Abstract
Objective
to examine the association of parental longevity with healthy survival to age 90 years.
Methods
this was a prospective study among a racially and ethnically diverse cohort of 22,735 postmenopausal women from the Women’s Health Initiative recruited from 1993 to 1998 and followed through 2017. Women reported maternal and paternal ages at death and current age of alive parents. Parental survival categories were <70, 70–79 (reference), 80–89 and ≥90 years (longevity). Healthy ageing was defined as reaching age 90 without major chronic conditions (coronary heart disease, stroke, diabetes, cancer, or hip fracture) or physical limitations.
Results
women whose mothers survived to ≥90 years were more likely to attain healthy ageing (OR, 1.25; 95% CI, 1.11–1.42) and less likely to die before age 90 (OR, 0.75; 95% CI, 0.68–0.83). Women whose fathers survived to ≥90 years did not have significantly increased odds of healthy ageing but showed 21% (OR, 0.79; 95% CI, 0.70–0.90) decreased odds of death before age 90. Women whose mother and father both lived to 90 had the strongest odds of healthy ageing (OR, 1.38; 95% CI, 1.09–1.75) and decreased odds of death (OR, 0.68; 95% CI, 0.54–0.85). The proportion of healthy survivors was highest among women whose mother and father lived to 90 (28.6%), followed by those whose mother only lived to 90 (23.2%).
Conclusions
parental longevity predicted healthy ageing in a national cohort of postmenopausal women, supporting the view that genetic, environmental, and behavioral factors transmitted across generations may influence ageing outcomes among offspring.
Keywords: longevity, ageing, healthspan, women, survival, older people
Introduction
Achieving healthy ageing has become an important public health priority in light of the rapidly growing ageing population in the USA. The traditional definition of healthy ageing encompasses the ability to reach old age with delayed onset of age-related diseases and disabilities [1]. Individuals with exceptional survival often remain healthier for longer periods of time and enjoy better physical function in late life, such that their number of years of survival spent in good health (i.e. healthspan) approaches lifespan [2, 3]. Although genetic, epigenetic, behavioral and lifestyle factors may play a role in this phenomenon [2, 4], factors predicting healthy ageing remain incompletely understood.
Offspring of long-lived parents are more likely to not only live longer, but to also delay onset of age-related diseases (e.g. cardiovascular disease [CVD] and diabetes), have fewer CVD risk factors (e.g. hypertension) and have slower declines in physical and cognitive function [5–20]. In the New England Centenarian Study, offspring of centenarians had 78%, 83% and 86% lower risk of developing myocardial infarction, stroke and diabetes, respectively, than a similarly aged referent cohort [5]. Among Ashkenazi Jewish adults, individuals with either one or two compared with no parents who survived to age 95 had reduced decline in objectively-measured physical function during a median 3-year follow-up period [17].
Few studies have examined parental longevity in relation to a composite measure of healthy ageing that includes both avoidance of major diseases and disability. Previous studies were also limited by small sample sizes and case-control designs. A greater understanding of the role of parental longevity in offspring ageing outcomes will shed light on the interplay between demographic, lifestyle and inherited factors allowing some individuals to age successfully. Among the Women’s Health Initiative (WHI), we examined associations of maternal and paternal longevity with healthy ageing, defined as survival to age 90 without major chronic conditions (coronary heart disease [CHD], stroke, diabetes, cancer or hip fracture) or physical limitations.
Methods
Study population and design
The WHI is a large, prospective study investigating major risk factors for chronic diseases among women. Study details are described in Supplementary Methods, available at Age and Ageing online and elsewhere [21]. Women were recruited from 1993 to 1998 and participated in one or more of three clinical trials or an observational study. This study was restricted to participants born on or before 28 February 1927 who had potential, because of birth year, to survive to age 90 during the follow-up period ending 28 February 2017. Only women who had complete information on maternal or paternal survival, survival status and physical function at age 90 were included, leading to an analytic cohort of 22,735 women with up to 22 years of follow-up. All participants provided written informed consent, and institutional review board approval was received by all participating institutions.
