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Journal of Aging Research
Volume 2011, Article ID 153756, 10 pages
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, firstname.lastname@example.org
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.
In developed countries, it has been widely documented that
females live longer than males [1–3]. This female advantage
in survival, the so-called Longevity Gender Gap (LGG),
results from lower female death rates throughout the lifespan
[4–6]. In traditional societies, the LGG was less pronounced
and even inversed  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 .
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  and this trend is conﬁrmed when extending
the comparison to the top 12 causes of deaths . The
cumulative eﬀect of these diﬀerences 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 [11–13]. 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 . 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 . 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 . 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) . The analysis of mortality
trajectories allows the identiﬁcation in more detail of the
critical age interval for determining between-gender level
diﬀerentials 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
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
oﬃce 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 aﬀect 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).
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.
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
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
Number of survivors
Figure 1: Comparing survival curves for males and females in
Villagrande for a hypothetical cohort of 100,000 newborns of the
already in 1908 . 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 eﬀect 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
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 diﬀerent 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.
uandPutzolu, in their study on the diﬀusion of
professional assistants for delivery, pointed out that in 1899
Number of survivors
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 , which is in line with the levels recorded
in other Sardinian villages and in other European countries
for the same period . 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.
Why do men usually live shorter than women? This ques-
tion has been addressed in several studies where potential
explanatory factors are examined [10,26–33]. 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 . 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 . 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 ,
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 , the probability
that females carry the same alleles in both X chromosomes
(homozygosity) is so high as to reduce the protective eﬀect 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 diﬀerent mechanisms. This may be
High C.I. 0.01%
Low C.I. 0.01%
Probability to die from xto x+5(%)
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 eﬀect of G6PD deﬁciency, an X-linked disorder
quite common in the island  that was hypothesized to
explain Sardinian longevity for males . Unfortunately
the few available epidemiological data donotsupport
the existence of a higher prevalence of G6PD deﬁciency in
villages with increased longevity. Recent ﬁndings suggest that
an X-linked component aﬀects 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 aﬀect male survival, probably inﬂuencing the
circulating levels of testosterone and hence its biological
eﬀects 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 .
Although the study of the endocrine proﬁle of Sardinian
oldest olds showed markedly higher testosterone serum levels
and lower estradiol than in younger controls  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 , 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 diﬀerential
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 . 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%) , 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 . Caselli and Lipsi  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 diﬀerences often observed between
males and females. The diﬀerence 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 , 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 diﬀerent
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 diﬀerences
in nutrition between males and females, but also in physical
activity and energy balance. Such diﬀerences in behavior
are mostly linked to the diﬀerent 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
diﬀerences 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 diﬀerences in dietary patterns between genders. Also
hypothetical diﬀerence in feeding boys and girls in their
childhood should be investigated. Drinking red wine from
Ogliastra was claimed to have a positive eﬀect on longevity
due to its higher content of antioxidants . 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 , men likely
had diﬀerent 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 . 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 . 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 diﬀerences 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
 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 , 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 diﬀerent 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”
. 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 .
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  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 . 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 diﬀerence
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 diﬀerence 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 diﬀerences between spouses are favorable
for male longevity . 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 . Astolﬁ et
al.  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  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.
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
diﬀerent 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. “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 diﬀerences 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
oﬃcers) as usually reported in the birth certiﬁcate.
4. As of 5 September 2006.
 Q. R. Hazzard, “The sex diﬀerences in longevity,” in Geriatric
Medicine and Gerontology, W. R. Hazzard, Ed., McGraw-Hill,
New York, NY, USA, 1994.
 R. Crose, Why Women Live Longer than Men? Jossey-Bass, San
Francisco, Calif, USA, 1997.
 J. Clarke, The Human Dichotomy: The Changing Numbers of
Males and Females, Pergamon, Amsterdam, The Netherlands,
 R. H. Daw, “The comparison of male and female mortality
rates,” Journal of the Royal Statistical Society, Series A (General),
vol. 124, no. 1, pp. 20–43, 1961.
 S. P. Phillips, “Risky business: explaining the gender gap in
longevity,” Journal of Men’s Health and Gender,vol.3,no.1,
pp. 43–46, 2006.
 R. Jacobsen, A. Oksuzyan, H. Engberg, B. Jeune, J. W. Vaupel,
and K. Christensen, “Sex diﬀerential in mortality trends of
old-aged Danes: a nation wide study of age, period and cohort
eﬀects,” European Journal of Epidemiology, vol. 23, no. 11, pp.
 D. J. Kruger and R. N. Nesse, “An evolutionary life-history
framework for understanding sex diﬀerences in human mor-
tality rates,” Human Nature, vol. 17, no. 1, pp. 74–97, 2006.
