor nutrition, and illiteracy should not enrich

690

for remarkable longevity records, these anomalous contra-indications of survival are routinely

ignored or downplayed. For example, the study by Chrysohoou et al. concluded that “physical

activity, dietary habits, smoking cessation, and midday naps” predict extreme longevity in the

Ikaria ‘blue zone’ [4]: a conclusion that questionably re-shapes past smoking status as a positive

indicator of survival. Genetic factors that convey a collective immunity to cancer and the diverse

695

sequelae of smoking, drinking, and not exercising are also frequently raised as an explanation for

the lifestyles of the extremely old [6,12,67].

In contrast, it could be suggested that the abundance of poor lifestyle choices in the extreme old

reflect high rates of undetected error. If this were the case, a large body of previous research

700

linking higher old-age survival to, for example, higher drinking [47,54] and obesity rates [68,69]

could be re-interpreted as the result of a positive correlation between poor lifestyle factors and

‘junk’ vital statistics data.

705

Type I error detection in extreme age databases

It seems incongruous that the discovery of thousands or hundreds of thousands of fake

centenarians by the respective Japanese, Greek and Italian governments and US researchers, has

not resulted in any corresponding reduction in the size of supercentenarian databases. Instead,

710

the number of validated supercentenarians increased smoothly across these fraud-discovery

events. Perhaps the more limited resources of individuals compiling old-age records, using

identical documents and similar techniques to government demographers, far exceeds the

capacity of developed-world governments to detect identity fraud. Alternatively, perhaps,

supercentenarian databases remain riddled with error.

715

Data cleaning and error correction using documentary validation, as described in the Kimura

case above, remains the main approach to combat age errors in remarkable longevity databases.

However, data cleaning often produces the mistaken impression that the resulting ‘validated’

data are largely free from error. Data in this study exhibit patterns consistent with a high

720

frequency of type I errors: diverse positive correlates of crime, anomalous poor health indicators,

age heaping, and over 20-fold higher rates of missing documentation than the general population.

However, these populations were already subjected to extensive analysis and validation [27] and

are widely considered high-quality ‘clean’ data [21].

725

The logic supporting these assumptions of data-cleanliness is informative. For example, post-

validation errors in the Italian data were previously assumed to be minimal, on the basis of a

belief that the data were clean [27]. Subsequently, it was acknowledged that an unknown number

of errors in these data could not be detected using documentary evidence, as “Occasionally…a

mistake will escape even a rigorous validation procedure” [21]. Finally, it was proposed that the

730

occurrence of such errors, which cannot be detected using documents, must be rare or

“essentially impossible”, because of the high quality of documents used to compile such data

[21]. That is, type I errors are assumed to occur at low frequency on the basis of documentary

evidence: documentary evidence that cannot detect the frequency of type I errors.

735

The opinion that such errors are rare might have been countered by another opinion: that a

handwritten century-old database containing millions of entries, no independent biological

validation, and an unknown type I error rate, might easily generate the few hundred annual errors

required for a supercentenarian database [66]. Prior observations that the Italian state paid

pensions to 30,000 deceased people [30], or that 82% of Japanese and 72% of Greek

740

centenarians were illusory or dead [35,70], or suggest the viability of this explanation. However,

such criticism would ignore a more fundamental problem.

Physical possession of valid documents is not an age guarantee. Consider a room containing 100

real Italian supercentenarians, each holding complete and validated documents of their age. One

745

random supercentenarian is then exchanged for a younger sibling, who is handed their real and

validated birth documents. How could an independent observer discriminate this type I

substitution from the 99 other real cases, using only documents as evidence?

Such hypothetical errors cannot be excluded on the basis of document consistency: every

750

document in the room is both real and validated. In addition, a real younger sibling is also likely

to have sufficient biographic knowledge to pass an interview: this has occurred in several

(subsequently discovered) cases including, for several years, the world’s former oldest man. As

such, any similar substitution error has the potential to indefinitely escape detection.

755

This ‘Italian sibling’ thought experiment illustrates why type I age-coding errors cannot be ruled

out, or even necessarily measured, on the basis of documentary evidence. It also reveals how

debates on the frequency of these errors are not driven by direct empirical measurements, but by

inference and opinion.

