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Usually women live longer than men and female centenarians largely outnumber male centenarians. The findings of previous studies identifying a population with a femininity ratio close to 1.0 among centenarians in the mountainous region of Sardinia was the starting point of an in-depth investigation in order to compare mortality trajectories between men and women in that population. The exceptional survival of men compared to women emerges from the comparison with similar Italian data. Age exaggeration for men has been strictly excluded as a result of the age validation procedure. The discussion suggests that besides biological/genetic factors, the behavioral factors including life style, demographic behavior, family support, and community characteristics may play an important role. No single explanation is likely to account for such an exceptional situation and a fully integrated multidisciplinary approach is urgently needed.
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Journal of Aging Research
Volume 2011, Article ID 153756, 10 pages
Research Article
A Population Where Men Live As Long As Women:
Villagrande Strisaili, Sardinia
Michel Poulain,1, 2 Gianni Pes,3and Luisa Salaris4
1FNRS, IACCHOS, Universit´
e Catholique de Louvain, 6000 Charleroi, Belgium
2Institute for Population Studies, Tallinn University, 10504 Tallinn, Estonia
3Dipartimento di Scienze Biomediche, Universit`
a degli Studi di Sassari, 07100 Sassari, Italy
4Dipartimento di Ricerche Economiche e Sociali, Universit`
a degli Studi di Cagliari, 09123 Cagliari, Italy
Correspondence should be addressed to Michel Poulain,
Received 15 February 2011; Revised 11 May 2011; Accepted 9 June 2011
Copyright © 2011 Michel Poulain et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Usually women live longer than men and female centenarians largely outnumber male centenarians. The findings of previous
studies identifying a population with a femininity ratio close to 1.0 among centenarians in the mountainous region of Sardinia
was the starting point of an in-depth investigation in order to compare mortality trajectories between men and women in that
population. The exceptional survival of men compared to women emerges from the comparison with similar Italian data. Age
exaggeration for men has been strictly excluded as a result of the age validation procedure. The discussion suggests that besides
biological/genetic factors, the behavioral factors including life style, demographic behavior, family support, and community
characteristics may play an important role. No single explanation is likely to account for such an exceptional situation and a
fully integrated multidisciplinary approach is urgently needed.
1. Introduction
In developed countries, it has been widely documented that
females live longer than males [13]. This female advantage
in survival, the so-called Longevity Gender Gap (LGG),
results from lower female death rates throughout the lifespan
[46]. In traditional societies, the LGG was less pronounced
and even inversed [7] and a secular trend of increasing LGG
is generally observed. Nevertheless the trend has changed in
the recent decades resulting in a slightly decreasing LGG [8].
In general, it has been observed that during the life
course, the occurrence of certain diseases such as cardiovas-
cular diseases, lung cancer and accidents are more frequent
among males [9] and this trend is confirmed when extending
the comparison to the top 12 causes of deaths [10]. The
cumulative eect of these dierences throughout the life
course, results in a greater proportion of females surviving
at more advanced ages. In populations experiencing a low
mortality, the femininity ratio (F/M) among centenarians
is usually above 4, that is, there are more than 4 female
centenarians per male centenarian (data source: Human
Mortality Database). However, recent research has shown
that in certain populations the F/M ratio among the oldest
olds may be remarkably lower, and when this occurs it is
often the result of a reduced excess of male mortality rather
than a higher mortality of women [1113]. Among these
populations, the one living in the Mediterranean island of
Sardinia certainly represents an interesting case study. This
region has been suspected to be characterized by a particu-
larly high male longevity [14]. Considering the importance
of age validation in longevity studies, the demographic data
were carefully checked by using all available data sources in
order to avoid cases of age exaggeration [15]. Based on these
validation results, an area with significantly higher levels of
longevity and lower F/M ratio among centenarians has been
identified in the central-eastern part of the island and was
called the Blue Zone [16]. As a result the topic of research
has been switched from individual longevity to population
longevity aiming to facilitate the identification of longevity
determinants shared by people living in such area.
This longevity Blue Zone located in the provinces of
Ogliastra and Nuoro in the mountainous region of Sardinia
2 Journal of Aging Research
shows a value of the Extreme Longevity Index (ELI1)
computed for the newborns between 1880 and 1900 that is
more than twice as high as that of whole Sardinia. Strikingly
the F/M ratio among centenarians in this population is close
to one, as 47 male centenarians were found and only 44
female centenarians. Thus the LGG usually observed among
the oldest olds in other populations is virtually nonexistent
in the longevity Blue Zone.
From these findings, the following question arises: How
is it possible that in this population the proportion of men
reaching the extreme end of age spectrum is the same as for
women? In order to answer this question, the population of
the municipality of Villagrande Strisaili was selected, as it is
the municipality with the highest ELI value in Sardinia (10.8
centenarians per 1,000 newborns) and an extraordinary low
F/M ratio; among the 30 centenarians found in Villagrande
16 are male. The life trajectory of each individual born in
the village during the period 1876–19122was followed from
birth to death.
The analysis of the collected data allows the comparison
of the mortality trajectory for men and women. Moreover the
life table estimates of Villagrande have been compared with
the corresponding ones for Italy extracted from the Human
Mortality Database (HMD) [17]. The analysis of mortality
trajectories allows the identification in more detail of the
critical age interval for determining between-gender level
dierentials in longevity among the populations considered.
In the discussion, possible explanations for the lack of
LGGobservedintheBlue Zone will be reviewed in light
of existing literature. As we will suggest, besides biologi-
cal/genetic factors, numerous behavioral characteristics may
count for explaining the male advantage. Accordingly only
multidisciplinary investigations could explain the excep-
tional survival of males in the population under study.
Having in mind this objective the few empirical evidences
presented here should be considered as a starting point for
further investigations.
2. Setting, Data, and Methods
2.1. Setting. The village of Villagrande is located at 700
meters above sea level in the province of Ogliastra, but
the altitude of its territory ranges from sea level to Punta
La Marmora at 1,834 meters. On 1 January 2010, 3,441
inhabitants lived in Villagrande (ISTAT) where agropastoral-
pastoral activities and traditional life style are still prevalent.