Parental survival variables
At baseline, women were asked, by questionnaire, whether their natural mother and/or father was still alive. Women who responded affirmatively were asked their natural mother’s or father’s current age (<70, 70–79, 80–89, 90–99 or ≥100 years). Women with deceased parents were subsequently asked at what age their biological parents died, selecting from the following categories: <40, 40–49, 50–59, 60–69, 70–79, 80–89, 90–99 or ≥100 years. Parental longevity was defined as having a mother or father who survived to ≥90 years. Maternal and paternal survival variables were categorized as follows: <70, 70–79, 80–89 or ≥90 years. These variables included women whose natural parent died and those whose natural parent was still alive and ≥90 years; women whose natural mother or father was still alive but did not reach age 90 were excluded from these variables (n = 121). A third variable representing the number of long-lived parents was created among women with deceased parents, with the following categories: no parent lived to 90; only father lived to 90; only mother lived to 90 and both mother and father lived to 90.
Study variables
At baseline, participants completed questionnaires assessing age, race/ethnicity, education, income, marital status, diet quality, smoking, alcohol consumption, physical activity, depressive symptoms and self-rated health. Trained clinic staff measured height and weight at baseline. Body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared. Information on history of age-related diseases (CHD, stroke, cancer, diabetes and hip fracture) was collected at baseline and follow-up (Supplementary Methods, available at Age and Ageing online).
Study outcome
Participants were classified as having survived to age 90 or died before this age. Trained physician adjudicators confirmed deaths according to hospital records, autopsy or coroner’s reports or death certificates. Periodic linkage to the National Death Index was performed for all participants, including those lost to follow-up, for verification if medical records or death certificates were not available.
Healthy ageing was defined as survival to ≥90 years without a history of major age-related diseases and with no limitations in physical function. Although there is no standard definition of healthy ageing, previous definitions were based on Rowe and Kahn’s model, which includes avoidance of major diseases and the maintenance of high physical function [1, 22–24]. Late-life physical function status was determined using the physical function subscale of the RAND 36-item Health Survey collected within 2 years of the 90th birth year and with the least missing data [25]. Values on this scale range from 0 to 100, with higher scores indicating better function. Good physical function was defined as not reporting any of the following limitations, as previously described: limited at least ‘a little’ on moderate activities (moving a table, vacuuming, bowling, or golfing; climbing one flight of stairs; walking more than one mile; walking several blocks or bathing or dressing) or limited ‘a lot’ on difficult activities (running, lifting heavy objects or strenuous sports; lifting or carrying groceries; climbing several flights of stairs; or bending, kneeling or stooping) [22]. The outcome variable had three categories, defined similarly to previous studies: healthy survival (survived to age 90 and met the definition of healthy ageing); usual survival (survived to age 90 but did not meet the definition of healthy ageing) and died before age 90 [22–24].
Statistical analysis
Comparisons of baseline characteristics by maternal survival, paternal survival and number of long-lived parents were performed using chi-square tests for categorical variables. Normally distributed and non-normally distributed continuous variables were compared by parental survival using analysis of variance and Kruskal–Wallis tests, respectively.
The analytic approach for this study was similar to previous studies examining predictors of ageing outcomes [22–24]. Multinomial logistic regression models were used to examine associations of maternal survival, paternal survival and number of long-lived parents with healthy ageing, with results reported as odds ratios (OR) and 95% confidence intervals (CI). Separate models were fit for each parental survival variable. The reference category for parental survival variables was 70–79 years, because this age range includes the current average age at death, 78.8 years, in the USA [26]. Usual survivors were considered the reference category for the outcome in the analyses. Multivariable models were adjusted for potential confounders including baseline age, WHI study membership (clinical trial or observational study), race/ethnicity, education, marital status, smoking, alcohol consumption, physical activity, diet quality, depressive symptoms, self-rated health and BMI, variables associated with longevity and healthy ageing [22–24]. Tests for linear trend were performed by including parental survival variables as continuous predictors in the models.