760

This issue presents a substantial problem for remarkable-age databases, embodied in a

deliberately provocative, if seemingly absurd, hypothesis:

Every ‘supercentenarian’ is an accidental or intentional identity thief, who owns real and

validated 110+ year-old documents, and is passably good at deception.

765

This hypothesis cannot be invalidated by the further scrutiny of documents, or by models

calibrated using document-informed ages [71,72]. Rather, invalidating this hypothesis requires a

fundamental shift: it requires the measurement of biological ages from fundamental physical

properties, such as amino acid chirality [73] or isotopic decay [74].

770

Until such document-independent validation of remarkable ages occurs, the type I error rate of

remarkable human age samples will remain unknown, and the validity of ‘supercentenarian’ data

in question.

775

Methods

The number and birthplace of all validated supercentenarians (individuals attaining 110 years of

age) and semisupercentenarians (SSCs; individuals attaining 105 years of age) were downloaded

from the Gerontology Research Group or GRG supercentenarian table [61], updated 2017, and

780

the International Database on Longevity or IDL [57]. These data were aggregated by subnational

units for birth locations, which were provided for the IDL data, and obtained through

biographical research for the GRG data. Populations were excluded due to incomplete

subnational birthplace records (<25% complete) or countries with an insufficient number of

provinces to fit spatial regressions (<15 total provinces), leaving population data on SSCs and

785

supercentenarians in the USA, France, and the United Kingdom (Fig 1).

To quantify the distribution of remarkable-aged individuals in Italy, province-specific

quinquennial life tables were downloaded from the Italian Istituto Nazionale di Statistica

Elders.Stat database [46] to obtain age-specific survivorship data (Fig 1c,f; S1 Code). Using

790

cross-sectional data across Italian provinces, probabilities of survival (lx) to ages 90-115, and life

expectancy at age 100 were fit as dependent variables, and survival rates at age 55 and life

expectancy at age 55 as independent variables, using simple linear regression (S1 Code).

While older ages were not available, extensive Japanese centenarian data were downloaded from

795

the Japanese Ministry of Health, Labour, and Welfare [32] through the Statistics Japan portal

[31] for all 47 prefectures (Fig S1), alongside data on prefectural income per capita (in 2011

yen), employment rates, age structure, survivorship, and a financial strength index, for 2010: the

most complete recent year available for these data (S1 Code; Fig S1). These data were also

linked to the most recent available prefecture-specific poverty rates [39].

800

Supercentenarians recorded in the GRG database and born in the USA were matched to the 1900

census counts for state and territory populations [22], and linked to the National Center for

Health Statistics estimates for the timing of complete birth and death certificate coverage in each

US state and territory [75]. Both the number of supercentenarian births overall, and estimates of

805

supercentenarians per capita, approximated by dividing supercentenarian number by state

population size in the 1900 US census [22], were averaged across the USA and represented as

discontinuity time series relative to the onset of complete-area birth registration (S1 Code).

To capture the geographic distribution of French supercentenarians, all 175 supercentenarians in

810

the GRG database who were either born or deceased in France were linked to the smallest

discoverable region of birth using biographical searches [61]. In addition, de-identified records in

the IDL were already linked to birth locations encoded by the Nomenclature for Territorial Units

level 3 codes (NUTS-3), which divide France into 101 regions [57]. These modern regions were

linked manually to their corresponding Savoyard-era department to obtain historic region-

815

specific estimates of life expectancy at birth [76] for the birth year and location of all

supercentenarians in metropolitan France. For each supercentenarian, life expectancy at birth

was then measured relative to the contemporary average life expectancy of metropolitan France

(S1 Code).

820

The number of total supercentenarians and SSCs born into Eurostat NUTS-3 coded regions,

either documented for French and UK regions in the IDL or estimated for Italian regional cohorts

by ISTAT, were linked to modern socioeconomic indicators available at this administrative

level: total regional gross domestic product (GDP), GDP per capita, GDP per capita adjusted for

purchase power scores (PPS), murder and employment rates per capita, and the number of 90+

825

year-olds, using the Eurostat regional database (S1 Code).

In the UK, additional data were obtained for the Index of Multiple Deprivation or IMD: a

national metric used to indicate relative levels of deprivation, including income deprivation in

people aged 60+, by the UK Office of National Statistics [25]. The IMD data are measured in

830

317 local authority districts, each of which is a subset of a single Eurostat NUTS-3 encoded

region. To capture the relative degree of deprivation within the UK, the IMD and its component

scores were averaged within each of the 175 NUTS-3 regions (S1 Code).