Despite the fact that until the 1960s this region was among
the poorest within the island, recent economic developments
brought the population of this area close to the average
welfare standard of the Italian population.
2.2. Data. The database developed for the present study
includes all individuals born in Villagrande from 1876 to
1912. For each individual we traced the exact date at death
or the proof that he/she was still alive at the date of inves-
tigation. The data was gathered from civil registers (which
record all births, marriages, and deaths), parish registers
and the population register (anagrafe). All information has
been collected in the municipality population registration
oce and was cross-checked with information reported in
the military register and orally reported information from
any relatives of these persons. With regard to those who
died outside the village, the information was recovered by
using annotations on date and place of death reported in the
margin of the birth certificate or transcription of the date
of death in the anagrafe. For those who emigrated and for
whom no death has been reported, the survival status has
been verified with the municipality of current residence.
A total number of 1,957 persons born in Villagrande
during the years 1876 to 19123have been considered in this
study of which:
(i) 1,624 who died in Villagrande itself;
(ii) 206 who died outside Villagrande;
(iii) 20 who were still alive at the date of investigation;4
(iv) 107 for whom the date of death or the survival is
2.3. Coverage. The data collection method enables to reduce
significantly the number of missing dates of death due to lack
of information (107 cases). The latter group of newborns
has been divided between outmigrants with the documented
date of emigration and those where no indication of
emigration was available. For those without information
on emigration, their date of marriage or the latest trace
in administrative documents, for example, military reports
was considered as partial information. As a result, there
were only 26 newborns for whom no information at all on
survival was found, whereas for other 81 we found at least
information attesting their survival at the time of marriage,
military examination, or emigration. A final coverage rate of
above 98 per cent was reached. This should be considered
exceptional in the context of historical demography and
family reconstruction. Moreover such level of coverage
contributed to the complete validation of the database and
the strength of the subsequent analysis.
2.4. Methods. Thepresenceofstillalivenewbornsand
newborns with partial information implied the setting up
of censoring strategies in order not to lose precious infor-
mation. The general rule was to take the last information
available that attested survival as censoring time.
The method utilized in this study is the classical cohort
life table construction privileging as output the mortality
rates and the cumulative survival curve. The computation
of the survival curve takes into account the contribution of
all censored newborns up to their exit of observation. The
exclusion of the 26 persons without information and the
censoring of the 101 others (20 alive and 81 with partial
information) can hardly aect the validity of our findings.
The distribution of the 1957 persons by gender, five years age
groups at death or survival is displayed in Tabl e 1 .
For comparative purposes, we utilized data for Italy
collected from birth cohort life tables available in the
HMD for the same birth cohorts 1876–1912 considered for
Journal of Aging Research 3
Tab l e 1: Observed number of deaths (showing also censored cases) by gender and age groups and cohorts of newborns including those who
were alive at the time of investigation (2006).
Males Females
Age completed 1876–1889 1890–1900 1901–1912 Alive Total 1876–1889 1890–1900 1901–1912 Alive Total
0 27 (1) 37 (1) 58 (1) 125 38 (1) 31 (1) 34 (1) 106
1–4 36 (2) 41 29 (1) 109 48 42 35 125
5–9 9 11 17 37 21 7 9 37
10–14 7 7 12 — 26 4 2 11 — 17
15–19 6 14 (6) 13 (3) 42 4 5 4 (2) 15
20–24 6 (1) 32 (5) 14 (2) 60 6 17 6 29
25–29 7 (5) 9 (1) 8 (1) 31 9 (2) 9 8 28
30–34 12 (7) 5 (4) 9 (3) 40 8 (1) 9 7 (2) 27
35–39 7 (2) 1 (1) 7 (3) 21 10 (1) 2 4 17
40–44 4 (1) 4 11 (2) 22 10 5 5 20
45–49 3 9 8 (1) 21 7 4 5 16
50–54 7 2 3 — 12 3 (1) 6 4 — 14
55–59 13 5 5 23 5 5 11 21
60–64 10 6 6 (1) 23 13 5 11 29
65–69 14 2 8 — 24 9 13 11 — 33
70–74 9 12 15 (2) 38 11 9 9 29
75–79 24 25 30 (1) 80 16 18 18 52
80–84 9 13 29 (2) 53 29 25 28 (4) 86
85–89 30 (1) 22 35 88 26 38 52 (2) 118
90–94 25 15 29 (2) 2 73 20 17 37 4 78
95–99 12 10 11 6 39 7 6 9 5 27
100+ 3 3 2 1 9 7 1 1 2 11
Tot a l 280 (20) 285 (18) 359 (25) 9 996 311 (6) 276 (1) 319 (11) 11 935
Unknown 335—11 636—15
Villagrande and involving separately males and females by
single year of birth and age.
3. Results
The survival curves from birth till age 100 are shown in
Figure 1 separately for men and women by considering all
birth cohorts 1876–1912 together. The corresponding data
are reported in Tabl e 2 .
At age 5, one newborn out of four has already died and
an additional tenth did not reach the age of 18. At age 50,
46.4% of males and 53.3% of females are surviving. From
age 50 to 75, males and females seem to be exposed to the
higher level of survival compared to females so that finally
at age 90 about 12% of the newborns—both for males and
females—are surviving.
The comparison with strictly comparable data for Italy
extracted from the Human Mortality Database is presented
in Figures 2(a) and 2(b) separately for men and women.
Compared to the Italian population the situation is really
exceptional in Villagrande. For infant and child mortality
two major demographic features emerge; in Villagrande a
lower mortality up to 2 years old than in Italy was recorded,
while from age 2 to 5 years old mortality estimates increase.
This particular trend was observed by Coletti for Sardinia
Males Villagrande
Females Villagrande
Number of survivors
Figure 1: Comparing survival curves for males and females in
Villagrande for a hypothetical cohort of 100,000 newborns of the
years 1876–1912.
already in 1908 [18]. This low trend in early mortality could
not be explained in terms of major economic development,
given the poor conditions of Sardinian population at the end
of 19th century, but the author hypothesizes that rather it
was determined by the positive eect of the common practice
4 Journal of Aging Research
Tab l e 2: Comparison of survival curves for males and females in
Villagrande with the corresponding data extracted from the Human
Mortality Database for the whole Italy (birth cohorts from 1876 till
1912 included).
