Late-life mortality is underestimated because of data errors

The global response to the pandemic: An empirical cluster analysis of policies targeting COVID-19

It is well known that countries differed in their response to the COVID-19 pandemic in terms of the timing and intensity of specific measures such as lockdowns, face masks and vaccine rollout. However, previous studies have not investigated systematic differences in the overall pandemic strategies. We use daily data from the Oxford COVID-19 Government Response Tracker (OxCGRT), between January 2020 and December 2022 focusing on 16 key pandemic policies, including containment, economic, and health system measures, and apply a three-dimensional k-means clustering algorithm to identify distinct overarching strategies based on the type, intensity, and timing of the response adopted by different countries. We identify four distinct strategies; 1) the traditional infectious disease control approach, adopted by a wide range of high- and middle-income countries, which emphasises strict containment policies and movement restrictions, 2) the public health-oriented approach, adopted by developed welfare states with ageing populations and high health care expenditures, which is more flexible over time and focuses more on economic and health policies, such as income support and testing strategies, with less emphasis on stringent containment, 3) high stringency with gradual relaxation, and 4) reactive policies at a minimal level, both adopted by less democratic low- and middle income countries with substantial inequalities and with younger and less vulnerable populations. The findings contribute to understanding how different countries adapted to the pandemic and how these responses may relate to broader socio-political contexts, including welfare state arrangements and economic resilience.

Signatures of Nonlinear Aging: Molecular Stages of Life: Sudden Changes During Aging as Potential Biomarkers for an Age Classification System

The traditional view of aging as a gradual, progressive process is increasingly being challenged. A growing body of evidence suggests the existence of abrupt transitions in the aging process, marked by sudden molecular shifts. Interestingly, the data indicates that such transitions occur not only in late life but also throughout the entire lifespan. Further research on the nature of such events could enhance our understanding of aging and pave the way for novel therapeutic strategies, including personalized medicine. We propose that these abrupt molecular shifts could serve as biomarkers, dividing the lifespan into distinct stages and providing the foundation for a much-needed staging system for aging. Furthermore, we argue that the sudden changes may be the hallmarks of aging tipping points, that is, points in time where aging processes are quickly amplified after surpassing critical biological thresholds.

Identification of a "Blue Zone" in the Netherlands: A Genetic, Personal, Sociocultural, and Environmental Profile

BACKGROUND AND OBJECTIVES

"Blue Zones" (BZs) are regions with exceptionally high numbers of longevous inhabitants. Several factors have been suggested to promote longevity in BZs, but the evidence generally does not meet scientific quality criteria. We aimed to characterize a municipality as a "relative BZ," satisfying 3 criteria: compared to other municipalities, more exceptionally longevous inhabitants, a higher life expectancy, and a more stable population.

RESEARCH DESIGN AND METHODS

The population-based Longitudinal Aging Study Amsterdam has been ongoing since 1992 in 11 municipalities across the Netherlands with 3- or 4-yearly measurement waves. Using all available waves, we included 39 genetic, personal, sociocultural, and environmental characteristics.

RESULTS

One municipality satisfied the 3 BZ criteria. In comparison with participants in other municipalities in the same province and other provinces in the Netherlands, BZ-participants more often had a polygenic risk score linked to longevity, smoked less, consumed less alcohol and more fruit, biked more minutes, did more often paid work, practiced singing more often, attached higher importance to religion, and lived in a more walkable and livable environment. In contrast, BZ-participants had a slower walking speed, more depressive symptoms, felt less purpose in life, had a larger waist circumference, walked and did sports less often, consumed less vegetables, and exchanged less instrumental support. Other indicators of their physical and mental health and social connectedness did not substantially differ from non-BZ-participants.

DISCUSSION AND IMPLICATIONS

Rather than clues to healthy aging, our findings suggest factors conducive to longevity regardless of impaired health.