Similar estimates of deprivation were obtained for French NUTS-3 regions, by downloading the

835

regional poverty rates [77] and poverty rates in the oldest available age group, ages 75 and over

from the French National Institute of Statistics and Economic Studies INSEE [77].

To overcome the three orders of magnitude differences in population size across subnational

geographic units, the number of centenarians, SSCs and supercentenarians were adjusted to per

840

capita rates. However, the ‘correct’ adjustment for per capita rates of remarkable longevity is

dependent on the a priori assumptions of their cause. For example, if the null hypothesis was that

all supercentenarians are ‘real’, adjustment for birth cohort size 110+ years previously would be

a more correct method for best predicting the population density of supercentenarians. However,

if the null hypothesis is that supercentenarians are more frequently modern-era pension frauds or

845

clerical mistakes, per capita correction for a birth cohort 110 years in the past is of uncertain

value for predicting modern events. In this latter case, the occurrence of supercentenarians would

be better and more accurately predicted by correcting for modern population sizes.

The former ‘historical per capita’ adjustment was used whenever possible. Per capita rates of

850

remarkable age attainment, calculated relative to the size of historical birth cohorts, were

downloaded from the respective government statistical bureaus of Japan and Italy [32,46]. Due

to the absence of birth certificates, USA supercentenarian data from the GRG [61] were

corrected to per capita rates based on population data in the 1900 US census [22]. However,

France and the UK were located into geographic units that have only existed since 2003. As a

855

result, there were no data on historical population sizes available for these geographic units. It

was therefore necessary to estimate per capita rates using modern population sizes surveyed at

the NUTS-3 geographic level within France and the UK.

To address this unavoidable difference in per capita rate calculations the number of the

860

centenarians, SSCs and supercentenarians were also corrected relative to the number of old-age

residents in each modern geographic unit of Japan, the UK, and France (Fig 3d-f; S1 Code). This

adjustment was less susceptible to large longitudinal shifts in population size, and better reflected

the density of older people in modern geographic units after survival and migration processes.

However, the insufficient granularity of birth cohorts within the UK, and the considerable

865

rearrangement of geographic units within France, remains an important constraint on the upper

accuracy of these models.

Collective socioeconomic indicators obtained for each country were used to develop linear

mixed models across all regions with a non-zero number cases, of centenarians in Japan, SSCs in

870

Italy and the UK, and supercentenarians in the UK and France (S1 Code), to predict the regional

per capita and per 90+ year old density of the oldest available populations in each country.

Linear mixed models were fit using either the population poverty rate (UK, France, and Japan) or

estimates of old-age poverty rates (percent in poverty over 75 in France, the IDOP index in the

UK) as the single predictor variable, and the number of centenarians, SSCs and

875

supercentenarians both per capita and per 90+ year old. These models were then extended by

fitting, as interactive effects, basic socioeconomic indicators used as global indicators of health

and deprivation available at a sufficient geographic level (S2 Code). Such models focused on

capturing basic indicators, representing crime rates, health, and income, available at the NUTS-3

regional level in the EU and the prefectural level in Japan.

880

Where available, French supercentenarians were linked to regional estimates of life expectancy

at birth, calculated quinquennially for each of the Savoyard-era departments of France into which

they were born [76]. These local rates were then corrected relative to the contemporary French

national average life expectancy at birth to yield the relative life expectancy at birth, in years

885

[76]. For example, Jeanne Calment was born in the Alpes-Maritime department in 1875, when

average life expectancy at birth was just 33.4 years and the contemporary national French

average life expectancy was 37.8 years: a relative life expectancy of -4.4 years. These rates were

then used to estimate whether regional life expectancy at birth of French cohorts containing

supercentenarians was significantly higher or lower than the French national average using a one

890

sample t-test.

To explore the potential for age manufacture amongst remarkable age records, birthdate data

were aggregated within the GRG and IDL databases. Enrichment for specific birth days is

usually indicative of nonrandom age selection due to fraud, error, and clerical uncertainty. This

895

check, however, is limited in that it cannot detect diverse sources of error, such as identity fraud

or failed death registrations, which retain a representative distribution of birth days.