In sensitivity analyses, to check for potential bias due to missing late-life functional data, women who survived to age 90 but had missing information on physical function were assumed to have physical limitations at this age in the models. To test the robustness of our definition of healthy ageing, alternative definitions were considered using different classifications for physical limitation. First, physical function was categorized according to the median, with good function indicated by a total score >45. Second, rather than including all domains of function, only mobility was examined; women who reported that their health limited ‘a lot’ or ‘a little’ their ability to walk one block or climb one flight of stairs were classified as having mobility disability.
P-values were two-tailed and considered statistically significant at P < 0.05. All analyses were performed using SAS Version 9.4 (SAS Institute, Cary, NC).
Results
Women were aged 73.5 (standard deviation 2.6; range, 68–81) years on average at baseline. Among the overall cohort, 19.0% experienced healthy survival to age 90, 27.6% had usual survival to age 90, and 53.5% died before age 90.
At baseline, women whose mothers lived longer were more likely to be white, college graduates, married or living as married, and current drinkers, and have excellent self-rated health, higher incomes and higher diet quality (Table 1). They were less likely to be obese, have depressive symptoms, or experience age-related diseases including CHD, stroke or diabetes. Similar differences were observed when comparing women according to paternal survival and number of long-lived parents (Table 2 and Supplementary Table 1, available at Age and Ageing online).
Table 1.
Baseline characteristics of postmenopausal women from the Women’s Health Initiative by maternal survival, 1993–1998 (N = 22,548)a
| Maternal survival, years | P-value | ||||
|---|---|---|---|---|---|
| <70 (N = 5,747) | 70–79 (N = 4,636) | 80–89 (N = 6,942) | ≥90 (N = 5,223) | ||
| Age, mean (SD), years | 73.7 (2.6) | 73.5 (2.5) | 73.4 (2.6) | 73.5 (2.5) | <0.001 |
| Race/ethnicity | |||||
| White | 4,965 (86.7) | 4,177 (90.5) | 6,388 (92.3) | 4,768 (91.6) | |
| Black | 449 (7.8) | 243 (5.3) | 284 (4.1) | 181 (3.5) | <0.001 |
| Hispanic | 98 (1.7) | 50 (1.1) | 74 (1.1) | 73 (1.4) | |
| Other | 214 (3.7) | 144 (3.1) | 178 (2.6) | 183 (3.5) | |
| Educational level | |||||
| Less than high school | 465 (8.1) | 302 (6.6) | 355 (5.1) | 209 (4.0) | |
| High school | 1,105 (19.3) | 853 (18.5) | 1,202 (17.4) | 831 (16.0) | <0.001 |
| Some college | 2,292 (40.1) | 1,763 (38.3) | 2,749 (39.8) | 2,070 (39.8) | |
| College graduate | 1,853 (32.4) | 1,688 (36.7) | 2,598 (37.6) | 2,089 (40.2) | |
| Income | |||||