An underappreciated peculiarity of late-life human mortality kinetics assessed through the lens of a generalization of the Gompertz-Makeham law

Much attention in biogerontology is paid to the deceleration of mortality rate increase with age by the end of a species-specific lifespan, e.g. after ca. 90 years in humans. Being analyzed based on the Gompertz law µ(t)=µ0e^γt with its inbuilt linearity of the dependency of lnµ on t, this is commonly assumed to reflect the heterogeneity of populations where the frailer subjects die out earlier thus increasing the proportions of those whose dying out is slower and leading to decreases in the demographic rates of aging. Using Human Mortality Database data related to France, Sweden and Japan in five periods 1920, 1950, 1980, 2018 and 2020 and to the cohorts born in 1920, it is shown by LOESS smoothing of the lnµ-vs-t plots and constructing the first derivatives of the results that the late-life deceleration of the life-table aging rate (LAR) is preceded by an acceleration. It starts at about 65 years and makes LAR at about 85 years to become 30% higher than it was before the acceleration. Thereafter, LAR decreases and reaches the pre-acceleration level at ca. 90 years. This peculiarity cannot be explained by the predominant dying out of frailer subjects at earlier ages. Its plausible explanation may be the acceleration of the biological aging in humans at ages above 65-70 years, which conspicuously coincide with retirement. The decelerated biological aging may therefore contribute to the subsequent late-life LAR deceleration. The biological implications of these findings are discussed in terms of a generalized Gompertz-Makeham law µ(t) = C(t)+µ0e^f(t).

Trend of incidence rate of age-related diseases: results from the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database in Korea: a cross- sectional study

BACKGROUND

This study aimed to identify and select age-related diseases (ARDs) in Korea, which is about to have a super-aged society, and to elucidate patterns in their incidence rates.

METHODS

The National Health Insurance Service-National Sample Cohort, comprising 1 million health insurance and medical benefit beneficiaries in Korea from 2002 to 2019, was utilized. We selected 14 diseases with high disease burden and prevalence among Koreans from the 92 diseases defined in the Global Burden of Diseases, Injuries, and Risk Factors Study as ARDs. The annual incidence rate represented the number of patients newly diagnosed with an ARD each year from 2006 to 2019, excluding those with a history of ARD diagnosis from 2002 to 2005. The incidence rate by age was categorized into 10-year units based on age as of 2019. The number of patients with ARDs in each age group was used as the numerator, and the incidence rate for each age group was calculated with the age group as the denominator.

RESULTS

Regarding the annual incidence rates of ARDs from 2006 to 2019, chronic obstructive pulmonary disease, congestive heart failure, and ischemic heart disease decreased annually, whereas dyslipidemia, chronic kidney disease, cataracts, hearing loss, and Parkinson's disease showed a significant increase. Hypertension, diabetes, cerebrovascular disease, osteoporosis, osteoarthritis, and age-related macular degeneration initially displayed a gradual decrease in incidence but exhibited a tendency to increase after 2015. Concerning age-specific incidence rates of ARDs, two types of curves emerged. The first type, characterized by an exponential increase with age, was exemplified by congestive heart failure. The second type, marked by an exponential increase peaking between ages 60 and 80, followed by stability or decrease, was observed in 13 ARDs, excluding congestive heart failure. However, hypertension, ischemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, and hearing loss in men belonged to the first type.

CONCLUSIONS

From an epidemiological perspective, there are similar characteristics in age-specific ARDs that increase with age, reaching a peak followed by a plateau or decrease in Koreans.

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

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.

Network topologies for maximal organismal health span and lifespan

The population dynamics of human health and mortality can be jointly captured by complex network models using scale-free network topology. To validate and understand the choice of scale-free networks, we investigate which network topologies maximize either lifespan or health span. Using the Generic Network Model (GNM) of organismal aging, we find that both health span and lifespan are maximized with a "star" motif. Furthermore, these optimized topologies exhibit maximal lifespans that are not far above the maximal observed human lifespan. To approximate the complexity requirements of the underlying physiological function, we then constrain network entropies. Using non-parametric stochastic optimization of network structure, we find that disassortative scale-free networks exhibit the best of both lifespan and health span. Parametric optimization of scale-free networks behaves similarly. We further find that higher maximum connectivity and lower minimum connectivity networks enhance both maximal lifespans and health spans by allowing for more disassortative networks. Our results validate the scale-free network assumption of the GNM and indicate the importance of disassortativity in preserving health and longevity in the face of damage propagation during aging. Our results highlight the advantages provided by disassortative scale-free networks in biological organisms and subsystems.

