Mechanisms underlying familial aggregation of exceptional health and survival: A three‐generation cohort study

The familial resemblance in length of adult life is very modest. Studies of parent‐offspring and twins suggest that exceptional health and survival have a stronger genetic component than lifespan generally. To shed light on the underlying mechanisms, we collected information on Danish long‐lived siblings (born 1886–1938) from 659 families, their 5379 offspring (born 1917–1982), and 10,398 grandchildren (born 1950–2010) and matched background population controls through the Danish 1916 Census, the Civil Registration System, the National Patient Register, and the Register of Causes of Death. Comparison with the background, population revealed consistently lower occurrence of almost all disease groups and causes of death in the offspring and the grandchildren. The expected incidence of hospitalization for mental and behavioral disorders was reduced by half in the offspring (hazard ratio 0.53, 95% confidence interval 0.45–0.62) and by one‐third in the grandchildren (0.69, 0.61–0.78), while the numbers for tobacco‐related cancer were 0.60 (0.51–0.70) and 0.71 (0.48–1.05), respectively. Within‐family analyses showed a general, as opposed to specific, lowering of disease risk. Early parenthood and divorce were markedly less frequent in the longevity‐enriched families, while economic and educational differences were small to moderate. The longevity‐enriched families in this study have a general health advantage spanning three generations. The particularly low occurrence of mental and behavioral disorders and tobacco‐related cancers together with indicators of family stability and only modest socioeconomic advantage implicate behavior as a key mechanism underlying familial aggregation of exceptional health and survival.