| <$20,000 | 1,607 (30.3) | 1,196 (27.7) | 1,555 (24.1) | 1,011 (21.0) | |
| $20,000-<$50,000 | 2,632 (49.6) | 2,146 (49.7) | 3,389 (52.4) | 2,494 (51.9) | <0.001 |
| ≥$50,000 | 1,070 (20.2) | 975 (22.6) | 1,523 (23.6) | 1,304 (27.1) | |
| Marital status | |||||
| Married/living as married | 2,679 (46.8) | 2,214 (47.9) | 3,463 (50.1) | 2,723 (52.3) | |
| Widowed | 2,205 (38.5) | 1,697 (36.8) | 2,473 (35.8) | 1,742 (33.5) | <0.001 |
| Divorced/separated | 606 (10.6) | 475 (10.3) | 697 (10.1) | 517 (9.9) | |
| Never married | 236 (4.1) | 232 (5.0) | 282 (4.1) | 225 (4.3) | |
| Smoking behavior | |||||
| Never smoked | 3,098 (54.9) | 2,481 (54.4) | 3,690 (53.9) | 2,834 (55.0) | |
| Past smoker | 2,263 (40.1) | 1,899 (41.7) | 2,855 (41.7) | 2,102 (40.8) | 0.09 |
| Current smoker | 285 (5.1) | 179 (3.9) | 301 (4.4) | 221 (4.3) | |
| Alcohol intake | |||||
| Nondrinker | 785 (13.8) | 577 (12.6) | 822 (11.9) | 618 (11.9) | |
| Past drinker | 1,274 (22.4) | 1,010 (22.0) | 1,341 (19.4) | 929 (17.9) | <0.001 |
| Current drinker | 3,628 (63.8) | 3,010 (65.5) | 4,737 (68.7) | 3,642 (70.2) | |
| Recreational physical activity, mean (SD), MET-hours/week | 12.0 (12.9) | 12.0 (13.5) | 12.3 (13.1) | 12.5 (12.8) | 0.001 |
| Healthy eating index score, mean (SD) | 68.8 (10.6) | 68.9 (10.3) | 69.4 (10.2) | 69.2 (10.3) | 0.01 |
| Body mass index, kg/m2 | |||||
| Underweight | 81 (1.4) | 54 (1.2) | 64 (0.9) | 81 (1.6) | |
| Normal weight | 2,006 (35.2) | 1,704 (37.2) | 2,597 (37.8) | 2,063 (39.8) | <0.001 |
| Overweight | 2,086 (36.6) | 1,673 (36.5) | 2,545 (37.0) | 1,941 (37.4) | |
| Obese | 1,521 (26.7) | 1,156 (25.2) | 1,669 (24.3) | 1,100 (21.2) | |
| Burnham depression scale score ≥0.06 | 488 (8.8) | 406 (9.0) | 533 (7.9) | 363 (7.2) | 0.002 |
| History of major age-related diseases | |||||
| Coronary heart disease | 1,030 (17.9) | 776 (16.7) | 977 (14.1) | 595 (11.4) | <0.001 |
| Stroke | 748 (13.0) | 574 (12.4) | 792 (11.4) | 516 (9.9) | <0.001 |
| Cancer | 1,802 (31.4) | 1,455 (31.4) | 2,219 (32.0) | 1,607 (30.8) | 0.57 |
| Diabetes | 958 (16.7) | 775 (16.7) | 1,017 (14.7) | 680 (13.0) | <0.001 |
| Hip fracture | 428 (7.5) | 339 (7.3) | 507 (7.3) | 376 (7.2) | 0.97 |
| ≥1 Disease | 3,557 (61.9) | 2,846 (61.4) | 4,090 (58.9) | 2,889 (55.3) | <0.001 |
| Self-rated health | |||||
| Excellent | 644 (11.3) | 526 (11.4) | 936 (13.6) | 797 (15.3) | |
| Very good | 2,120 (37.3) | 1,750 (38.0) | 2,768 (40.2) | 2,215 (42.6) | <0.001 |
| Good | 2,208 (38.8) | 1,802 (39.2) | 2,499 (36.3) | 1,739 (33.5) | |
| Fair/poor | 717 (12.6) | 525 (11.4) | 688 (10.0) | 447 (8.6) | |
MET, metabolic equivalent; SD, standard deviation.
aValues are represented as No. (%), unless otherwise indicated. Data do not sum to total due to missing data.
Table 2.