As population representative birthdates were unavailable within the target populations, the

distribution of births was tabulated by days of the month to remove the often poorly-categorized

900

or undocumented effects of birth seasonality. This distribution was compared to both modern

birthdate distributions from seventy million births in the US, which suffer from increased

distortion due to elective induced births and caesarean sections on certain dates, and to the

distribution of birthdays under a uniform distribution of births.

905

To facilitate reproduction of these findings, all shareable data and code are available in a single

structured file, with instructions and links for the non-shareable data, in S1 Data.

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Acknowledgements

1110

The author would like to acknowledge Zoe Campbell and Prof Heather Booth for providing

much-needed feedback and editing advice, Chris Mulligan for providing inspiration to use US

birth data, Sally Morell and Dr Jim Docherty for interesting leads, and a large section of the

scientific community for providing commentary and support.

1115

Author Contributions

SJN conceived, designed, analyzed and wrote the study

1120

Competing Interests

The author declares no competing interests.

Figure S1. Poverty and the distribution of Japanese Centenarians. The 47 prefectures of Japan

1125

putatively contain over 48,000 centenarians, with generally higher concentration of centenarians per

capita (a) and per 90-99 year-old person (b) in prefectures with high poverty rates (c) and lower-ranked

prefectural incomes (d).

Figure S2. Italian provinces by GDP per capita and rates of extreme longevity. According to figures

1130

from the Italian national statistics office and regional GDP data from the OECD, purchase-power parity

adjusted GDP is negatively correlated with the frequency of (a) centenarians, (b) SSCs and (c)

supercentenarians per capita across Italy: a pattern repeated in employment rates (d-f). Furthermore, the

total number of 90+ year old people, shown here in log scale, is also negatively associated with the per

capita number of centenarians (g), SSCs (h) and supercentenarians (i) across Italy. Linear mixed model

1135

regressions shown in green, Sardinian provinces shown in blue.

Figure S3. Historical life expectancy in the home region of birth for French

supercentenarians. Supercentenarians are born in regions with an 84-day shorter life

expectancy at birth, a non-significant reduction relative to the national average (one sample t-test

1140

NS; p = 0.52; N=143). Comparisons for supercentenarians born in overseas provinces and

imperial holdings are unavailable, data show metropolitan France only.

1145

Figure S4. Age heaping of supercentenarian births. The distribution of modern birthdates (a), shown

here by 70 million US birthdates observed from 1969-1988, display limited variation across days of the

month. However, supercentenarian birth dates in the GRG (N = 1739) are 142% more likely to be born on

the first day of the month and 118% more likely to be born on days that are multiples of five (orange

points) compared with randomly distributed births (b). Age heaping on the first day of the month or in

1150

multiples of five is not as clear in the IDL data (c), possibly as a result of the removal of US birth days

and months, or differences in cultural patterns (the 25th is heavily under-represented) and data quality.

Points are labeled by the percentage of births over- or under-represented, relative to random sampling.

1155

Figure S5. Distribution of life expectancy estimates in US small-area census tracts,

including the Loma Linda ‘blue zone’. When calculated independently by the Centers for

Disease Control, the suburbs of Loma Linda range from the 27th to 75th percentiles of life

expectancy at birth in the USA (green lines), relative to all other census tracts (orange). The

1160

absolute upper estimate, the female-only life expectancy calculated by ‘blue zone’ proponents

(blue line), falls in the 98th percentile of life expectancy: high, but still behind 1401 longer-lived

US census tracts and the nations of Japan, Singapore, Monaco, Spain, and South Korea.

1165

Table S1. Top 20 UK regions for the density of 105+ year old people, or SSCs, per capita.

National Ranking, 1 = Worst, 131 = Best

Region

Total

SSCs

per

capita

(rank)

Income

Deprivation

Affecting

Older People

90+ year-

olds per

capita

(1=fewest)

Index of

Multiple

Deprivation

Crime

rate

Health

index

Tower Hamlets

Lewisham &

Southwark

Darlington

Lambeth

Camden & City of

London

119

110

Kensington &

Chelsea and

Hammersmith &

Fulham

112

Isle of Wight

128

East Cumbria

120

121

130

Southampton

Portsmouth

Derby

North and West

Norfolk

126

129

Telford and

Wrekin

Manchester

Haringey &

Islington

Leicester

Tyneside

Liverpool

Suffolk

101

120

East Kent

123

Table S2. Top 20 French regions for supercentenarians per capita (metropolitan and ranked

overseas territories only).