Age Villagrande Italy
Males Females Males Females
0 100000 100000 100000 100000
5 76506 75294 68333 69639
10 72791 71337 65950 67028
15 70181 69519 64851 65706
20 65964 67914 62907 63940
25 59940 64813 59438 61947
30 56827 61818 56845 60087
35 52811 58930 54591 58368
40 50703 57112 52648 56795
45 48494 54973 50797 55320
50 46386 53262 48773 53801
55 45181 51765 46176 51927
60 42871 49519 42676 49483
65 40562 46417 37929 46079
70 38153 42888 31743 41275
75 34337 39786 24114 34525
80 26305 34225 15779 25754
85 20984 25027 8258 16098
90 12149 12406 3162 7694
95 4819 4064 777 2480
100 904 1176 105 456
Probability to survive from 50 to 75
74,0% 74,7% 49,4% 64,2%
of prolonged breastfeeding and the limited participation of
Sardinian women to external works. Subsequent studies on
regional data [19,20] and on selected villages confirmed this
trend of low early mortality [21,22].
Considering the mortality rates from age 5 until age
18, it emerges that once a newborn managed to reach
5 years old, he/she faced more favourable conditions for
survival. Nevertheless we observe in Villagrande a higher
risk of death from age 6 to 10 compared to the mainland,
while estimates until 18 are similar in the two populations.
Therefore the survival advantage at early ages of individuals
born in Villagrande Strisaili is not maintained, but generates
overmortality at subsequent ages. This changing trend might
be interpreted in terms of dierent timing in the selection
process of frail individuals. In the Italian population frails
are eliminated in the first years of life, while in Villagrande
Strisaili this process appears to be postponed.
The analysis of adult mortality appears to be more
complex since the latter is mainly due to external causes
such as losses in WW I for men and maternal mortality for
women. Military data show that no less than 40 males born
in Villagrande died during WW I and that most of them
were born in the period 1890–1900. For women, maternal
mortality was also high during the reproduction period.
Orr `
uandPutzolu[23], in their study on the diusion of
professional assistants for delivery, pointed out that in 1899
Males Italy
Males Villagrande
Number of survivors
Females Italy
Females Villagrande
Number of survivors
Figure 2: (a) Comparison of survival curves for males in Villa-
grande with the corresponding data extracted from the Human
Mortality Database for the whole of Italy (birth cohorts from
1876 till 1912 included). (b) Comparing survival for females
in Villagrande with strictly comparable data extracted from the
Human Mortality Database for the whole of Italy (birth cohorts
from 1876 till 1912 included).
there was no professional assistant in Villagrande and in
the surrounding area. However, in the village, a maternal
mortality rate varying between 10.6 and 11.1 per 1,000 births
was estimated [24], which is in line with the levels recorded
in other Sardinian villages and in other European countries
for the same period [25]. Due to the higher mortality risk
for both sexes between 18 and 50, the proportions of 46.4%
of men and 53.3% of women surviving at age 50 are similar
to the ones observed for the whole of Italy (Figures 2(a) and
About three out of four males and females surviving at
age 50 finally reached age 75. When comparing these figures
with the ones of the Italian population a lower mortality
risk is evident mostly for men. (For men, 74% of those aged
Journal of Aging Research 5
50 survive up to 75 for Villagrande compared to 49% in
Italy. For women these proportions are, respectively, 75%
and 64%.) The lower level of the mortality risk for men
is confirmed when comparing the mortality rates (Figures
3(a) and 3(b)). For men the mortality rates are significantly
lower starting at age 60 (considering a confidence interval
of 0.01) while for women mortality rates are also lower but
significant only from 70 to 85 and no longer significant
after that age. Finally, it is worth noting that the proportion
of those surviving at 90 years in the life table computed
for Villagrande is balanced almost evenly between men and
women (10,7% for men and 11,4% for women), and this
result must be considered exceptional compared with the
situation in Italy.
4. Discussion
Why do men usually live shorter than women? This ques-
tion has been addressed in several studies where potential
explanatory factors are examined [10,2633]. Why men live
as long as women in Villagrande and, more generally, in the
Sardinian longevity Blue Zone, is a related question emerging
from the results of this study. To discuss this question more
in detail, we will review several factors proposed in the
literature to explain the LGG advantaging females and try
to understand why they seem not to work in the population
under concern. In addition some other factors that may
directly favor male longevity will be considered.
4.1. Biological/Genetic Factors. The first group of factors
invoked to explain the female advantage in longevity relates
to biological traits. An increased level of homozygosity in the
population, which may reduce the variability of the genetic
pool, has been reported to favor male longevity [34]. As
almost everywhere in the whole Blue Zone, the population
of Villagrande was characterized by a high level of endogamy
untilWWII[35,36]. In addition, the role of gender-specific
genes in longevity has been largely investigated. Women have
two X chromosomes, one from their father and the other
from their mother, while males have only one X chromosome
and one Y chromosome. Because of this, women have two
cell lines and if any recessive allele detrimental for survival
is inherited, the allele on the second X chromosome could
compensate the expression of the first one, a protective
strategy that is lacking in males [37]. On the other hand,
an increased mutation load in the X chromosome may
result from the higher paternal age at reproduction, a
condition relatively common in central Sardinia, and that
may contribute to reduce life span only in daughters [38],
as sons do not inherit the paternal X chromosome. One
possibility is that in genetically homogeneous populations
such as the one living in Central Sardinia [39], the probability
that females carry the same alleles in both X chromosomes
(homozygosity) is so high as to reduce the protective eect of
having two X chromosomes. Alternatively, specific X-linked
recessive alleles may exist in the Blue Zone population, as a
result of local selective pressures, that may extend the life
expectancy of men via dierent mechanisms. This may be
Italy males
Villagrande males
High C.I. 0.01%
Low C.I. 0.01%
Probability to die from xto x+5(%)
Italy males
Villagrande males
High C.I. 0.01%
Low C.I. 0.01%
Probability to die from xto x+5(%)
Figure 3: (a) Compared five years’ probability of dying for males in
Villagrande with strictly comparable data extracted from the HMD
for the whole Italy (birth cohorts from 1876 till 1912 included). (b)
Compared five years’ probability of dying for females in Villagrande
with strictly comparable data extracted from the HMD for the
whole Italy (birth cohorts from 1876 till 1912 included).
the possible eect of G6PD deficiency, an X-linked disorder
quite common in the island [40] that was hypothesized to
explain Sardinian longevity for males [41]. Unfortunately
the few available epidemiological data [42]donotsupport
the existence of a higher prevalence of G6PD deficiency in
villages with increased longevity. Recent findings suggest that
an X-linked component aects the telomere length and that
brings an additional potential explanation for the LGG as
the telomere length is highly inherited, longer in women and
linked to survival [43,44].