Baseline characteristics of postmenopausal women from the Women’s Health Initiative by paternal survival, 1993–1998 (N = 22,291)a
| Paternal survival, years | P-value | ||||
|---|---|---|---|---|---|
| <70 (N = 8,552) | 70–79 (N = 6,124) | 80–89 (N = 5,434) | ≥90 (N = 2,181) | ||
| Age, mean (SD), years | 73.5 (2.6) | 73.5 (2.6) | 73.5 (2.6) | 73.5 (2.5) | 0.59 |
| Race/ethnicity | |||||
| White | 7,641 (89.7) | 5,572 (91.3) | 4,941 (91.3) | 1,942 (89.2) | |
| Black | 504 (5.9) | 289 (4.7) | 233 (4.3) | 88 (4.0) | <0.001 |
| Hispanic | 123 (1.4) | 59 (0.9) | 65 (1.2) | 40 (1.8) | |
| Other | 253 (3.0) | 182 (3.0) | 174 (3.2) | 108 (5.0) | |
| Educational level | |||||
| Less than high school | 585 (6.9) | 358 (5.9) | 261 (4.8) | 100 (4.6) | |
| High school | 1,582 (18.6) | 1,101 (18.1) | 934 (17.3) | 310 (14.3) | <0.001 |
| Some college | 3,482 (41.0) | 2,357 (38.7) | 2,102 (38.8) | 829 (38.1) | |
| College graduate | 2,849 (33.5) | 2,271 (37.3) | 2,116 (39.1) | 935 (43.0) | |
| Income | |||||
| <$20,000 | 2,189 (27.6) | 1,486 (26.2) | 1,207 (23.9) | 414 (20.5) | |
| $20,000-<$50,000 | 3,976 (50.2) | 2,887 (50.9) | 2,630 (52.1) | 1,046 (51.9) | <0.001 |
| ≥$50,000 | 1,760 (22.2) | 1,294 (22.8) | 1,216 (24.1) | 556 (27.6) | |
| Marital status | |||||
| Married/living as married | 4,102 (48.1) | 3,003 (49.2) | 2,747 (50.8) | 1,129 (51.9) | |
| Widowed | 3,165 (37.1) | 2,180 (35.7) | 1,911 (35.3) | 759 (34.9) | 0.01 |
| Divorced/separated | 891 (10.5) | 632 (10.4) | 533 (9.9) | 187 (8.6) | |
| Never married | 364 (4.3) | 284 (4.7) | 221 (4.1) | 100 (4.6) | |
| Smoking behavior | |||||
| Never smoked | 4,508 (53.4) | 3,213 (53.4) | 3,019 (56.4) | 1,232 (57.4) | |
| Past smoker | 3,520 (41.7) | 2,527 (42.0) | 2,131 (39.8) | 832 (38.8) | <0.001 |
| Current smoker | 407 (4.8) | 283 (4.7) | 203 (3.8) | 82 (3.8) | |
| Alcohol intake | |||||
| Nondrinker | 1,005 (11.9) | 701 (11.5) | 758 (14.0) | 297 (13.7) | |
| Past drinker | 1,811 (21.4) | 1,285 (21.2) | 1,030 (19.1) | 386 (17.8) | <0.001 |
| Current drinker | 5,661 (66.8) | 4,090 (67.3) | 3,612 (66.9) | 1,487 (68.5) | |
| Recreational physical activity, mean (SD), MET-hours/week | 11.8 (12.9) | 12.4 (13.3) | 12.5 (13.4) | 12.3 (12.3) | 0.001 |
| Healthy eating index score, mean (SD) | 68.8 (10.4) | 69.2 (10.3) | 69.3 (10.4) | 69.6 (10.2) | 0.005 |
| Body mass index, kg/m2 | |||||
| Underweight | 103 (1.2) | 84 (1.4) | 55 (1.0) | 37 (1.7) | |
| Normal weight | 3,061 (36.1) | 2,288 (37.7) | 2,102 (39.1) | 824 (38.0) | 0.002 |
| Overweight | 3,151 (37.2) | 2,234 (36.9) | 1,968 (36.6) | 823 (38.0) | |
| Obese | 2,161 (25.5) | 1,457 (24.0) | 1,256 (23.3) | 482 (22.3) | |
| Burnham depression scale score ≥0.06 | 716 (8.7) | 483 (8.1) | 410 (7.7) | 156 (7.4) | 0.12 |
| History of major age-related diseases | |||||
| Coronary heart disease | 1,458 (17.1) | 918 (15.0) | 702 (12.9) | 261 (12.0) | <0.001 |
| Stroke | 1,031 (12.1) | 684 (11.2) | 645 (11.9) | 230 (10.6) | 0.13 |
| Cancer | 2,697 (31.5) | 1,933 (31.6) | 1,699 (31.3) | 679 (31.1) | 0.97 |
| Diabetes | 1,407 (16.5) | 900 (14.7) | 785 (14.5) | 302 (13.9) | <0.001 |
| Hip fracture | 562 (6.6) | 486 (7.9) | 423 (7.8) | 158 (7.2) | 0.007 |
| ≥1 Disease | 5,200 (60.8) | 3,625 (59.2) | 3,156 (58.1) | 1,242 (57.0) | <0.001 |
| Self-rated health | |||||
| Excellent | 991 (11.7) | 792 (13.0) | 753 (14.0) | 336 (15.5) | |
| Very good | 3,247 (38.3) | 2,362 (38.8) | 2,234 (41.4) | 931 (43.0) | <0.001 |
| Good | 3,262 (38.4) | 2,249 (37.0) | 1,906 (35.3) | 731 (33.8) | |
| Fair/poor | 987 (11.6) | 679 (11.2) | 503 (9.3) | 165 (7.6) | |
MET, metabolic equivalent; SD, standard deviation.
