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Globally, the lifespan of populations increases but the healthspan is lagging behind. Previous research showed that survival into extreme ages (longevity) clusters in families as illustrated by the increasing lifespan of study participants with each additional long-lived family member. Here we investigate whether the healthspan in such families follows a similar quantitative pattern using three-generational data from two databases, LLS (Netherlands), and SEDD (Sweden). We study healthspan in 2143 families containing index persons with 26 follow-up years and two ancestral generations, comprising 17,539 persons. Our results provide strong evidence that an increasing number of long-lived ancestors associates with up to a decade of healthspan extension. Further evidence indicates that members of long-lived families have a delayed onset of medication use, multimorbidity and, in mid-life, healthier metabolomic profiles than their partners. We conclude that both lifespan and healthspan are quantitatively linked to ancestral longevity, making family data invaluable to identify protective mechanisms of multimorbidity. Although human life expectancy has been increasing, time spent in good physical and cognitive health has not been rising at similar rate. Here, the authors show that both lifespan and healthspan are quantitatively linked to ancestral longevity, and that those from the longest-lived families have a healthier metabolomics profile before the onset of disease, highlighting the important role of the family in healthy survival.

Survival to extreme ages clusters within families. However, identifying genetic loci conferring longevity and low morbidity in such longevous families is challenging. There is debate concerning the survival percentile that best isolates the genetic component in longevity. Here, we use three-generational mortality data from two large datasets, UPDB (US) and LINKS (Netherlands). We study 20,360 unselected families containing index persons, their parents, siblings, spouses, and children, comprising 314,819 individuals. Our analyses provide strong evidence that longevity is transmitted as a quantitative genetic trait among survivors up to the top 10% of their birth cohort. We subsequently show a survival advantage, mounting to 31%, for individuals with top 10% surviving first and second-degree relatives in both databases and across generations, even in the presence of non-longevous parents. To guide future genetic studies, we suggest to base case selection on top 10% survivors of their birth cohort with equally long-lived family members. While human lifespan is only moderately heritable, “getting old” runs in families. Here, van den Berg et al. study mortality data from three-generation cohorts to define a threshold for longevity and find that individuals have an increasing survival advantage with each additional relative in the top 10% survivors of their birth cohort.

Research on early-life mortality in contemporary and historical populations has shown that infant and child mortality tend to cluster in a limited number of high-mortality families, a phenomenon known as 'mortality clustering'. This paper is the first to review the literature on the role of the family in early-life mortality. Contemporary results, methodological and theoretical shortfalls, recent developments, and opportunities for future research are all discussed in this review. Four methodological approaches are distinguished: those based on sibling deaths, mother heterogeneity, thresholds, and excess deaths in populations. It has become clear from research to date that the death of an older child harms the survival chances of younger children in that family, and that fertility behaviour, earlier stillbirths, remarriages, and socioeconomic status all explain mortality clustering to some extent.

We investigate how experiencing parental death in infancy, childhood, or adolescence affected individuals' health using two distinct measures: mortality before age 20 and young adult height. Using two complementary indicators of health enables us to gain more insights into processes of selection and the scarring of health. Employing nationally representative data for the Netherlands for the 1850–1940 period, we analyze the survival of roughly 36,000 boys and girls using Cox proportional hazard models, and the stature of more than 4,000 young adult men using linear regression models. Results show that losing a parent—particularly a mother—at an early age (0–1 or 1–5) was related to a strongly increased risk of mortality. We find no evidence that losing a parent at these ages affected stature in young adulthood. For boys, experiencing maternal death between ages five and 12 was strongly associated with a shorter young adult height; however, we did not find evidence for an association between experiencing paternal death and shorter stature. We conclude that stature may not be a particularly good measure of the effects of early-life adversity if the health shock greatly increases mortality, as these effects create potential issues of health selection.

How do early-life conditions affect adult mortality? Research has yielded mixed evidence about the influence of infant and child mortality in birth cohorts on adult health and mortality. Studies rarely consider the specific role of mortality within the family. We estimated how individuals' exposure to mortality as a child is related to their adult mortality risk between ages 18 and 85 in two historical populations, Utah (USA) 1874-2015 and Zeeland (The Netherlands) 1812-1957. We examined these associations for early community-level exposure to infant and early (before sixth birthday) and late (before eighteenth birthday) childhood mortality as well as exposure during these ages to sibling deaths. We find that that exposure in childhood to community mortality and sibling deaths increases adult mortality rates. Effects of sibling mortality on adult all-cause mortality risk were stronger in Utah, where sibling deaths were less common in relation to Zeeland. Exposure to sibling death due to infection was related to the surviving siblings' risk of adult mortality due to cardiovascular disease (relative risk: 1.06) and metabolic disease (relative risk: 1.42), primarily diabetes mellitus, a result consistent with an inflammatory immune response mechanism. We conclude that early-life conditions and exposure to mortality in early life, especially within families of origin, contribute to adult mortality.