On the Commentary by Anatoly I. Mikhalsky Published in Biochemistry (Moscow), Vol. 88, No. 1, pp. 162-163 (2023)

Caution is needed in using cohort data when studying age-related mortality dynamics, because mortality depends not only on age, but also on the changing living conditions over time. A hypothesis is proposed for further testing that the actuarial aging rate may even decrease in more recent birth cohorts of people due to improved living conditions.

What Is an Aging-Related Disease? An Epidemiological Perspective

There are no established or standardized definitions of aging-related disease. Data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 were used to model the relationship between age and incidence of diseases. Clustering analysis identified 4 groups of noncommunicable diseases: Group A diseases with an exponential increase in incidence with age; Group B diseases with an exponential increase in incidence that usually peaked in late life which then declined or plateaued at the oldest ages; and Groups C and D diseases with an onset in earlier life and where incidence was stable or decreased in old age. From an epidemiological perspective, Group A diseases are "aging-related diseases" because there is an exponential association between age and incidence, and the slope of the incidence curves remains positive throughout old age. These included the major noncommunicable diseases dementia, stroke, and ischemic heart disease. Whether any of the other diseases are aging-related is uncertain because their incidence either does not change or more often decreases in old age. Only biological studies can determine how the aging process contributes to any of these diseases and this may lead to a reclassification of disease on the basis of whether they are directly caused by or are in continuity with the biological changes of aging. In the absence of this mechanistic data, we propose the term "aging-related disease" should be used with precision based on epidemiological evidence.

Why Gilgamesh failed: the mechanistic basis of the limits to human lifespan

The purpose of this Perspective is to clarify for an interdisciplinary audience the fundamental concepts of human longevity and provide evidence for a limit to human lifespan. This observed limit is placed into a broader framework by showing how it has arisen through the process of evolution and by enumerating the molecular mechanisms that may enforce it. Finally, we look toward potential future developments and the prospects for possibly circumventing the current limit.

The curse of the plateau. Measuring confidence in human mortality estimates at extreme ages

In recent years, the importance of describing mortality at the limits of the life span has led to a number of relevant and controversial studies. Whereas considerable efforts have been devoted to collecting data and estimating models on the oldest-old individuals, the testing of statistical confidence about the conclusions of analyses at extreme ages has been largely neglected. How certain can we be in saying that the risk of dying increases, levels out, or, paradoxically, decreases over age 105? Can we recognize particular mortality age patterns at such high ages? In this paper, it is shown that very little can be confidently asserted about mortality at extreme ages. Instead of analysing actual data, we perform a series of simulation studies mimicking actual scenarios from controlled mechanisms. Our findings are thus robust with respect to factors such as particular observation schemes, heterogeneity, and data quality issues. Given the sample sizes currently available and the levels of mortality experienced in present populations, we show that before age 110, only a Gompertzian increase of mortality may be detected. Afterwards a plateau will be regularly recognized as the most suitable pattern, regardless of the complexity of the true underlying mortality.

What have we learned about mortality patterns over the past 25 years?

In this paper, I examine progress in the field of mortality over the past 25 years. I argue that we have been most successful in taking advantage of an increasingly data-rich environment to improve aggregate mortality models and test pre-existing theories. Less progress has been made in relating our estimates of mortality risk at the individual level to broader mortality patterns at the population level while appropriately accounting for contextual differences and compositional change. Overall, I find that the field of mortality continues to be highly visible in demographic journals, including Population Studies. However much of what is published today in field journals could just as easily appear in neighbouring disciplinary journals, as disciplinary boundaries are shrinking.