aValues are represented as No. (%), unless otherwise indicated. Data do not sum to total due to missing data.
Compared with women whose mothers lived to 70–79 years, women whose mothers lived to ≥90 years had 25% (OR, 1.25; 95% CI, 1.11–1.42) increased odds of survival to age 90 without major diseases or physical limitations (Table 3). Women whose mothers lived to ≥90 years had 25% (OR, 0.75; 95% CI, 0.68–0.83) decreased odds of death before age 90. Compared with women whose fathers lived to 70–79 years, women whose fathers achieved longevity did not have increased odds of healthy ageing (OR, 1.11; 95% CI, 0.96–1.29) but had 21% (OR, 0.79; 95% CI, 0.70–0.90) decreased odds of death before age 90. Increasing maternal and paternal survival were significantly linearly associated with healthy ageing (P-values for trend = 0.008 and 0.006, respectively) and death before age 90 (P-values for trend = 0.001 and 0.008, respectively).
Table 3.
Multivariable associations of parental longevity with healthy survival to age 90 among postmenopausal women from the Women’s Health Initiative, 1993–2017
| Healthy survival to age 90 vs. usual survival to age 90a | Death before age 90 vs. usual survival to age 90 | |||
|---|---|---|---|---|
| Crudeb | Multivariable-adjustedc,d | Crudeb | Multivariable-adjustedc,d | |
| OR (95% CI) | OR (95% CI) | |||
| Maternal survival, years | ||||
| <70 | 1.02 (0.90–1.15) | 1.05 (0.92–1.20) | 0.98 (0.89–1.07) | 0.95 (0.86–1.05) |
| 70–79 | 1.00 [ref] | 1.00 [ref] | 1.00 [ref] | 1.00 [ref] |
| 80–89 | 1.12 (0.99–1.25) | 1.08 (0.96–1.23) | 0.94 (0.86–1.02) | 0.95 (0.86–1.04) |
| ≥90 | 1.29 (1.15–1.45) | 1.25 (1.11–1.42) | 0.72 (0.65–0.79) | 0.75 (0.68–0.83) |
| Paternal survival, years | ||||
| <70 | 0.89 (0.81–0.99) | 0.90 (0.81–1.00) | 1.02 (0.95–1.11) | 1.00 (0.92–1.09) |
| 70–79 | 1.00 [ref] | 1.00 [ref] | 1.00 [ref] | 1.00 [ref] |
| 80–89 | 1.01 (0.90–1.12) | 0.98 (0.87–1.10) | 0.93 (0.86–1.02) | 0.96 (0.87–1.06) |
| ≥90 | 1.12 (0.98–1.29) | 1.11 (0.96–1.29) | 0.74 (0.66–0.83) | 0.79 (0.70–0.90) |
| Number of long-lived parents | ||||
| No parent lived to 90 | 1.00 [ref] | 1.00 [ref] | 1.00 [ref] | 1.00 [ref] |
| Only father lived to 90 | 1.12 (0.96–1.31) | 1.12 (0.95–1.32) | 0.75 (0.66–0.85) | 0.80 (0.70–0.92) |
| Only mother lived to 90 | 1.20 (1.09–1.33) | 1.19 (1.06–1.32) | 0.75 (0.69–0.81) | 0.80 (0.73–0.87) |
| Both mother and father lived to 90 | 1.45 (1.16–1.81) | 1.38 (1.09–1.75) | 0.64 (0.52–0.79) | 0.68 (0.54–0.85) |
CI, confidence interval; OR, odds ratio.