National Ranking, 1 = Worst, 101 = Best

Region

Super-

centenarians

(IDL)

Super-

cent. per

capita

(rank)

Poverty

rate ages

75+ (%)

Poverty rate

ages 75+

Poverty rate

GDP per

capita,

PPS adjusted

Creuse

17.0

Martinique

31.1

Guadeloupe

Cantal

13.9

Haute-Loire

11.1

Lozère

14.5

Lot

12.2

Indre

10.5

Yonne

7.0

Aude

14.4

Tarn

11.1

Paris

9.6

100

Jura

8.5

Maine-et-Loire

6.8

Aveyron

12.6

Hautes-Alpes

9.9

Orne

8.3

Ariège

12.8

Corse-du-Sud

15.9

Alpes-de-Haute-

Provence

10.8

123

1170

Table S3. Top 20 Italian provinces and regions for supercentenarians per capita.

National Ranking, 1 = Worst 116 = Best

Province

Region

Super-

centenarians

per 100k (l110)

Rank

l110

Survival

to age 55

Unemployment

GDP per

capita,

PPS

adjusted

90+ year-

olds per

capita

(1=fewest)

Olbia-Tempio

Sardinia

Medio

Campidano

Sardinia*

Carbonia-

Iglesias

Sardinia

Isernia

Molise

102

Matera

Basilicata

Prato

Tuscany

114

L'Aquila

Abruzzo

Rieti

Lazio

Belluno

Veneto

Campobasso

Molise

Catanzaro

Calabria

Gorizia

Friuli-

Venezia

Giulia

107

Ogliastra

Sardinia*

Pistoia

Tuscany

Metropolitan

City of Rome

Lazio

111

104

Vibo Valentia

Calabria

Brescia

Lombardy

106

Chieti

Abruzzo

Cremona

Lombardy

Fermo

Marche

* 'Blue zone’ region

1175

Table S4. Top 20 Japanese prefectures for centenarians per capita in 2015.

National Ranking, 1 = Worst, 47 = Best

Prefecture

Centenarians

(total)

Rank

Centenarians

per capita

Poverty rate

(%)

Poverty rate

Financial

strength

Income per

capita 2011

Shimane

515

16.7

Kochi

486

23.7

Okinawa*

872

34.8

Kagoshima

985

24.3

Tottori

334

18.9

Yamaguchi

806

16.9

Kumamoto

972

21.5

Saga

441

15.6

Toyama

554

11.2

Okayama

980

20.6

Ehime

720

20.2

Miyazaki

566

23.0

Nagasaki

700

22.2

Hiroshima

1395

16.9

Kagawa

482

17.2

Tokushima

377

21.8

Niigata

1105

16.0

Nagano

1000

15.5

Yamanashi

392

19.1

Oita

536

21.3

* 'Blue zone’ region

1180

A Review of Longevity Validations up to May 2023

Preprint

Full-text available

May 2023

Background: The ages of the oldest humans are important data for scientific studies in gerontology, medicine and demographics. Scientists often reference specific cases such as Jeanne Calment, or resources such as the International Database on Longevity. However, numerous inherent dangers and pitfalls have dogged the history of human longevity record keeping. Many people who were believed to be the oldest person in their day turned out to be younger than claimed. This could affect scientific conclusions based on their assumed longevity. In this work we review longevity validations at the top of the official lists of the world’s oldest ever men and women. We aim to outline a stronger “cast-iron” standard for the purposes of future scientific studies of extreme longevity.Results: To inform the higher standard, we have examined individual cases of validation, including those that have been withdrawn or disputed. We highlight their weaknesses and show how deeper investigation could help validate similar claims in the future. We also consider the use of DNA testing to verify the identity of supercentenarians. A self-use questionnaire is offered to validators to help further improve consistency and completeness of their reporting.In a few cases, such as the lives of Sarah Knauss, Christian Mortensen and Israel Kristal we have found new evidence that improves confidence in their validation, but for others our search casts serious doubt on authenticity, or leaves questions over whether the standard of validation is good enough. Having previously disputed the longevity of Jeanne Calment, we now add Nabi Tajima from Japan and Johnson Parks from the U.S. to those who should be invalidated, and we question whether birth records for Japanese supercentenarians can be considered reliable. We also challenge the validation of several U.S cases which were based on unreliable census data in the SSA Kestenbaum study.Conclusions: Correct assessment of the chronological age is a necessary step for biologists studying the determinants of exceptional longevity. We hope that our findings could be used to improve the quality of age validations. They may also influence demographers' conclusions about the future of life expectancy

