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Must we throw out the blue zones?


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New biostats preprint: Supercentenarians and the oldest-old are concentrated into regions with no birth certificates and short lifespans

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The observation of individuals attaining remarkable ages, and their concentration into geographic sub-regions or ‘blue zones’, has generated considerable scientific interest. Proposed drivers of remarkable longevity include high vegetable intake, strong social connections, and genetic markers. Here, we reveal new predictors of remarkable longevity and ‘supercentenarian’ status. In the United States, supercentenarian status is predicted by the absence of vital registration. The state-specific introduction of birth certificates is associated with a 69-82% fall in the number of supercentenarian records. In Italy, which has more uniform vital registration, remarkable longevity is instead predicted by low per capita incomes and a short life expectancy. Finally, the designated ‘blue zones’ of Sardinia, Okinawa, and Ikaria corresponded to regions with low incomes, low literacy, high crime rate and short life expectancy relative to their national average. As such, relative poverty and short lifespan constitute unexpected predictors of centenarian and supercentenarian status, and support a primary role of fraud and error in generating remarkable human age records.

Several years ago was this, not sure if it has been discussed before: Japan, Checking on Its Oldest, Finds Many Gone 

The Japanese pensions scandals (published in the international journal of pensions!)

Bit of an overstatement, as we still have prospective epidemiology that generally agrees with the overall principles, but. Does anyone think this casts doubt on accepted blue zone anecdata?

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Fascinating Mikii,I hadn't realized just how shaky some of the Blue Zone data may be. Here are interesting passages from the paper you pointed to (my emphasis) :

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For example, Okinawa has the highest number of centenarians per capita of any Japanese prefecture and remains world-famous for remarkable longevity. Okinawa also has the highest murder rate per capita, the worst over-65 dependency ratio, the second-lowest median income, and the lowest median lifespan of all 47 Japanese prefectures [23].

Like the ‘blue zone’ islands of Sardinia and Ikaria, Okinawa also represents the shortest-lived and second-poorest region of a rich high-welfare state. These regions may have higher social connections and vegetable intakes, yet they also rank amongst the least educated and poorest regions of their respective countries. The hypothesis that these relatively low literacy rates and incomes are generating age-reporting errors and pension fraud, and therefore remarkable age records, seems overlooked.

Indicators of poverty and fraud, and contra-indications of health, are also ignored in remarkable-age surveys. For example, smoking rates of e.g. 17-50% [6] and illiteracy rates of 50-80% [5,6] are often observed in samples of the oldest-old. Surveying the ‘blue zone’ of Ikaria, Chrysohoou et al. observed that the oldest-old have: a below-median wage in over 95-98% of cases, moderate to high alcohol consumption (5.1-8.0 L/ year), a 10% illiteracy rate, an average 7.4 years of education, and a 99% rate of smoking in men [3].

Instead of prompting skepticism, under the relatively safe assumption that smoking, drinking, poverty, and illiteracy should not enrich for remarkable longevity records, these contra-indications of survival are routinely ignored. In contrast, it could be suggested that the abundance of supercentenarians in these regions reflect high rates of undetected error.

And:

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This issue presents a substantial problem for remarkable-age databases, embodied in a deliberately provocative, if seemingly absurd, hypothesis: Every ‘supercentenarian’ is an accidental or intentional identity thief, who owns real and validated 110+ year-old documents, and is passably good at their job.

This hypothesis cannot be invalidated by the further scrutiny of documents, or by models calibrated using document-informed ages [28,29]. 

This reminds me of the suspicious around Jean Calment's identity and age, which we discussed here.

I find all this to be good reason for skepticism about so-called "Blue Zone" longevity and claims about the lifestyle habits of the oldest old.

--Dean

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Yes, yes, yes. This is pretty much exactly what I said about the Blue Zones and I cited the Japanese fraud situation:

https://www.crsociety.org/topic/11488-cold-exposure-other-mild-stressors-for-increased-health-longevity/?do=findComment&comment=31565

"Put me down as deeply suspicious of the whole hype about Blue Zones. Because I think it's a natural human tendency to try to find and believe in good news. I am very, very skeptical about the integrity of statistics and demographic data coming from any of these places, including Okinawa which saw extreme WWII action, and whose pension system (and all its weaknesses and temptations) is Japanese. 