It has also been hypothesized that Y-chromosome allelic
variants may aect male survival, probably influencing the
circulating levels of testosterone and hence its biological
eects on vasculature and other tissues. Men with higher
6 Journal of Aging Research
testosterone levels show reduced markers of inflammation
and metabolic syndrome and decreased risk of mortality for
all causes independently from the overall health status [45].
Although the study of the endocrine profile of Sardinian
oldest olds showed markedly higher testosterone serum levels
and lower estradiol than in younger controls [46] the real
significance of these results is still to be clarified. Moreover,
a study carried out in a limited number of Sardinian male
centenarians and younger control subjects failed to find
any significant association between longevity and Y-related
markers [47], although an additional set of markers and a
larger sample may be required to further clarify the role of Y
chromosome on increased survival.
The role of mitochondrial DNA on gender dierential
longevity has also been investigated. In particular, the
frequency of a polymorphic variant called J haplogroup
was reported to be increased in male centenarians from
continental Italy [48]. In the Ogliastra population, the
frequency of such haplogroup in the whole population is
more than twice the average frequency in Sardinia (18.3%
versus 6.7%) [49], making this polymorphism a valuable
candidate to explain the reduced excess male mortality.
Other genetic traits have been claimed to favor male
longevity, such as the β-thalassemia trait that confers some
“protection” against the development of premature cardio-
vascular diseases [50]. Caselli and Lipsi [51] showed that the
population in the Blue Zone presents the lowest mortality
in Sardinia but also the lowest cardiovascular mortality.
They concluded that these findings indicate the existence
of a specific genetic or environmental factor that protects
Sardinian men, further research being needed to clarify the
exact nature of these factors.
Potential explanatory factors in this first group also
include anthropometric dierences often observed between
males and females. The dierence in average height between
male and female may be lower in the Blue Zone population,
while the average body mass index of females may be
relatively higher compared to males. If these two hypotheses
are confirmed this would lead to a longevity advantage for
males as some studies have shown that there is an inverse
relationship between both height and body mass index and
longevity [52,53]. Evidence derived from military conscripts
shows a shorter height on average for men in the Blue Zone
compared to those in the whole of Sardinia [54], whereas
no such data are available for women, thus precluding the
possibility to test this hypothesis.
4.2. Behavioral and Sociocultural Factors. The second group
of factors is related to individual behavior and Sociocultural
traits of the population. First of all it is important to mention
that migration does not introduce any bias in our results as
all and only individuals born in Villagrande are included in
the study even though some of them later emigrated outside
the village and did not die in the village. By evidence these
persons who emigrated from the village could be dierent
with regard to behavior and/or social characteristics from
those who stay living in the village all their life. Nevertheless
it has a limited impact as emigrants represent less than 10%
of the newborns.
Other individual behaviors include possible dierences
in nutrition between males and females, but also in physical
activity and energy balance. Such dierences in behavior
are mostly linked to the dierent occupations of males and
females as well as other aspects of their life style. Although
no specific study up to now ascertained any gender-related
dierences in Sardinian nutrition, it may be hypothesized
that the distinct role of women within the families and the
prevalent occupation of men may have induced apprecia-
ble dierences in dietary patterns between genders. Also
hypothetical dierence in feeding boys and girls in their
childhood should be investigated. Drinking red wine from
Ogliastra was claimed to have a positive eect on longevity
due to its higher content of antioxidants [55]. Combined
with the traditional Sardinian higher consumption of wine
by males compared to females, this may hypothetically
contribute to male longevity. Besides, as in the longevity
Blue Zone men were mostly shepherds while women were
mostly responsible for all domestic tasks including animal
breeding and vegetable and cereal cultivation [56], men likely
had dierent physical activities compared to women during
their active life that lasted until advanced ages. The additional
circumstance of living in a mountainous area increases the
daily energy expenditure of most men compared to women,
also favoring longevity [57,58]. Women were the main
responsible for the care of goods and property but also the
trustees of transmission of the ethical values, including self-
defense, implying a certain degree of aggressivity [59]. Some
specific character traits of males in the Blue Zone compared
to females like a better tolerance to stress, a high level of
extraversion and sociability, and possibly a better ability to
take advantage of the positive aspects of the health transition,
may also play a positive role in their longevity especially
by lowering cardiovascular mortality [60]. However, data on
personality characteristics of men in Villagrande is currently
not available and only future research will allow testing this
Accordingly, the absence of a gender gap in mortality
risk might also be attributed to dierences in men’s and
women’s social behavior within a rather archaic society
that acknowledges distinct roles to males and females. In
particular, the population of central Sardinia during the
centuries experienced a kind of matriarchal organization
[61] that lasted till the onset of industrialization in the
late 1950s. Nevertheless the concept of a “matriarchal
organization” in Sardinia, as it was put by Pitzalis-Acciaro
in 1978 [61], is a controversial one and has been challenged
by anthropologists thereafter [62,63]. Anyway, during the
last few centuries Sardinian society was clearly dominated by
men, as elsewhere in the Mediterranean countries, especially
among rural communities of farmers. The situation may
have been slightly dierent among pastoral communities,
where the chronic absence of men increased the workload
and responsibility of women. This does not mean, however,
that women had a real power; instead they had to shoulder
the toughest jobs and accordingly it could be better to refer
to a “women-centered” society, rather than “matriarchal”
[64]. This specific role of women within the family, and
hence within the community, probably implied an increased
Journal of Aging Research 7
“chronic stress burden” compared to men, which ultimately
may have contributed to disfavor female longevity [63].