Human mortality at extreme age

We use a combination of extreme value statistics, survival analysis and computer-intensive methods to analyse the mortality of Italian and French semi-supercentenarians. After accounting for the effects of the sampling frame, extreme-value modelling leads to the conclusion that constant force of mortality beyond 108 years describes the data well and there is no evidence of differences between countries and cohorts. These findings are consistent with use of a Gompertz model and with previous analysis of the International Database on Longevity and suggest that any physical upper bound for the human lifespan is so large that it is unlikely to be approached. Power calculations make it implausible that there is an upper bound below 130 years. There is no evidence of differences in survival between women and men after age 108 in the Italian data and the International Database on Longevity, but survival is lower for men in the French data.

The degree of frailty as a translational measure of health in aging

Frailty is a multiply determined, age-related state of increased risk for adverse health outcomes. We review how the degree of frailty conditions the development of late-life diseases and modifies their expression. The risks for frailty range from subcellular damage to social determinants. These risks are often synergistic-circumstances that favor damage also make repair less likely. We explore how age-related damage and decline in repair result in cellular and molecular deficits that scale up to tissue, organ and system levels, where they are jointly expressed as frailty. The degree of frailty can help to explain the distinction between carrying damage and expressing its usual clinical manifestations. Studying people-and animals-who live with frailty, including them in clinical trials and measuring the impact of the degree of frailty are ways to better understand the diseases of old age and to establish best practices for the care of older adults.

Are We Approaching a Biological Limit to Human Longevity?

Until recently human longevity records continued to grow in history, with no indication of approaching a hypothetical longevity limit. Also, earlier studies found that age-specific death rates cease to increase at advanced ages (mortality plateau) suggesting the absence of fixed limit to longevity too. In this study, we reexamine both claims with more recent and reliable data on supercentenarians (persons aged 110 years and older). We found that despite a dramatic historical increase in the number of supercentenarians, further growth of human longevity records in subsequent birth cohorts slowed down significantly and almost stopped for those born after 1879. We also found an exponential acceleration of age-specific death rates for persons older than 113 years in more recent data. Slowing down the historical progress in maximum reported age at death and accelerated growth of age-specific death rates after age 113 years in recent birth cohorts may indicate the need for more conservative estimates for future longevity records unless a scientific breakthrough in delaying aging would happen. The hypothesis of approaching a biological limit to human longevity has received some empirical support and it deserves further study and testing.

Comparative analysis of completeness of death registration, adult mortality and life expectancy at birth in Brazil at the subnational level

Background

Estimates of completeness of death registration are crucial to produce estimates of life tables and population projections and to estimate the burden of disease. They are an important step in assessing the quality of data. In the case of subnational data analysis in Brazil, it is important to consider spatial and temporal variation in the quality of mortality data. There are two main sources of data quality evaluation in Brazil, but there are few comparative studies and how they evolve over time. The aim of the paper is to compare and discuss alternative estimates of completeness of death registration, adult mortality (45q15) and life expectancy estimates produced by the National Statistics Office (IBGE), Institute for Health Metrics and Evaluation (IHME), and estimates presented in Queiroz et al. (2017) and Schmertmann and Gonzaga (2018), for 1980 and 2010.

Methods

We provide a descriptive and comparative analysis of aforementioned estimates from four (4) sources of estimates at subnational level (26 states and one Federal District) in Brazil from two different points in time.

Results

We found significant differences in estimates that affect both levels and trends of completeness of adult mortality in Brazil and states. IHME and Queiroz et al. (2017) estimates converge by 2010, but there are large differences when compared to estimates from the National Statistics Office (IBGE). Larger differences are observed for less developed states. We have showed that the quality of mortality data in Brazil has improved steadily overtime, but with large regional variations. However, we have observed that IBGE estimates show the lowest levels of completeness for the Northern of the country compared to other estimates. Choice of methods and approaches might lead to very unexpected results.

Conclusion

We produced a detailed comparative analysis of estimates of completeness of death registration from different sources and discuss the main results and possible explanations for these differences. We have also showed that new improved methods are still needed to study adult mortality in less developed countries and at a subnational level. More comparative studies are important in order to improve quality of estimates in Brazil.