aHealthy survival defined as: survival to age 90 free of major chronic diseases (coronary heart disease, stroke, cancer, diabetes or hip fracture) and physical limitations.
bCrude model adjusted for age and race/ethnicity.
cMultivariable model adjusted for age, race/ethnicity, study component (observational study or clinical trial), education, marital status, smoking, alcohol consumption, diet quality, body mass index, depressive symptoms, physical activity and self-rated health.
dMaternal longevity: P-value for trend = 0.008 (healthy survival) and 0.001 (death); paternal longevity: P-value for trend = 0.006 (healthy survival) and 0.008 (death).
Compared with women without any long-lived parents, women with only long-lived mothers had increased odds of healthy ageing (OR, 1.19; 95% CI, 1.06–1.32), whereas women with only long-lived fathers did not have increased odds of healthy ageing (OR, 1.12; 95% CI, 0.95–1.32) (Table 3). Women with a single long-lived parent had similar decreased odds of death before age 90 (Table 3). The strongest odds of healthy ageing were among women whose mother and father both lived to 90 (OR, 1.38; 95% CI, 1.09–1.75); these women were also the least likely to die before age 90 (OR, 0.68; 95% CI, 0.54–0.85). Women with two long-lived parents had the highest proportion of healthy survivors (28.6%), and women with no long-lived parent had the highest proportion of death before age 90 (56.2%) (Supplementary Figure 1, available at Age and Ageing online).
In sensitivity analyses assuming that women with missing data on physical function had physical limitations at age 90, findings in multivariable models were similar. In analyses using alternative classifications for physical limitation in definitions of healthy ageing, findings were similar (data not shown).
Discussion
Among a national cohort of >22,000 postmenopausal women, parental longevity predicted survival to age 90 free of major age-related diseases and physical limitations. Women whose mothers survived to ≥90 years had 25% increased likelihood of achieving healthy ageing. Having both a mother and father who achieved longevity was associated with the strongest likelihood of healthy ageing. These findings support the notion that individuals with familial longevity may be more likely to not only achieve longevity themselves but to also enjoy their later years without morbidity or disability.
Our findings agree with prior studies showing that offspring of long-lived parents may live longer and healthier lives [5–20]. A study among Italians observed that, compared with an age-matched group without long-lived parents and from a similar birth cohort, offspring of centenarians had lower BMI and smaller proportion of obese individuals, and were also more likely to be able to walk 500 meters without requiring help [20]. In a recent study among >186,000 participants, increasing parental survival was associated with greater education, higher income, more physical activity, less smoking and lower prevalence of obesity, similar to our study [6]. We found that parental longevity predicted healthy ageing after adjustment for these confounders, suggesting that sociodemographic and lifestyle factors do not entirely explain associations of parental longevity with healthy ageing.
Parental longevity likely represents the combined effects of genetic, behavioral and environmental factors transmitted across generations that, throughout the life course, influence ageing outcomes among offspring. The protective association between parental longevity and adverse health outcomes may be largely due to genetic factors [4, 27, 28]. In a recent genome-wide association study, 10 genetic loci were associated with attained parental age, including APOE, a gene associated with longevity [4, 27, 28]. In the WHI, single nucleotide polymorphisms representing variation in APOE were associated with longevity and a composite outcome of healthy ageing defined similarly to the one used in the present study [27]. Offspring may inherit genetic factors that protect against major diseases and disability; however, it is unknown whether a similar set of genetic factors influences both disease and disability.