Some specific Sociocultural traits of the population living
in the Blue Zone may also favor male longevity. Some
gender stereotypes and related social norms may favor men
compared to women and this seems to be the case in
Ogliastra [59] where oldest men are the target of intense
attention within the family but also in the local community,
which may bring them support for living longer. Also it is
well established that a stronger family support and long-
standing living arrangement in a married couple may help
to live longer [65]. If men marry younger women, they will
largely escape widowhood that has a negative impact for
living longer at least for men. Moreover, a high level of
remarriage among widowed men increases the age dierence
with their last spouse and keeps a high proportion of men
still married in old ages. Among the 324 ever-married men
of Villagrande who died above age 80, 41 (13%) have been
married more than once and the age dierence with their
(last) spouse, for 136 of them (39%), was larger than 10
years (median 9.1) while only 25 (7%) had an older spouse.
Such larger age dierences between spouses are favorable
for male longevity [66]. In addition, after widowhood, older
women tend to live more often alone while older men will live
preferably with an unmarried child taking into account that
entering a nursing home is an exception for the population
concerned. Overall this situation also favors male longevity.
Furthermore the possible role of fertility and more
specifically the impact of the timing of the reproductive
period on women’s survival have to be considered. Histori-
cally, Sardinian women were characterized by high fertility
and an older age at birth of their children [67]. Astolfi et
al. [68] shows that the spatial pattern of late reproduction
behavior in Sardinia display areas that are very similar to
the longevity Blue Zone assuming that there exists some
common explanation linking late reproduction behavior
and longevity. Such association has been proved in other
populations [69,70] but only as far as female longevity is
concerned. Accordingly such argument cannot be considered
as improving longevity of males compared to females.
Nevertheless a more recent investigation on large historical
databases [71] shows that late reproductive behavior is not
only associated with female postmenopausal longevity but
also with survival past age 50 of brothers of late-fertile
women. According to these authors, these results support the
hypothesis that both the late female fertility and the slow
somatic aging for both men and women may be promoted by
the same genetic variants. These arguments could explain the
relative higher longevity observed in the Blue Zone but not
the male advantage identified in the population under study.
Nevertheless the similarities observed between the spatial
patterns of late fertility and high longevity could be related
to higher endogamy.
5. Conclusion
An intensive data collection and complete family reconstruc-
tion allowed finding the date of death or confirming the
survival at the date of survey of almost all 1957 children born
in Villagrande during the years 1876–1912. The cohort life
table has been estimated and the mortality trajectory iden-
tified separately for men and women. The survival curves
and mortality rates have been compared with similar ones
for Italy extracted from the HMD. The exceptional situation
of men in Villagrande emerges from that comparison, as men
are living as long as women do, which is unusual elsewhere.
Three conclusions can be drawn from our preliminary
investigations. First age exaggeration for men has been clearly
excluded as a result of the age validation exercise among
the possible reasons explaining why men apparently live as
long as women in Villagrande, as well as in the Sardinian
Blue Zone. Secondly, we consider that the above-mentioned
factors may work jointly in a population characterized by a
sort of “matriarchal” organization but the overall impact of
these factors should be strong enough to explain why men are
living as long as women do in that population, a significantly
dierent situation compared to all populations in developed
Thirdly, it is unlikely that a single explanation can be
found for justifying such an exceptional situation. Quoting
Franceschi et al. [11]“besides the classical biomedical disci-
plines such as gerontology, geriatrics, genetics and immunol-
ogy among others, a new integrated approach, including
demography, historical demography, anthropology, and other
social sciences, appears to be necessary to disentangle the
complex interaction between the environmental/cultural and
biological/genetic components responsible for sex dierences in
The results of this investigation indicate that the usually
observed higher mortality for men is not valid for the
population of Villagrande and, by extension, to the one of
the Blue Zone. Among the whole list of potential factors
only few evidences have been found so far. The explanatory
research should be continued keeping in mind that only a
multidisciplinary approach will help finding the underlying
set of explanatory factors.
The authors are very grateful to the Municipality of Villa-
grande Strisaili and more precisely to Mrs. Rita Usai and
Simona Rubiu for their invaluable help to this research. All
our thanks are addressed also to Dany Chambre, Michel
Foulon, Sandra Errigo, and Anne Herm who contributed
to the data collection. This research was partially supported
by the operating program of the Autonomous Region of
Sardinia (PO FSE 2007-2013) according to the LR 7/2007 for
the “Promozione della ricerca scientifica e dell’innovazione
tecnologica in Sardegna” [Promotion of the Scientific
Research and of the Technological Innovation in Sardinia].
1. ELI (extreme longevity index) is the proportion of
newborns in a given place who became centenar-
ian wherever and thus estimates the probability for
8 Journal of Aging Research
a newborn in a given place to reach the age 100. In
the Blue Zone, 91 centenarians were found among
the 17,865 newborns of the years 1880–1900 while
1132 centenarians were counted among the 516,276
newborns in the whole Sardinia. The ELI values are,
respectively, 5.1 centenarians per 1,000 newborns in the
Blue Zone compared to 2.1 for Sardinia.
2. Although the data are available since 1866, the year
when the civil registers were first held in Sardinian
municipalities, only the cohorts born after 1876 are
considered, as the data related to the earlier birth
cohorts are less complete. The last year of observation,
1912 has been chosen in order to include the cohorts
of those who were at least 95 years old at the time
of investigation and to exclude those whose infant
mortality could be increased during WW I.
3. From the totality of those born in Villagrande were
excluded only those babies (120 out of 2077) that clearly
were accidentally born in the village, where their parents
were living at that time for work-related reasons. To
identify these newborns we utilized the origins of both
parents and their occupation (miners, workers involved
in the construction of roads and train networks, police
ocers) as usually reported in the birth certificate.
4. As of 5 September 2006.
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... Among these communities, one is located in the innermost area of the Mediterranean island of Sardinia, where the number of age-validated centenarians, especially males, is remarkably high [13]. Although numerous explanatory hypotheses have been advanced in the past decade [14,15], the causes of the LBZ's exceptional longevity are still poorly understood. Considering that the Sardinian population is a genetic isolate [16] it has been speculated that a relatively limited genetic diversity might have favored, at least in part, the emergence of genetic variants conducive to longer survival [17]. ...
