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Healthy survival


Suppose for a moment you are a man (Bandolier readers who are not will excuse us for a moment for a little reverie). Suppose you are 55 years old and healthy. Suppose you have developed a burning desire to:

  1. Make sure that you get the very last drop out of your pension fund, or
  2. To see Macclesfield win the European Championship (any other extremely remote sporting achievement), or
  3. Want to see documents about the present government released under the 30-year rule.

Whichever you choose, you need to live for another 30 years, and since you are going to do that, you need to remain free of physical or mental problems. This has also been called exceptional survival, exceptional because so few actually achieve it. Bandolier 78 examined findings of the US Nurses' Study that showed that women with healthy lifestyles lived far longer than those who did not. We now have a similar finding for men [1].


This was a report of the Honolulu Heart Program, which recruited over Japanese-American men in 1965-1968. The men were aged 45 to 68 years old (average 54 years). In subsequent years it has followed up mortality and development of major physical illness and cognition, during eight follow up visits up to 2005. A physical examination was performed at baseline, as well as biochemical and other variables.

Participants were classified into one of four types:
  1. Non survivors, who died before a specified age (75, 80, 85, 90 years).
  2. Usual survivors but disabled with a physical or cognitive disability.
  3. Usual survivors with chronic disease but no disability.
  4. Exceptional survivors who survived to a specified age without major chronic disease or cognitive or physical impairment.

Chronic disease of interest included coronary heart disease, stroke, cancer, COPD, Parkinson's disease, and diabetes. Physical impairment was defined as difficulty walking half a mile (about 800 metres).


Of 8006 original participants, 5,820 were healthy at baseline, did not die within one year, and had full baseline information including physical functioning. The classification at age 85 years is shown in Figure 1. Only 11% of men were exceptional survivors.

Figure 1: Percentage of men in the cohort with different outcomes by age 85 years

A set of risk factors was created after analysis of 29 different variables at baseline:

In the absence of any of these risk factors, a man aged 55 would have a high probability of survival to age 85 years (69%), and of exceptional survival among those alive at 85 years free of disease and cognitive impairment (55%); the probability of being alive at a age 85 and being free of major disease was the product of these (38%). With six or more risk factors, there was much less likelihood of any of these outcomes (22%, 9%, and 2% respectively).

Figures 2, 3, and 4 show the results graphically. With between 1 and 5 risk factors, the probabilities gradually declined, in a more or less linear manner. Thus for a man aged 55 years with three risk factors, the chance of survival to 85 years would be 50%, of being an exceptional survivor if alive at 85 years 30%, and of being both alive and free of major disease at 85 years about 15%.

Figure 2: Probability of 55 yr man being alive at 75, 80, or 85 years, with 0 or ≥6 risk factors

Figure 3: Probability of 55 yr man being free of serious disease at 75, 80, or 85 years if alive, with 0 or ≥6 risk factors

Figure 4: Probability of 55 yr man being alive at 75, 80, or 85 years and free of serious disease, with 0 or ≥6 risk factors


The major benefits of healthy living for men in this study were not dissimilar to those for women in the US Nurses' Study (Bandolier 78). In the end it all comes down to the usual healthy living advice. Don't smoke, drink moderately, don't be overweight, exercise, eat sensibly, and, for men, get married (helps with all the above).

Most of all, there is a steep relationship between both survival and being free of major disease and the number of risk factors. In the range 0-2 risk factors, the decline is moderate. At three or more risk factors, the decline is steep with each additional one. The lesson is to keep them to a minimum.

Essentially this is the Bandolier healthy living advice, available from the website. So, if you want to know the winner of the 2035 FA Cup, Ashes, or World Series, you know how to do it.


  1. BJ Willcox et al. Midlife risk factors and healthy survival in men. JAMA 2006 296: 2343-2350.

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