University of Oulu

Mikkola, T. M., Kautiainen, H., Von Bonsdorff, M. B., Wasenius, N. S., Salonen, M. K., Haapanen, M. J., Kajantie, E., & Eriksson, J. G. (2023). Healthy ageing from birth to age 84 years in the Helsinki Birth Cohort Study, Finland: A longitudinal study. The Lancet Healthy Longevity, 4(9), e499–e507.

Healthy ageing from birth to age 84 years in the Helsinki Birth Cohort Study, Finland : a longitudinal study

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Author: Mikkola, Tuija M1,2,3; Kautiainen, Hannu1,4; von Bonsdorff, Mikaela B1,5;
Organizations: 1Public Health Research Program, Folkhälsan Research Center, Helsinki, Finland
2Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
3Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
4Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
5Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
6Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
7Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
8Clinical Medicine Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
9Department of Clinical and Molecular Medicine, Norwegian University for Science and Technology, Trondheim, Norway
10New Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
11Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Brenner Centre for Molecular Medicine, Singapore
12Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Elsevier, 2023
Publish Date: 2023-09-04


Background: The true prevalence of healthy ageing on a population level is unknown. In this study we aimed to examine the upper limit for the prevalence of healthy ageing, by quantifying the probability of surviving and remaining free of chronic diseases that could impact functioning (ie, healthy survival) across adulthood. We also estimated the prevalence of clinically assessed healthy ageing, and the determinants of healthy survival and healthy ageing.

Methods: In this longitudinal study, we assessed men and women born in 1934–44 from the Helsinki Birth Cohort Study (Helsinki, Finland; n=13 140). We obtained information on chronic diseases, deaths, and early-to-midlife variables from national registers, databases, and health records for the period Jan 1, 1971, to Dec 31, 2017 (follow-up 951 088 person-years). We also collated data from clinical visits conducted in 2001–04 and 2017–18. Healthy ageing was defined on the basis of clinical data according to six criteria covering chronic diseases, cognitive function, physical performance, depressive symptoms, pain interference, and social functioning. We analysed the probability of healthy survival across adulthood using the Kaplan-Meier method, and the determinants of healthy survival using Cox regression models. We assessed the association of healthy ageing status in 2017–18 (n=813 with available data) with late-midlife factors collected in 2001–04 using age-adjusted logistic regression.

Findings: The probability of healthy survival was 42·8% (95% CI 41·6–44·0) in men and 40·1% (38·9–41·4) in women at age 65 years, and 22·5% (21·5–23·6%) in men and 24·4% (23·3–25·6) in women at age 75 years. Healthy survival was associated with socioeconomic position in childhood (adjusted hazard ratio [aHR], upper-middle class vs manual worker, men: 1·21 [1·11–1·31]; women: 1·15 [95% CI 1·05–1·26]) and years of education (aHR per 1 SD increase, men: 1·12 [1·08–1·16]; women: 1·03 [1·00–1·07]). In men, healthy survival was also associated with lower maternal BMI in late pregnancy (aHR per 1 SD increase 0·93 [0·90–0·96]), and in women, with shorter height at age 7 years (aHR per 1 SD increase 0·95 [0·91–0·99]). Among the 813 individuals with relevant clinical assessment data, 159 (19·6%) met all six criteria for healthy ageing at mean age 76 years (SD 3). In addition to age, we found that nutrition (Alternative Healthy Eating Index, age-adjusted odds ratio [aOR] per 1 point increase 1·03 [1·01–1·05]), former smoker status (vs non-smoker status, aOR 0·68 [0·47–0·98], and use of lipid-lowering medication (vs not used, aOR 0·60 [0·42–0·87]) in late midlife (mean age 61 years [SD 3]) were associated with healthy ageing.

Interpretation: The probability of healthy survival, as the upper limit for healthy ageing, was less than 50% from age 65 years. The probability of healthy survival and healthy ageing was influenced by several factors across the life course. Promotion of healthy ageing needs to take a life course approach.

Funding: Signe and Ane Gyllenberg Foundation, Samfundet Folkhälsan, Finska Läkaresällskapet, Medicinska Understödsföreningen Liv och Hälsa, European Commission Seventh Framework Programme, EU Horizon 2020, and the Academy of Finland.

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Series: The Lancet. Healthy longevity
ISSN: 2666-7568
ISSN-E: 2666-7568
ISSN-L: 2666-7568
Volume: 4
Issue: 9
Pages: e499 - e507
DOI: 10.1016/S2666-7568(23)00135-6
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work was supported by the Signe and Ane Gyllenberg Foundation, Samfundet Folkhälsan, Finska Läkaresällskapet, Medicinska Understödsföreningen Liv och Hälsa, the European Commission within the Seventh Framework Programme (project DORIAN, grant agreement number 278603), and the EU Horizon 2020 programme (project LifeCycle, grant number 733206; and project DYNAHEALTH, grant number 633595). The Academy of Finland supported JGE (grant numbers 129369, 129907, 135072, 129255, and 126775).
EU Grant Number: (733206) LIFECYCLE - Early-life stressors and LifeCycle health
(633595) DYNAHEALTH - Understanding the dynamic determinants of glucose homeostasis and social capability to promote Healthy and active aging
Academy of Finland Grant Number: 129369
Detailed Information: 129369 (Academy of Finland Funding decision)
129907 (Academy of Finland Funding decision)
135072 (Academy of Finland Funding decision)
129255 (Academy of Finland Funding decision)
126775 (Academy of Finland Funding decision)
Copyright information: © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.