... Long considered as hinged in the Mediterranean food tradition, the LBZ population, however, underwent a progressive change in dietary habits, owing to a relative economic development at the end of the 1950s [14]. These historical trends recommend the use of a longitudinal approach when examining the relationship between diet and health outcomes in the Sardinian LBZ. ...
... This study aimed to investigate the evolution of dietary pattern across NT in the oldest subjects living in a secluded area of Sardinia where an exceptional proportion of individuals who become centenarians was documented [13][14][15]. Although a number of studies investigated the role of nutrition on longevity both in general [7] and in the LBZs in particular [45], detailed information addressing the relationship between NT and health status is still scarce. ...
Full-text available
Health and longevity in humans are influenced by numerous factors, including lifestyle and nutrition. However, the direct relationship between lifetime eating habits and functional capacity of the elderly is poorly understood. This study investigated the dietary changes across nutrition transition (NT) in the early 1960s, in a population located in the Sardinia island known for its longevity, dubbed as “Longevity Blue Zone” (LBZ), as well as the relationship between the dietary patterns and a panel of health indicators. A total of 150 oldest-old participants (89 women and 61 men, age range 90–101 years) living in the LBZ were recruited. Participants were interviewed using validated questionnaires to assess the consumption frequency of common food items, as well as the correlation with self-rated health, comorbidity, affective and cognitive level, physical mobility, disability and anthropometric parameters. Differences between subgroups were evaluated using the Mann-Whitney U test for independent samples or the Wilcoxon signed-rank test for paired samples. Correlation analysis was performed by calculating the Spearman correlation coefficient, separately in males and females. Compared to the pre-NT epoch, the consumption of meat, olive oil and fresh fruit slightly increased, while the consumption of lard, legumes and vegetables decreased. A significant association was found between increased olive oil intake across NT and self-rated health (ρ = 0.519), mobility (ρ = 0.502), improved vision (ρ = −0.227) and hearing (ρ = −0.314); increased chicken meat intake and performance in activities of daily living (basic activities of daily living: ρ = 0.351; instrumental activities of daily living: ρ = 0.333). Instead, vegetable consumption showed low correlation with health indicators. A mild increase in meat intake, mostly pastured poultry, is associated with better physical performance in the Sardinian LBZ elders, suggesting that a supply of protein may have been crucial to maintaining adequate functional capacity.
... Since 1978, human longevity studies have found a variety of populations show shorter or smaller males and females live longer or have lower mortality rates [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Although studies of shorter women living longer are less common, several studies have found that shorter women have lower mortality or longevity rates [20,22,23]. ...
... The data selected for this study represent a larger variety of countries with similar economic backgrounds. The height and life expectancy data in this study were evaluated to determine whether previous longevity studies [11,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] are supported by a broad range of male vs. female longevity differences. The entropy theory predicts that larger, higher energy bodies within the same species exhibit more rapid increases in disorder (aging) over huma n lifetimes [17]. ...
... Thus, these men outlived the average woman by about 2 decades. In addition, a study of Sardinian centenarians found men represented half the population [25]. ...
Full-text available
Many papers have provided reasons for why women live longer than men. These include XX vs. XY chromosomes, sex hormones, and better care of their health. These factors certainly can affect male and female health but none has been proven to explain the actual difference that exists in life expectancy between the sexes. Another controversial factor commonly ignored is the size difference between men and women, but past research has shown that differences in male and female height and associated life expectancy are related by similar but inverse percentages (such as 8% taller and 9% shorter life expectancy). This paper provides additional evidence that supports early findings that shorter height is a major factor in explaining why women live longer. To test the inverse relation between height and life expectancy, a list of developed countries was used to compare height and life expectancy differences between men and women. The results showed men were 7.8% taller and had an 8.5% lower life expectancy. These results are similar to previous study findings in 1992, 2003, and 2009. They are also consistent with scores of studies showing shorter or smaller body size is related to greater longevity independent of sex.
... Thus, the hypothesis of a positive influence of low thyroid function on human survival needs further support and in particular, should be tested in populations where the proportion of long livers is considerably higher. One of these populations lives on the Mediterranean island of Sardinia (Poulain et al. 2004(Poulain et al. , 2011Pes and Poulain 2016), which was recognised as one of the world's longevity hot spots . ...
... The research carried out in the past two decades in Sardinia has pointed to important determinants of population longevity, such as physical exercise (Pes et al. , 2018, leisure activities (Fastame et al. 2018), environmental factor , nutritional factor (Pes et al. , 2015, anthropometric factor (Salaris et al. 2012), genetic factor , and social context (Poulain et al. 2011). Epidemiological and/or ecological studies investigating the relationship between exceptional longevity and decreased thyroid function markers in Sardinia are missing. ...
... ELI x is defined as the probability of a newborn child in a given municipality reaching the threshold age x. The x value may vary depending on the definition of which level of longevity is considered "extreme", although ELI 100 is the usual value (Poulain et al. 2011) defined as the ratio between the number of centenarians born in a given municipality between 1880 and 1900 and the number of people born in the same place and the same year of centenarians, regardless of their final residence. The main advantage of ELI 100 , compared with centenarian prevalence, i.e. the number of centenarians relative to the total population, is that (1) it considers a larger number of surviving or already dead centenarians covering 21 birth cohorts from 1880 to 1900 inclusive; (2) it limits potential bias due to migration, as centenarians are counted according to their place of birth and compared with the total number of newborn individuals in the same place; and (3) it is not affected by changes in population fertility during the past century (Poulain et al. 2004). ...