 F. Mesle, “Progr`
ecents de l’esp´
erance de vie en France : ies
hommes comblent une partie de leur retard,” Population, vol.
61, pp. 437–462, 2006.
women to men: historical perspectives and cross-national
comparisons,” Aging-Clinical and Experimental Research, vol.
12, no. 2, pp. 65–76, 2000.
 S. Austad, “Why women live longer than men: sex diﬀerences
in longevity,” Gender Medicine, vol. 3, no. 2, pp. 79–92, 2006.
 C. Franceschi, L. Motta, S. Valensin et al., “Do men and
women follow diﬀerent trajectories to reach extreme lon-
gevity? Italian multicenter study on centenarians (IMUSCE),”
Aging-Clinical and Experimental Research, vol. 12, no. 2, pp.
 G. Passarino, C. Calignano, A. Vallone et al., “Male/female
ratio in centenarians: a possible role played by population
genetic structure,” Experimental Gerontology, vol. 37, no. 10-
11, pp. 1283–1289, 2002.
entials in the femininity ratio among centenarians: variations
between northern and southern Italy from 1870,” Populat ion
Studies, vol. 60, no. 1, pp. 99–113, 2006.
 L. Deiana, L. Ferrucci, G. M. Pes et al., “AKEntAnnos.
The sardinia study of extreme longevity,” Aging Clinical and
Experimental Research, vol. 11, no. 3, pp. 142–149, 1999.
 M. Poulain, G. M. Pes, C. Carru et al., “The validation of
exceptional male longevity in Sardinia,” in Human Longe vity,
Individual Life Duration and the Growth of the Oldest-Old
Eds., chapter 7, pp. 146–166, Springler & Kluwer, New York,
NY, USA, 2006.
 M. Poulain, G. M. Pes, C. Grasland et al., “Identiﬁcation of
a geographic area characterized by extreme longevity in the
Sardinia island: the AKEA study,” Experimental Gerontology,
vol. 39, no. 9, pp. 1423–1429, 2004.
 Human Mortality Database (Wilmoth J., University of Cali-
fornia, Berkeley and Shkolnikov V., Max Planck Institute for
Demographic Research), 2011, http://www.mortality.org.
 F. Coletti, La Mortalit`
a nei Primi Anni d’et`
a e la Vita Sociale in
Sardegna, Fratelli Bocca, Torino, Italy, 1908.
 L. Pozzi, La lotta per la vita. Evoluzione e Geograﬁa della
Sopravvivenza in Italia fra ’800 e ’900, Forum, Udine, Italy,
 A. M. Gatti, “Livelli e caratteristiche della mortalit`
diocesi di Ales in Sardegna (1801–1825),” in Omaggio a Danilo
e, Milano, Italy, 1990.
 A. M. Gatti, “La mortalit`
a infantile tra ottocento e novecento.
La Sardegna nel panorama italiano,” in Quaderni del Diparti-
mento di Ricerche Economiche e Sociali, vol. 13, University of
Cagliari, Cagliari, Italy, 2002.
 M. Breschi, S. Mazzoni, P. M. Melis, and L. Pozzi, “Nuove
indagini per l’analisi della mortalit`
a nei primi anni di vita in
Sardegna,” in Salute, Malattia e Sopravvivenza in Italia fra ’800
e ’900, M. Breschi and L. Pozzi, Eds., pp. 191–216, Forum,
Udine, Italy, 2007.
 L. Orr `
u and F. Putzolu, Il Parto e la Nascita in Sardegna.
Tradizione Medicalizzazione Ospedalizzazione, CUEC, Cagliari,
 L. Salaris, Searching for Longevity Determinants: Following
Survival of Newborns in In-Land Village in Sardinia (1866–
2006), Ph.D. thesis, Presses Universitaires de Louvain, 2009.
 A. M. Gatti, “Nascita dell’ostetricia e mortalit`
a materna in
Sardegna (XVII-XIX secolo),” in Bollettino di Demograﬁa
Storica, vol. 30-31, pp. 79–94, Si.De.S. Societ`
Demograﬁa Storica, Roma, Italy, 1999.
 D. L. Wingard, “The sex diﬀerential in morbidity, mortality,
and lifestyle,” Annual Review of Public Health, vol. 5, pp. 433–
 I. Waldron, “What do we know about causes of sex diﬀerences
in mortality? A review of the literature,” Population Bulletin of
the United Nations, no. 18, pp. 59–76, 1985.
Journal of Aging Research 9
 L. M. Verbrugge and D. L. Wingard, “Sex diﬀerentials in health
and mortality,” Women and Health, vol. 12, no. 2, pp. 103–145,
 F. M. Antonini, “Perch´
e le donne sono pi`
uomini?” Giornale di Gerontologia, vol. 39, no. 4, pp. 177–178,
 B. B. Kalben, “Why men die younger: causes of mortality
diﬀerences by sex,” North American Actuarial Journal, vol. 4,
pp. 83–111, 2000.