A Review of Longevity Validations to 2020

Preprint

Full-text available

Apr 2021

Scientists who specialise in the study of supercentenarian lifespans warn us of the inherent dangers and pitfalls that have dogged the history of human longevity record keeping. Many people who were believed to be the oldest person in their day turned out to be younger than claimed. In recent decades validators have sought to apply more robust and objective standards for scientific age checking, but have they succeeded? It’s an important question. The demographics of extreme ages have had surprisingly far-reaching applications beyond promoting the wellbeing of the aged. Influence has ranged from setting the price of our pension annuities to guiding governments on retirement age and other planning policies. In this work we review longevity validations at the top of the official lists of the world’s oldest ever men and women. In a few cases, such as the lives of Sarah Knauss, Christian Mortensen and Israel Kristal we have found new evidence that improves confidence in their validation, but for others our search casts serious doubt on authenticity, or leaves questions over whether the standard of validation is good enough. Taken as a whole our findings could affect conclusions reached by demographers about the future of life expectancy.

Review of Longevity Validations at Extreme Ages

Preprint

Full-text available

Dec 2019

The verification of human longevity is a hazardous process with many errors, false claims and myths among the true records. In the light of past withdrawn and disputed cases we conduct a sceptical reappraisal of validations from the top of the lists of world's oldest people. Longevity data is used increasingly by scientists with applications in research programs trying to understand and combat the processes of aging. Our goal is to evaluate the robustness and accuracy of the information being referenced. We identify weaknesses with the standards and practices in use but we also find significant new evidence for some important cases including Sarah Knauss. We propose ambitious new standards so that the process of validation can continue to improve with the benefits of new technology, including DNA testing.

Early-life physical performance predicts the aging and death of elite athletes

Article

Full-text available

May 2023

Saul Newman

Athleticism and the mortality rates begin a lifelong trajectory of decline during early adulthood. Because of the substantial follow-up time required, however, observing any longitudinal link between early-life physical declines and late-life mortality and aging remains largely inaccessible. Here, we use longitudinal data on elite athletes to reveal how early-life athletic performance predicts late-life mortality and aging in healthy male populations. Using data on over 10,000 baseball and basketball players, we calculate age at peak athleticism and rates of decline in athletic performance to predict late-life mortality patterns. Predictive capacity of these variables persists for decades after retirement, displays large effect sizes, and is independent of birth month, cohort, body mass index, and height. Furthermore, a nonparametric cohort-matching approach suggests that these mortality rate differences are associated with differential aging rates, not just extrinsic mortality. These results highlight the capacity of athletic data to predict late-life mortality, even across periods of substantial social and medical change.

Dietary Trends and Dementia - A Multi-Country Ecological Analysis

Preprint

Full-text available

Jan 2023

Robert Lee Reed

Background: This research evaluates the association between increased animal product consumption and population-level dementia incidence. Design/methodology/approach: Publicly available data from 54 countries across a 10-year span was used to conduct a multivariate panel data regression to determine significant relationships between dietary changes and rates of dementia. Fixed effects analysis controls for the effect of omitted time-invariant differences between countries. Findings: Excess calorie consumption is associated with a significant increase in dementia whereas fish consumption appears protective. On a population-level basis, increases in milk and egg consumption were associated with an increase in dementia rates. Meat, as a broadly defined category, was found to have no significant effect. Practical Implications: This study supports the well-documented benefits of calorie control and fish consumption to protect against dementia, but indicates that egg and milk consumption is associated with increased population-level dementia incidence. Originality/value: This research expands current literature by using an updated data set, evaluating considerably more countries, and utilizing a regression model that controls for the effects of time-invariant sources of heterogeneity in the data. Keywords: Nutrition Recommendations, Ecological Studies, Mediterranean Diet, Dementia, Blue Zone Diet, Western Diet, Alzheimer's Paper type: Research paper

Late-life mortality is underestimated because of data errors

Article

Full-text available

Feb 2019
PLOS BIOL

Knowledge of true mortality trajectory at extreme old ages is important for biologists who test their theories of aging with demographic data. Studies using both simulation and direct age validation found that longevity records for ages 105 years and older are often incorrect and may lead to spurious mortality deceleration and mortality plateau. After age 105 years, longevity claims should be considered as extraordinary claims that require extraordinary evidence. Traditional methods of data cleaning and data quality control are just not sufficient. New, more strict methodologies of data quality control need to be developed and tested. Before this happens, all mortality estimates for ages above 105 years should be treated as unreliable.