Full-text available
This study aims to test the hypothesis that a high prevalence of endemic goitre, considered as a proxy measure for subclinically reduced thyroid function in the population, is geographically associated with exceptional longevity. Using historical data available for 377 Sardinian municipalities in the first half of the twentieth century, we performed an ecological study to investigate the geographic distribution of goitre and its spatial association with demographic indicators of population longevity. This analysis was conducted by using both conventional ordinary least square and geographically weighted regression models to take into account spatial autocorrelation and included other longevity-associated factors previously identified in Sardinia. The spatial analysis revealed that the goitre rate (p < 0.0001), the proportion of inhabitants involved in pastoralism (p = 0.016), the terrain inclination (p = 0.008), and the distance from the workplace as a proxy for physical activity (p = 0.023) were consistently associated with population longevity at an aggregated level in the 377 municipalities. Within the limits of an ecological study design, our findings support the existence of a significant association between high goitre prevalence and increased probability to survive into old age. The present study confirms previous results and is consistent with animal studies and epidemiological surveys in other long-lived areas known as Blue Zones. Potential mechanisms underlying this association need to be further investigated.
... In the present work we studied the role of the bitter receptor, TAS2R38 and its genetic variants on longevity. Our results show that the genetically homogeneous cohort of subjects ranging in age from 90 to 105 years of the an area, which was recognised as one of the world's longevity hot spots (Longevity Blue Zone) 80 , differed based on the genotype distribution and haplotype frequencies of TAS2R38 gene from the two genetically heterogeneous cohorts from the South of Sardinia where the longevity level is distinctly lower. Conversely, no differences were found between these two latter cohorts. ...
... In most populations, females have been reported to live longer than males, with geographical differences in the female/male ratio 86 . However, the population living in the Sardinian LBZ is an exception among the other long-lived populations since the female/male ratio in the oldest old is close to 1:1 80 . In addition, several studies have shown that PROP phenotype and genotype variations are associated with gender, with females being more responsive than males 14,87 . ...
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Bitter taste receptors play crucial roles in detecting bitter compounds not only in the oral cavity, but also in extraoral tissues where they are involved in a variety of non‒tasting physiological processes. On the other hand, disorders or modifications in the sensitivity or expression of these extraoral receptors can affect physiological functions. Here we evaluated the role of the bitter receptor TAS2R38 in attainment of longevity, since it has been widely associated with individual differences in taste perception, food preferences, diet, nutrition, immune responses and pathophysiological mechanisms. Differences in genotype distribution and haplotype frequency at the TAS2R38 gene between a cohort of centenarian and near-centenarian subjects and two control cohorts were determined. Results show in the centenarian cohort an increased frequency of subjects carrying the homozygous genotype for the functional variant of TAS2R38 (PAV/PAV) and a decreased frequency of those having homozygous genotype for the non-functional form (AVI/AVI), as compared to those determined in the two control cohorts. In conclusion, our data providing evidence of an association between genetic variants of TAS2R38 gene and human longevity, suggest that TAS2R38 bitter receptor can be involved in the molecular physiological mechanisms implied in the biological process of aging.
... Another example is the population in Sardinia, which grows much older and sustains health until late life. Anthropological research has indicated that besides genetic and biological factors, the behavioural factors including life style, demographic behaviour, family support, and community characteristics may play an important role (Poulain/Pes/Salaris 2011). ...
... Populations across the globe are living longer than ever, and centenarians, once considered rare, are becoming more and more prevalent. Interestingly, throughout life, women have lower mortality rates and live longer than men (Austad, 2011), as exemplified in centenarians, where women outnumber men 5:1, with some variations depending on population (Passarino et al., 2002), with those countries that are considered the "healthiest" showing a smaller gap in female-male longevity (Poulain et al., 2011). These sex differences aren't just in humans, they are seen throughout the animal kingdom as well, where overall there is a female bias for longer lifespan in both laboratory and captive settings (Austad and Fischer, 2016) and in the wild (Lemaitre et al., 2020). ...
In every population across the world, women live significantly longer than men; however, the underlying physiological processes that drive these sex differences in age-specific mortality are largely unknown. Recently, the role of adipose tissue in aging and longevity has been a focus of biomedical research in both humans and rodent models. Specifically, brown adipose tissue, a thermoregulatory tissue originally thought to not exist past infancy in humans, has been shown to potentially play a role in health throughout the lifespan. Females have larger adult brown adipose depots that are not just larger in size but also more efficient in non-shivering thermogenesis. This improved functioning of the brown adipose tissue may potentially lead to improved female health, and we hypothesize that this advantage may be of even bigger significance in the older population. Here, we briefly review what is known about sex differences in aging and how sex differences in brown adipose tissue may be contributing to the female lifespan advantage. These questions have usually been addressed in large experimental studies in rodents as a translational model of human aging. Overall, we propose that a better understanding of the thermogenesis-metabolism nexus is necessary in biomedical research, and sex differences in these factors may contribute to the female longevity bias seen in human populations.
... The twenty-year-old discovery of the exceptional longevity of people living on the Mediterranean island of Sardinia [1][2][3][4] demography of this ethnic group over a wide period of time [5][6][7][8]. This trend was somewhat anticipated by the interest in historical demographic research on ancient Sardinians. ...
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The discovery early in this century of the exceptional longevity of the Sardinian population has given new impetus to demographic studies of this phenomenon during the classical period. In the 1970s, it was hypothesised that the average mortality rate in Roman Sardinia was lower than in metropolitan Rome itself, postulating an ancient precedent for the remarkable longevity observable nowadays in the island’s population. In the present study, the available evidence was examined in order to test this hypothesis. Literary, juridical, epigraphic, papyrological, anthropological and archaeological sources regarding the population of the Roman Empire, including Sardinia, were retrieved by accessing Science Direct, PubMed, Scopus and Google Scholar databases, as well as regional libraries, regardless of time limitation, and were independently reviewed by the authors. For Roman Sardinia, only funerary epitaphs were retrieved, in contrast with the numerous sources available for the whole Roman Empire. Inscriptions revealing the existence of three alleged nonagenarians, two centenarians, two ultracentenarians and one supercentenarian were found, corresponding to 2% in a total of 381 inscriptions. The majority were located in a highly Romanised rural area of central-western Sardinia. However, the ages reported in the epitaphs may be inaccurate because of the influence of confounders such as age rounding, approximations and/or amplifications, and are unrelated to the total number of inhabitants. In conclusion, the funerary evidence, the only available data from Roman Sardinia, is too weak to estimate the life expectancy of the local ancient population and cannot offer valuable arguments to support the hypothesis that exceptional longevity has been a Sardinian trait since Roman times.