It remains unknown how different types of sources affect the reconstruction of life courses and families in large-scale databases increasingly common in demographic research. Here, we compare family and life-course reconstructions for 495 individuals simultaneously present in two well-known Dutch data sets: LINKS, based on the Zeeland province's full-population vital event registration data (passive registration), and the Historical Sample of the Netherlands (HSN), based on a national sample of birth certificates, with follow-up of individuals in population registers (active registration). We compare indicators of fertility, marriage, mortality, and occupational status, and conclude that reconstructions in the HSN and LINKS reflect each other well: LINKS provides more complete information on siblings and parents, whereas the HSN provides more complete life-course information. We conclude that life-course and family reconstructions based on linked passive registration of individuals constitute a reliable alternative to reconstructions based on active registration, if case selection is carefully considered.

It remains unknown how different types of sources affect the reconstruction of life courses and families in large-scale databases increasingly common in demographic research. Here, we compare family and lifecourse reconstructions for 495 individuals simultaneously present in two well-known Dutch data sets: LINKS, based on the Zeeland province’s full-population vital event registration data (passive registration), and the Historical Sample of the Netherlands (HSN), based on a national sample of birth certificates, with follow-up of individuals in population registers (active registration). We compare indicators of fertility, marriage, mortality, and occupational status, and conclude that reconstructions in the HSN and LINKS reflect each other well: LINKS provides more complete information on siblings and parents, whereas the HSN provides more complete life-course information. We conclude that life-course and family reconstructions based on linked passive registration of individuals constitute a reliable alternative to reconstructions based on active registration, if case selection is carefully considered.

Survival to extreme ages clusters within families. However, identifying genetic loci conferring longevity and low morbidity in such longevous families is challenging. There is debate concerning the survival percentile that best isolates the genetic component in longevity. Here, we use three-generational mortality data from two large datasets, UPDB (US) and LINKS (Netherlands). We studied 21,046 unselected families containing index persons, their parents, siblings, spouses, and children, comprising 321,687 individuals. Our analyses provide strong evidence that longevity is transmitted as a quantitative genetic trait among survivors up to the top 10% of their birth cohort. We subsequently showed a survival advantage, mounting to 31%, for individuals with top 10% surviving first and second-degree relatives in both databases and across generations, even in the presence of non-longevous parents. To guide future genetic studies, we suggest to base case selection on top 10% survivors of their birth cohort with equally long-lived family members.

Marriage is protective of survival and contributes to healthy ageing, whereas both singlehood and widowhood are related to increased mortality and poor health. The long-term change in the mortality differentials by marital status, and its interaction with gender and social class, has not been systematically addressed in the literature. In this study, we explore the marriage premium for survival and widowhood, bereavement and divorce penalties for survival over time using an established database for Southern Sweden (SEDD) between 1905 and 2015. We show that married men have and had a survival premium, while especially widowers have increased mortality, most strongly directly after bereavement but also in the longer run. It is remarkable that there is such stability in the survival advantage of married men, despite massive social, economic and demographic changes. Mortality differentials by marital status are smaller for women and absent for much of the twentieth century. Over time, it appears that there has been convergence in the patterns of mortality by marital status between men and women. The divergence in mortality by marital status for women started in the blue-collar class. White-collar and blue-collar men were similarly affected by marital status. Overall, we conclude that marital status is important for longevity, and has been so for the entire twentieth century for men, and increasingly also for women.

The socioeconomic health gradient has widened since the mid-21st century, but the role of childhood neighborhoods remains underexplored. Most neighborhood studies on health are cross-sectional, and longitudinal research is lacking. We analyze how socioeconomic neighborhood conditions in childhood influence cause-specific deaths in adulthood. We use uniquely detailed geocoded longitudinal microdata for the Swedish town of Landskrona, 1939-1967, linked to Swedish national registers, 1968-2015. We measure neighborhood SES by social class and use dynamic sizes of individual neighborhoods. Cox proportional hazards models are employed to estimate the impact of neighbor’s social class in childhood (ages 1-17) on mortality in ages 40-69. We control for class origin, class in adulthood, schools, and physical neighborhood characteristics. The class of the nearby, same-age, childhood neighbors had a lasting effect on male all-cause and preventable, but not non-preventable, mortality. Men who grew up with having 10% more children from white-collar families as close-proximity neighbors had an 8% lower mortality risk due to preventable causes of death in adulthood. The mortality for women was not affected by their childhood neighbors, although both a lower adult class and class origin increased their mortality. Because preventable causes of death are linked to lifestyle factors, this study suggests that childhood neighborhood peers had a strong and lasting influence on the health behavior of men growing up before the health gradient was fully established. Hence, our applied life-course perspective on childhood neighborhoods is crucial to better understand the mortality differentials by SES.