Hypothetical errors and plateaus: A response to Newman

Article

Full-text available

Dec 2018
PLOS BIOL

Kenneth W. Wachter

Newman questions recent claims about a plateau in mortality rates for Italians beyond age 105 on the basis of a hypothetical model. His model implies implausibly high error rates for extreme ages. For individuals over 110, for whom birth certificates have been collected, the form in which Italian births were registered precludes the kinds of clerical errors in year of birth that Newman assumes.

Errors as a primary cause of late-life mortality deceleration and plateaus

Article

Full-text available

Dec 2018
PLOS BIOL

Saul Newman

Author summary In diverse species, mortality rates increase with age at a relatively fixed rate within populations. However, recent discoveries have suggested this relationship breaks down in advanced old age, with mortality rate increases slowing and even reaching a plateau. This late-life mortality deceleration has initiated sustained debate on the cause of late-life deceleration and plateaus. Proposed explanations include evolutionary patterns, the exhaustion of selective pressure, population heterogeneity, and even the cessation of the ageing process. Here, I demonstrate that apparent late-life mortality decelerations and plateaus can be generated by low-frequency errors. I then reveal how indicators of demographic data quality predict the magnitude of late-life mortality deceleration and the existence of late-life plateaus in human populations. These findings suggest that human late-life mortality plateaus are largely, if not entirely, artefacts of error processes. As a result, late-life mortality plateaus and decelerations may be explained by error patterns in humans and many other species without invoking complex biological, heterogeneity, or evolutionary models. This finding has immediate consequences for demographic modelling, evolutionary biology, and the projected upper limits of human and nonhuman life.

Plane inclinations: A critique of hypothesis and model choice in Barbi et al

Article

Full-text available

Dec 2018
PLOS BIOL

Saul Newman

This study highlights how the mortality plateau in Barbi and colleagues can be generated by low-frequency, randomly distributed age-misreporting errors. Furthermore, sensitivity of the late-life mortality plateau in Barbi and colleagues to the particular age range selected for regression is illustrated. Collectively, the simulation of age-misreporting errors in late-life human mortality data and a less-specific model choice than that of Barbi and colleagues highlight a clear alternative hypothesis to explanations based on evolution, the cessation of ageing, and population heterogeneity.

Predicting age from the transcriptome of human dermal fibroblasts

Article

Full-text available

Dec 2018
GENOME BIOL

Biomarkers of aging can be used to assess the health of individuals and to study aging and age-related diseases. We generate a large dataset of genome-wide RNA-seq profiles of human dermal fibroblasts from 133 people aged 1 to 94 years old to test whether signatures of aging are encoded within the transcriptome. We develop an ensemble machine learning method that predicts age to a median error of 4 years, outperforming previous methods used to predict age. The ensemble was further validated by testing it on ten progeria patients, and our method is the only one that predicts accelerated aging in these patients. Electronic supplementary material The online version of this article (10.1186/s13059-018-1599-6) contains supplementary material, which is available to authorized users.

Associations of Body Mass Index and Waist Circumference with 3-Year All-Cause Mortality Among the Oldest Old: Evidence from a Chinese Community-Based Prospective Cohort Study