The ability to maintain physical function in old age is a key component of healthy ageing [1]. Parental longevity has been linked to less decline in physical function in ageing [17, 18]. Besides environmental factors, variation in late-life disability is also partly attributable to genetic factors [29, 30], a finding that is supported by the association of parental longevity with survival to age 90 without physical limitations in the present study. Variation in APOE has been associated with increased risk of gait speed decline and disability among community-dwelling older adults and was associated with disability-free survival in the WHI [27, 30].
Our study has several limitations. Women who consented to further follow-up were more likely to be white, educated, and healthier at baseline than those who were lost to follow-up, thus findings may be biased by selective attrition. Parental age at death was based upon participant report and not validated, which may have resulted in misclassification. Women whose natural mother or father was still alive but did not reach age 90 were not included; however, as reported, a small number of women met this criterion. We did not evaluate cognitive outcomes, such as dementia, in our definition of healthy ageing, due to limited data because they were not collected regularly among all WHI participants. Finally, we lacked information on parental cause of death.
Strengths of our study include the ethnically diverse cohort, large sample size and 22 years of follow-up with information on late-life physical function. Our study examined a large number of women who survived to age 90 and who achieved healthy ageing as defined by this study. We were able to examine both paternal and maternal survival and had information on many confounders and adjudicated chronic diseases. Finally, any confounding due to birth cohort effects was minimized due to the narrow baseline age range of the cohort.
In summary, maternal and paternal longevity predicted survival to age 90 without major chronic conditions or physical limitations in a national cohort of postmenopausal women. Our findings suggest that daughters of long-lived parents may be more likely to live a long and healthy life. From a public health perspective, future studies with life course data are needed to clarify how environmental factors and behaviors, some of which are transmitted across generations, interact with genetic and epigenetic factors to influence ageing outcomes.
Key points.
We examined the association between parental longevity and healthy ageing to 90 years among women.
Women whose mother and father both lived to 90 had the greatest chances of achieving healthy ageing.
Examined separately, maternal, but not paternal, longevity was associated with increased likelihood of healthy ageing.
Daughters of long-lived parents may be more likely to live a long and healthy life.
Genetic, environmental and behavioral factors transmitted across generations may influence ageing outcomes among offspring.
Supplementary Material
Acknowledgements
We would like to acknowledge the following Women’s Health Initiative Investigators: Program Office: (National Heart, Lung, and Blood Institute, Bethesda, Maryland) Jacques Rossouw, Shari Ludlam, Dale Burwen, Joan McGowan, Leslie Ford and Nancy Geller Clinical Coordinating Center: (Fred Hutchinson Cancer Research Center, Seattle, WA) Garnet Anderson, Ross Prentice, Andrea LaCroix and Charles Kooperberg. Investigators and Academic Centers: (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA) J.E.M.; (MedStar Health Research Institute/Howard University, Washington, DC) B.V.H.; (Stanford Prevention Research Center, Stanford, CA). Marcia L. Stefanick; (The Ohio State University, Columbus, OH) Rebecca Jackson; (University of Arizona, Tucson/Phoenix, AZ) Cynthia A. Thomson; (University at Buffalo, Buffalo, NY). Jean Wactawski-Wende; (University of Florida, Gainesville/Jacksonville, FL) Marian Limacher; (University of Iowa, Iowa City/Davenport, IA) Robert Wallace; (University of Pittsburgh, Pittsburgh, PA) Lewis Kuller and (Wake Forest University School of Medicine, Winston-Salem,NC) Sally Shumaker.
Funding
This work was supported by National Heart, Lung and Blood Institute, National Institutes of Health, US Department of Health and Human Services [contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C and HHSN271201100004C]. The National Heart, Lung and Blood Institute has representation on the Women’s Health Initiative Steering Committee, which governed the design and conduct of the study, the interpretation of the data and preparation and approval of manuscripts.
Ethics Approval
Fred Hutchinson Cancer Research Center Ethics Committee, Seattle, WA.
Conflicts of interest
None.
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