 A. Case and C. Paxson, “Sex diﬀerences in morbidity and
mortality,” Demography, vol. 42, no. 2, pp. 189–214, 2005.
 A. Oksuzyan, K. Juel, J. W. Vaupel, and K. Christensen, “Men:
good health and high mortality. Sex diﬀerences in health and
aging,” Aging Clinical and Experimental Research, vol. 20, no.
2, pp. 91–102, 2008.
“Social, behavioral, and biological factors, and sex diﬀerences
in mortality,” Demography, vol. 47, no. 3, pp. 555–578, 2010.
 M. Bonaf`
e, M. Cardelli, F. Marchegiani et al., “Increase of
homozygosity in centenarians revealed by a new inter-Alu
PCR technique,” Experimental Gerontology,vol.36,no.7,pp.
 A. Cannas, Biddamanna. Vida longa. Villagrande Strisaili,
paese di longevi, Cagliari, 2007.
 A. Moroni, A. Anelli, W. Anghinetti et al., “La consanguineit`
umana nell’isola di Sardegna dal secolo XVIII al secolo XX,”
L’Ateneo Parmense, vol. 1, supplement 8, pp. 69–92, 1972.
 K. Christensen, K. H. Ørstavik, and J. W. Vaupel, “The X chro-
mosome and the female survival advantage: an example of the
intersection between genetic, epidemiology and demography,”
Annals of the New York Academy of Sciences, vol. 954, pp. 175–
 L. A. Gavrilov, N. S. Gavrilova, G. N. Evdokushkina et al.,
“Determinants of human longevity: parental age at reproduc-
tion and oﬀspring longevity,” Longevity Report, vol. 10, no. 54,
pp. 7–15, 1996.
 L. L. Cavalli Sforza, P. Menozzi, A. Piazza et al., The History
and Geography of Human Genes, Princeton University Press,
Princeton, NJ, USA, 1994.
 E. Sanna, G. G. Cosseddu, G. Floris, R. Bruno, A. Salis, and M.
Silvetti, “Present-day G-6-PD deﬁcit in Sardinia with respect
to malarial morbidity and mortality in the past,” Zeitschrift
fur Morphologie und Anthropologie, vol. 78, no. 2, pp. 257–267,
 A. G. Schwartz and L. L. Pashko, “Dehydroepiandrosterone,
glucose-6-phosphate dehydrogenase, and longevity,” Ageing
Research Reviews, vol. 3, no. 2, pp. 171–187, 2004.
 E. Sanna, G. G. Cosseddu, G. Floris et al., “Micromapping the
distribution of G6PD deﬁciency in Sardinia with data collected
from the 1950s to the 1980s,” in Adaptation to Malaria. The
Interaction of Biology and Culture,L.S.GreeneandM.E.
Danubio, Eds., pp. 293–322, New York, NY, USA, 1997.
 A. Aviv, J. Shay, K. Christensen, and W. Wright, “The longevity
gender gap: are telomeres the explanation?” Science of Aging
Knowledge Environment, vol. 2005, no. 23, article pe16, 2005.
 T. S. Nawrot, J. A. Staessen, and J. P. Gardner, “Telomere length
and possible link to X chromosome,” The Lancet, vol. 363, no.
9408, pp. 507–510, 2004.
 G. A. Laughlin, E. Barrett-Connor, and J. Bergstrom, “Low
serum testosterone and mortality in older men,” Journal of
Clinical Endocrinology and Metabolism,vol.93,no.1,pp.68–
 G. Delitala, F. Sanciu, G. Fanciulli et al., “Gonadal hormones
and adrenal steroidogenesis in centenarians,” Biochimica Clin-
ica, vol. 30, p. S37, 2006.
 G. Passarino, P. A. Underhill, L. L. Cavalli-Sforza et al., “Y
chromosome binary markers to study the high prevalence of
males in Sardinian centenarians and the genetic structure of
the Sardinian population,” Human Heredity,vol.52,no.3,pp.
 G. De Benedictis, G. Rose, G. Carrieri et al., “Mitochondrial
DNA inherited variants are associated with successful aging
and longevity in humans,” The FASEB Journal, vol. 13, no. 12,
pp. 1532–1536, 1999.
 C. Fraumene, E. Petretto, A. Angius, and M. Pirastu, “Striking
diﬀerentiation of sub-populations within a genetically homo-
geneous isolate (Ogliastra) in Sardinia as revealed by mtDNA
analysis,” Human Genetics, vol. 114, no. 1, pp. 1–10, 2003.
