Background Longevity, a hallmark of successful ageing, is a multifactorial trait with influences from birth onwards. However, limited evidence exists on the pathways linking diverse life-course exposures to longevity, especially within a single cohort. Methods We investigated associations between life-course factors and longevity among community-dwelling adults aged 79 (N=547) from the Lothian Birth Cohort 1921 with a mortality follow-up of 24 years. Cox proportional hazards and structural equation (path) models were used to explore how factors from early-life (social class, childhood IQ, education), mid-life (social class), later-life (health, lifestyle, psychosocial well-being), as well as sex, personality and APOE e4 status, influence survival time in days. Results During follow-up (1999-2023), 538 participants (98%) died (mean age of death=89.3 years) and 9 survived (mean age=101.6 years). Factors associated with lower mortality risk in the multivariable Cox model were higher cognitive function (HR=0.72; 95% CI:0.59-0.88), better physical function (HR=0.61; 95% CI:0.44-0.85), and greater physical activity (HR=0.81; 95% CI 0.71-0.92), while history of cancer was associated with higher mortality risk (HR=1.84; 95% CI:1.22-2.77). The life-course path model identified the same direct predictors, with additional contributions from female sex and non-smoking status, to greater longevity. Early- and mid-life factors (IQ, education, social class), and emotional stability, conscientiousness, and female sex, were indirectly and positively associated with survival trajectories via multiple dimensions of adult health. Conclusions In understanding why people live to very old ages it is necessary to consider factors from throughout the life course, and to include demographic, psychosocial, and health variables.

中文翻译：

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通往超长寿命的生命历程之路：来自 1921 年洛锡安出生队列的证据


背景 长寿是成功老龄化的标志，是一种多因素特征，从出生起就受到影响。然而，关于不同生命历程暴露与长寿之间联系的途径，特别是在单个队列中，证据有限。方法 我们调查了来自 1921 年洛锡安出生队列的 79 岁社区居住成年人 (N=547) 的生命历程因素与寿命之间的关联，并进行了 24 年的死亡率随访。 Cox比例风险和结构方程（路径）模型被用来探索早期生活（社会阶层、儿童智商、教育）、中年（社会阶层）、晚年（健康、生活方式、心理社会福祉）的因素如何）以及性别、性格和 APOE e4 状态都会影响生存时间（以天为单位）。结果 在随访期间（1999-2023），538 名参与者（98%）死亡（平均死亡年龄=89.3 岁），9 名参与者幸存（平均年龄=101.6 岁）。多变量 Cox 模型中与较低死亡风险相关的因素是较高的认知功能（HR=0.72；95% CI：0.59-0.88）、更好的身体功能（HR=0.61；95% CI：0.44-0.85）和更多的身体活动（HR=0.81；95% CI：0.71-0.92），而癌症病史与较高的死亡风险相关（HR=1.84；95% CI：1.22-2.77）。生命历程路径模型确定了相同的直接预测因素，以及女性性别和非吸烟状况对延长寿命的额外贡献。早年和中年因素（智商、教育、社会阶层）以及情绪稳定性、责任心和女性性别通过成人健康的多个维度与生存轨迹间接、正相关。 结论 在理解人们为什么能活到很老的时候，有必要考虑整个生命历程的因素，包括人口、社会心理和健康变量。