Cardio-metabolic consequences of dietary carbohydrates: reconciling contradictions using nutritional geometry

Carbohydrates are the major source of dietary energy, but their role in health and disease remains controversial. Recent epidemiological evidence suggests that the increased consumption of carbohydrates is associated with obesity and increased risk of mortality and dietary trials show that carbohydrate restriction leads to weight loss and improved glycaemic status in obese and diabetic subjects. In contrast, the diets of populations with long and healthy lifespans (e.g. traditional Okinawans from Japan) are high in carbohydrate and low in protein, and several clinical and preclinical studies have linked low-carbohydrate-high-protein diets with increased mortality risk. In this paper we attempt to reconcile these contradictory findings by moving beyond traditional single-nutrient analyses to consider the interactions between nutrients on health outcomes. We do so using the Geometric Framework (GF), a nutritional modelling platform that explicitly considers the main and interactive effects of multiple nutrients on phenotypic characteristics. Analysis of human data by GF shows that weight loss and improved cardio-metabolic outcomes under carbohydrate restriction derive at least in part from reduced caloric intake due to the concomitantly increased proportion of protein in the diet. This is because, as in many animals, a specific appetite for protein is a major driver of food intake in humans. Conversely, dilution of protein in the diet leverages excess food intake through compensatory feeding for protein ('protein leverage'). When protein is diluted in the diet by readily digestible carbohydrates and fats, as is the case in modern ultra-processed foods, protein leverage results in excess calorie intake, leading to rising levels of obesity and metabolic disease. However, when protein is diluted in the diet by increased quantities of less readily digestible forms of carbohydrate and fibre, energy balance is maintained and health benefits accrue, especially during middle age and early late-life. We argue that other controversies in carbohydrate research can be resolved using the GF methodology in dietary studies.

Jeanne Calment's Unique 122-Year Life Span: Facts and Factors; Longevity History in Her Genealogical Tree

Jeanne Calment's (JC) still unmatched validated human life span of 122 years and 164 days, over 3 years longer than any other, surprises many. While her case is broadly accepted as a golden standard of validation, her record age still raises skepticism among some. The probability of such a record to be achieved by someone born in the second half of the 19th century, in the world population documentarily eligible to age validation, and also in the G7 countries, can be calculated by applying some logistic and Gompertz mortality models to these populations, taken, respectively, from the age of 117 and of 100. This probability appears substantial, respectively, 7.1% and 4.7%, when using a four-parameter logistic model, which I validated on the observed survivals of centenarians until the age of 118. A 3-year interval with the second oldest is then expected. The known facts and documents constitute consistent evidence that JC died at 122: regular official records during her life, her verified memories from her 19th century life, her usage of specialized terms and of an abbreviation system specific to this period of time, photographs, her signature and handwriting, testimonies from numerous witnesses of her life, plus the expertise of gerontologists. Meanwhile, nothing contradicts her record: the daughter/mother identity swap hypothesis appears unrealistic and not supported by any evidence; especially no plausible motive can be found, on the contrary. The latest article, which defends this hypothesis, "Bayesian assessment of the longevity of JC," contains major errors, making its result subjective and invalid. The study of JC's genealogical tree on six generations, using longevity performance and total immediate ancestor longevity indicators, shows how, in two centuries, her ancestors have been living 10% longer on average at each generation, increasingly overperforming their French 25-year-old contemporaries, from around 7% in the early 18th century to 43% for her parents, and up to 56% for her older brother and 80% for herself, which suggests a progressive concentration of longevity factors. In addition to the hereditary factors, JC's personal overperformance suggests also some environmental factors, and indeed many are known. Further knowledge could be obtained by studying JC's existing blood and DNA samples: those could not only provide an additional proof of her authenticity, but more importantly could be of immense contribution for understanding deeper the factors and patterns of her longevity, and more generally the longevity and aging processes in humans in general as well.