 M. Gallerani, C. Scapoli, I. Cicognani et al., “Thalassaemia
trait and myocardial infarction: low infarction incidence in
male subjects conﬁrmed,” Journal of Internal Medicine, vol.
230, no. 2, pp. 109–111, 1991.
 G. Caselli and R. M. Lipsi, “Survival diﬀerences among
the oldest old in Sardinia: who, what, where, and why,”
Demographic Research, vol. 14, pp. 267–294, 2006.
 T. T. Samaras, H. Elrick, and L. H. Storms, “Is height related to
longevity?” Life Sciences, vol. 72, no. 16, pp. 1781–1802, 2003.
 L. Salaris, M. Poulain, I. S. Piras et al., “Height and longevity
among males born in Villagrande Strisaili, (1866–1915),” in
Proceedings of the 43rd Riunione Scientiﬁca SIS, Section C24—
Mortality, Health and Poverty, pp. 649–652, CLUEP Padova,
Torino, Italy, June 2006.
 L. Salaris, M. Poulain, and T. T. Samaras, “Height and survival
at older ages among males born in an in-land village in
Sardinia (Italy), 1866–2006,” submitted.
 R. Corder, W. Mullen, N. Q. Khan et al., “Oenology: red wine
procyanidins and vascular health,” Nature, vol. 444, no. 7119,
p. 566, 2006.
 L. Edelsward, Highlands Visions. Recreating Rural Sardinia,
Ph.D.Deissertation, Department of Anthropology. McGill
 D. E. Warburton, C. W. Nicol, and S. S. Bredin, “Health
beneﬁts of physical activity: the evidence,” Canadian Medical
Association Journal, vol. 174, no. 6, pp. 801–809, 2006.
 G. M. Pes, F. Tolu, and M. Poulain, “Lifestyle and nutrition
related to male longevity in Sardinia: an ecological study,”
Nutrition, Metabolism & Cardiovascular Diseases. In press.
 L. Assmuth, Women’s Work, Women’s Worth: Changing Life
courses in Highland Sardinia, vol. 39 of Tra n s a c t i o n s o f
the Finnish Anthropological Society, Finnish Anthropological
E. G. Schouten, “Dispositional optimism and all-cause and
cardiovascular mortality in a prospective cohort of elderly
Dutch men and women,” Archives of General Psychiatry, vol.
61, no. 11, pp. 1126–1135, 2004.
 M. Pitzalis-Acciaro, In Nome della Madre. Ipotesi sul Matriar-
cato Barbaricino, Feltrinelli Economica, Milano, Italy, 1978.
 M. G. Da Re, La casa e I Campi. La Divisione Sessuale del Lavoro
nella Sardegna Tradizionale, CUEC, Cagliari, Italy, 1990.
 A. Oppo, “Where there’s no woman there’s no home: proﬁle
of the agro-pastoral family in nineteenth-century Sardinia,”
Journal of Family History, vol. 15, no. 1, pp. 483–502, 1990.
 C. Eller, The Myth of a Matriarchal Prehistory,TheUniversity
Press Group, 2011.
10 Journal of Aging Research
 J. Gaymu, P. Festy, M. Poulain, and G. Beets, Future Elderly
Living Conditions in Europe, INED, Paris, Farnce, 2008.
 D. Foster, L. Klinger Vartabedian, and L. Wispe, “Male
longevity and age diﬀerences between spouses,” Journals of
Gerontology, vol. 39, no. 1, pp. 117–120, 1984.
 L. Bernardi and A. Oppo, Fertility and Family Conﬁgurations
in Sardinia, MPIDR Working Paper WP 2007-033, Max Planck
Institute for Demographic Research, 2007.
behaviour in Sardinia: spatial analysis suggests local aptitude
towards reproductive longevity,” Evolution and Human Behav-
ior, vol. 30, no. 2, pp. 93–102, 2009.
 H. G. M ¨
uller, J. M. Chiou, J. R. Carey, and J. L. Wang, “Fertility
and life span: late children enhance female longevity,” Journals
of Gerontology, Series A Biological Sciences and Medical Sciences,
vol. 57, no. 5, pp. 202–206, 2002.
 Y. Zeng and J. W. Vaupel, “Association of late childbearing with
healthy longevity among the oldest-old in China,” Populat ion
Studies, vol. 58, no. 1, pp. 37–53, 2004.
 K. R. Smith, A. Gagnon, R. M. Cawthon, G. P. Mineau, R.
Mazan, and B. Desjardins, “Familial aggregation of survival
and late female reproduction,” Journals of Gerontology, Series
A Biological Sciences and Medical Sciences,vol.64,no.7,pp.