... The study of the oldest-old, including centenarians, from a population distinctive for its longevity and robust psychological health could be especially revealing. However, while it has been speculated that psychological traits contribute to the longevity of this population [23], empirical evidence is lacking. ...
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A body of research documented that the study of mental health of the oldest individuals may contribute to understand the psychological characteristics of longevity. This study had two related aims. First, to fully characterize the psychological health of Sardinian elders in the very late adult span. Second, to determine the psychological health of long-lived individuals (i.e., centenarians) from this population. Three gender-matched age groups (octogenarian, nonagenarian, centenarian) of cognitively healthy, community dwelling adults were recruited in Sardinia, an Italian island characterized by higher levels of longevity. Comparisons of total and sub-scale levels of psychological well-being and depressive symptomatology were made while controlling for social desirability. There were few differences in any index of psychological health between the groups; only a decrease in the coping strategies sub-scale of psychological well-being was observed between the centenarians and the octogenarians. Social desirability was differentially associated with specific dimensions of depressive symptoms and psychological well-being. These findings highlight that there is minimal age-related decline in the psychological health of a longevous population, even among its very oldest members. The present outcomes suggest that older Sardinians represent an advantageous population for the investigation of the psychological markers of longevity, since they demonstrate positive adaptation to the challenges (e.g., changes related to their social network) of very late adulthood.
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En esta tesis doctoral se realiza un análisis demográfico y territorial de los niveles, tendencias y determinantes de la mortalidad en Colombia durante el periodo 1980 a 2010. El propósito principal fue profundizar en la comprensión de los cambios en los patrones de mortalidad a medio plazo, haciendo énfasis en sus transformaciones estructurales y desigualdades territoriales. Las principales fuentes de información utilizadas fueron los microdatos del registro de defunciones y las tablas de vida elaboradas por el Departamento Administrativo Nacional de Estadística -DANE- y la Comisión Económica para América Latina -CEPAL-.
Human longevity may be found in single individuals as well as in the population as a whole (“population longevity”). Longevity Blue Zones (LBZs), which are areas with an unusually high number of oldest old, have been identified in Sardinia and the Greek island of Ikaria. We compared the lifestyle, health status and some genetic markers of the LBZ populations with those of reference populations from Italy and Greece; the data were extracted from the GEHA database. In the LBZs, the proportion of individuals who never married or were married and still living with their spouse was significantly greater. Nonagenarians males and females with a high self‒perception of optimism and/or a high score for self-rated health were also found in larger proportions in LBZs. Among the variables with lower frequency were the proportion of the widowed, the percentage of subjects who had suffered a stroke and the frequency of Apoε4 and Apoε2 and the TT genotype of FOXO3A gene. Compared to behavioral and health indicators, the impact of genetic factors might be relatively less important in the LBZs. Nevertheless, further research is needed to identify potential epigenetic traits that might play a predominant role due to the interaction between genetics and the human and physical environments.
At the time of Italian Unification, in the mid-nineteenth century, Sardinia was known as one of the most economically and socially archaic parts of the new nation. This article considers family life and women's roles in both the cereal-producing villages and the pastoral mountain communities of Sardinia. Although nuclear family households characterize much of the island, in the pastoral portion of the island strong uxorilocal tendencies are found. The reasons for this, and the reasons for the relative gender equality found in Sardinian marriages are discussed, as is the impact on family life of the privatization of communal lands that took place in the nineteenth century.
The difference between the ages at which male and female rates of mortality are equal (called the female advantage) is proposed as a measure of comparison of the mortality of the sexes. The female advantage is calculated for various periods of time in a number of different countries. The application of the female advantage method to cause of death figures is briefly considered. A study of the pattern of the female advantages for ages over 40 leads to an approximate empirical relationship between the ages at which the mortality rates for the sexes are equal.
Life expectancy for both sexes and all ages has risen almost without interruption in France since the early 1950s. Women’s life expectancy at birth increased by 14.6 years from 1950 to 2005, and men’s by 13.3 years. In the last twenty years, the gap in life expectancy between the sexes has stopped widening and begun to close. This is mainly due to an acceleration in the improvement among men, but some slowing in improvement among women under 60 is also perceptible. At later ages, on the other hand, improvement continued to be more rapid for women than men. Although cancer mortality is falling for both men and women, cancer is now the leading cause of death, overtaking cardio-vascular disease, for which mortality has considerably reduced. Among the oldest groups, the exceptionally high mortality due to the 2003 heat wave caused only a brief interruption in the positive trend brought about mainly by lower cardio-vascular mortality. Future improvement will depend on success in the control of cancer and neuro-degenerative diseases.
It is generally accepted that, on average, women live longer than men. Few, however, are aware that there is an underlying and consistent pattern of factors contributing to the sex mortality differential. This paper attempts to synthesize the evidence supporting and refuting the hypotheses for the sex mortality differential. The extent of the sex mortality differential is examined. It has existed since at least 1750; it occurs at all age groups, even prenatally, in nearly all animal species studied and for almost every major cause of death. Evidence supports both the biological/genetic and the social/cultural/environmental/behavioral schools of hypotheses, as well as interactions between the two, but the determining component may revolve around the differing chromosomes and hormones between the sexes. Behavioral distinctions, especially cigarette smoking, also affect the sex mortality differential. "Sex differences in mortality are well estab-lished facts. In the human population of devel-oped countries where infectious diseases are not significant causes of death, the penalty for male-ness is that almost every important disease has a higher mortality rate in males than in females" (Hayflick 1982). "Some of my colleagues at the Department of Sociology in Helsinki wonder whether it is meaningful to study mortality differences. After all, the death rate is the same for everyone: one death per person" (Valkonem 1993).
At the time of Italian Unification, in the mid-nineteenth century, Sardinia was known as one of the most economically and socially archaic parts of the new nation. This article considers family life and women's roles in both the cereal-producing villages and the pastoral mountain communities of Sardinia. Although nuclear family households characterize much of the island, in the pastoral portion of the island strong uxorilocal tendencies are found. The reasons for this, and the reasons for the relative gender equality found in Sardinian marriages are discussed, as is the impact on family life of the privatization of communal lands that took place in the nineteenth century.