If Jeanne Calment Were 122, That Is All the More Reason for Biosampling

This article discusses the need for biosampling as a way to test "super-duper" centenarians (persons aged >120 years) to identify biological pathways for Homo sapiens to live to their fullest biological lifespan potential (estimated by extreme value theory to be currently between 123 years and 128 years) and, by extension, the possibility of biosampling leading to the identification through scientific research testing and data analysis areas of potential life extension. Studies of twins have shown that the proportion of longevity attributed to heredity (genetic potential) versus environment increases substantially the higher the age group being tested, especially after age 75 years. Even among the oldest-old, the proportion attributed to biological factors continues increasing the higher the age category, which is a selective process as the genetically weaker of the remaining survivors continue to die off first, leaving a more and more highly selected remaining population. This self-selection process means that the very oldest individuals are already the "genetic lottery winners" who have the biological potential to come close to the maximum human lifespan. Testing of these persons may result in faster breakthroughs in the attempt to extend the human lifespan through biological testing and analysis. Indeed, it is possible that, just as some human lifespans are shortened due to random genetic mutations unique to the individual (such as persons with progeria), it is possible that there could be some humans whose maximum genetic potential was due in part to a genetic mutation unique to that particular individual. This remains an area of potential research that has not yet been thoroughly biotested-but one that could change soon, and biotesting a 122-year-old woman's biosamples would be a prime opportunity for such a test: Jeanne Calment. Because only one 122-year-old woman has been validated in recorded scientific history, the uniqueness of the case makes it a unique opportunity that should not be passed by. Herewith, I take a closer look at the Jeanne Calment case and the conclusion is the same as the start: Jeanne Calment was 122 years, her age is relatively unique but not impossible to repeat in the future; however, her samples may be available right now, and thus remains the only current opportunity to study a >120-year-old person from a biological perspective.

New Trend in Old-Age Mortality: Gompertzialization of Mortality Trajectory

There is great interest among gerontologists, demographers, and actuaries in the question concerning the limits to human longevity. Attempts at getting answers to this important question have stimulated many studies on late-life mortality trajectories, often with opposing conclusions. One group of researchers believes that mortality stops growing with age at extreme old ages, and that hence there is no fixed limit to the human life span. Other studies found that mortality continues to grow with age up to extreme old ages. Our study suggests a possible solution to this controversy. We found that mortality deceleration is best observed when older, less accurate life span data are analyzed, while in the case of more recent and reliable data there is a persistent mortality growth with age. We compared the performance (goodness of fit) of two competing mortality models - the Gompertz model and the Kannisto ("mortality deceleration") model - at ages of 80-105 years using data for 1880-1899 single-year birth cohorts of US men and women. The mortality modeling approach suggests a transition from mortality deceleration to the Gompertzian mortality pattern over time for both men and women. These results are consistent with the hypothesis about disappearing mortality deceleration over time due to improvement in the accuracy of age reporting. In the case of more recent data, mortality continues to grow with age even at very old ages. This observation may lead to more conservative estimates of future human longevity records.

A universal transcriptomic signature of age reveals the temporal scaling of Caenorhabditis elegans aging trajectories

We collected 60 age-dependent transcriptomes for C. elegans strains including four exceptionally long-lived mutants (mean adult lifespan extended 2.2- to 9.4-fold) and three examples of lifespan-increasing RNAi treatments. Principal Component Analysis (PCA) reveals aging as a transcriptomic drift along a single direction, consistent across the vastly diverse biological conditions and coinciding with the first principal component, a hallmark of the criticality of the underlying gene regulatory network. We therefore expected that the organism's aging state could be characterized by a single number closely related to vitality deficit or biological age. The "aging trajectory", i.e. the dependence of the biological age on chronological age, is then a universal stochastic function modulated by the network stiffness; a macroscopic parameter reflecting the network topology and associated with the rate of aging. To corroborate this view, we used publicly available datasets to define a transcriptomic biomarker of age and observed that the rescaling of age by lifespan simultaneously brings together aging trajectories of transcription and survival curves. In accordance with the theoretical prediction, the limiting mortality value at the plateau agrees closely with the mortality rate doubling exponent estimated at the cross-over age near the average lifespan. Finally, we used the transcriptomic signature of age to identify possible life-extending drug compounds and successfully tested a handful of the top-ranking molecules in C. elegans survival assays and achieved up to a +30% extension of mean lifespan.