Article

Full-text available

May 2018
J AM MED DIR ASSOC

Objective: Current international and national guidelines for body mass index (BMI) and waist circumference (WC) have been recommended to all adults. However, whether recommendations applied to the oldest old (aged 80+) is poorly known. The study objective was to investigate the relation of BMI and WC with 3-year all-cause mortality among the oldest old. Design, setting, and participants: A total of 4361 Chinese oldest old (mean age 91.8) participated in this community-based prospective cohort study. Measurements: BMI and WC were measured at baseline in 2011 and were used as continuous variables and as categorized variables by recommendations or by tertiles. Adjusted, sex-stratified Cox models with penalized splines and Cox models were constructed to explore the association. Results: Greater BMI and WC were linearly associated with lower mortality risk in both genders. The mortality risk was the lowest in overweight or obese participants (BMI ≥ 24.0) and was lower in participants with abdominal obesity. Compared to the upper tertile, those in the middle and lower tertile of BMI had a higher risk of mortality for men [hazard ratio (HR): 1.23 (1.02-1.48) and 1.53 (1.28-1.82)] and for women [HR: 1.21 (1.03-1.41) and 1.35 (1.15-1.58)]; it was also found in participants in the middle and lower tertile of WC for men [HR: 1.21 (1.01-1.46) and 1.41 (1.18-1.69)] and for women [HR: 1.35 (1.15-1.58) and 1.55 (1.32-1.81)] (all the P values for trend <.001). These findings were robust in further sensitivity analyses or when using propensity score matching, in subgroup analyses, or in octogenarians, nonagenarians, and centenarians. Conclusions: In Chinese oldest old, both higher BMI and higher WC predict better survival in both genders. The finding suggests optimal BMI and WC may be sensitive to age, thus, the current recommendations for the oldest old may need to be revisited.

Apparent Age Estimation Using Ensemble of Deep Learning Models

Article

Full-text available

Jun 2016

In this paper, we address the problem of apparent age estimation. Different from estimating the real age of individuals, in which each face image has a single age label, in this problem, face images have multiple age labels, corresponding to the ages perceived by the annotators, when they look at these images. This provides an intriguing computer vision problem, since in generic image or object classification tasks, it is typical to have a single ground truth label per class. To account for multiple labels per image, instead of using average age of the annotated face image as the class label, we have grouped the face images that are within a specified age range. Using these age groups and their age-shifted groupings, we have trained an ensemble of deep learning models. Before feeding an input face image to a deep learning model, five facial landmark points are detected and used for 2-D alignment. We have employed and fine tuned convolutional neural networks (CNNs) that are based on VGG-16 [24] architecture and pretrained on the IMDB-WIKI dataset [22]. The outputs of these deep learning models are then combined to produce the final estimation. Proposed method achieves 0.3668 error in the final ChaLearn LAP 2016 challenge test set [5].

The plateau of human mortality: Demography of longevity pioneers

Article

Jun 2018

Mortality rates level off at extreme age The demography of human longevity is a contentious topic. On the basis of high-quality data from Italians aged 105 and older, Barbi et al. show that mortality is constant at extreme ages but at levels that decline somewhat across cohorts. Human death rates increase exponentially up to about age 80, then decelerate, and plateau after age 105. Science , this issue p. 1459

Centenarians in Europe

Article

Aug 2017
MATURITAS

Objectives The group of individuals aged 80 and over is growing faster than other segments of the population, and within this group the number of centenarians has risen exponentially worldwide. This paper reports the numbers of centenarians (total, and ratio relative to total population) in 32 European countries and their key characteristics: gender distribution, level of education, and type of residence. Study design Population based study. Measures We used national census data collected in 2011 for individuals aged 100 and over living in Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland and the UK. Data on gender, residence and education were used. Results The total number of centenarians was 89156, corresponding to 17.3 centenarians per 100000 inhabitants of the total population and 98.0 centenarians per 100000 individuals aged 65 and older. Centenarian ratios were highest in France, Italy and Greece, and lowest in Bulgaria, Romania, and Croatia. The percentage of men was 16.5% on average, and ranged from around 13% (Germany, Latvia, Belgium) to 37% (Hungary). Across Europe, 62.7% of the centenarians lived in private households, with a range from 10.9% (Iceland) to 90.0% (Romania). Education levels varied across countries, with an average of 13.6% having no formal education, ranging from 0.0% (the UK, Finland, Iceland) to 61.6% (Portugal). Conclusions Centenarian numbers have increased substantially since last available data. The findings will inform specific health promotion policies, the strengthening of current services and the development of innovative care systems.

Global well-being since 1820

Chapter

Oct 2014

This chapter provides an introduction to, and summary of, the contents of this book. It outlines the aim of the project and provides an overview of the indicators covered, comparing them with those used in the OECD Better Life Initiative. The chapter also presents the criteria used throughout the report to assess the quality of the indicators used, and discusses practical issues concerning country and period coverage and calculation of regional trends. Finally, the chapter summarises the content of each chapter and their main highlights.

Supercentenarians and the oldest-old are concentrated into regions with no birth certificates and short lifespans

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