But that's just me. I suppose I'm cursed by an aversion to hype."

As I said in that post, the only possibly useful demographic data of that type comes from Scandinavia. And to be fair, one of the Blue Zones is Loma Linda, with presumably better data integrity. But all the other claims I think belong in the wastebasket. Needless to say, the whole concept of "blue zones" is something that is promoted by various hypesters and moneyspinners with books to sell and articles to peddle and so on and so forth. As always with fraud and exaggerated claims you will find the pickpockets and three card monty operators, and so it is with the "blue zone" hype.

A much more serious problem however is lack of integrity in medical research. The sheer numbers of studies that are deliberately biased in their data is staggering - the majority of them - which has me increasingly sceptical of all reported medical studies, which leaves me in quite a pickle. If we can't trust science as it's practiced in medicine, then what are our options? I used to be an eager consumer of all the wonderful studies Al posts, but these days I scan them while always thinking "maybe, maybe not". It's a depressing situation. Everyone has something to sell and something to hype - and that most certainly includes scientists and researchers eager for grants, prestige, money, position, tenure and a thousand other extra-scientific motivations. It's hype all the way down.

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3 hours ago, Dean Pomerleau said:

...

This reminds me of the suspicious around Jean Calment's identity and age, which we discussed here.

...

Good way to spread doubt about large scale epidemiological studies and nonsense fed by Russian disinformation propaganda. It's effectively what the antivaxers do.

The Russian attacks on the credibility of Jean Calment are built on innuendo and suggest a vast conspiracy of local townspeople and Western researches who have repeatedly verified her age.

As to Okinawa, the data showing diet and health patterns comes directly from the US Military, which is generally fairly good at compiling statistics. If I remember, the data was recrunched and more data was collected by the Japanese government after it took control in the 1970s.

Sure, one can find problems in any large population study. But generally, as long as there was reasonable care in collecting the data (and there is no reason to doubt this in the Okinawan studies), patterns emerge in large samples and these patterns tell a story.

But hey, Darwin is next:

https://www.themoscowtimes.com/2019/08/06/charles-darwin-repents-for-evolution-theory-during-chat-with-russian-priest-a66724

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Here is a good summary of the Jean Clement's nonsense and its Russian connection:

"The world’s oldest person record stood for decades. Then came a Russian conspiracy theory.
 

The email came just hours into the new year, landing in the inboxes of the two renowned French gerontologists who had validated the age of the oldest person ever documented in the modern world.

Also copied was the consultant who analyzed age-related cases for Guinness World Records, which had given Jeanne Calment the title before she died at 122 in 1997.

“Colleagues, take action, take evidence for verification,” read the message, from the email account of Russian doctor Valery Novoselov, continuing in cryptically rendered English. “Otherwise, there will be many people who will want to participate in this show.”

Novoselov, the chairman of gerontology for a naturalist society at Moscow State University, had recently conscripted a researcher to write a report contesting Calment’s record. The study made an explosive claim: that Calment was not Jeanne but her daughter Yvonne, who had stolen her deceased mother’s identity to avoid paying inheritance taxes, and was therefore not older than 100. It kicked off a storm of media attention that was cresting when Novoselov’s message was sent.

Novoselov made a vague threat about law enforcement in the email to the three men.

“Do not write about the war between Russia and the West,” he wrote. “Concerning the behavior of one of the participants of the show, a complaint was written to the NIA. Last week I wrote a request to the SK RF (similar to the FBI). Next week there will be an appeal to the FBI.”

The gerontologists who received the email said they already were questioning the soundness of the Russian study. Now one of the people behind it was saying he had made a complaint to the United States’ National Institute on Aging and the SK RF — a federal investigative committee in Russia that deals with politically involved crimes, as well as terrorism and theft.

There were other strange events.

Random accounts had been popping up on the 110 Club, an online forum dedicated to supercentenarians, to talk about the case. The Wikipedia page for Jeanne Calment had recently undergone edits that wove in doubt about her age. And an internal message from the 110 Club’s administrator’s board appeared on Novoselov’s Facebook page.

This was not how academic disputes were typically settled. And Russia was not particularly well thought of in the close-knit world of people who study the exceptionally old in Europe and the United States. At least one of the scientists started wondering whether something else was going on.
...

 

The gerontology department of the naturalist society that he heads prominently displays one of its main goals for 2019 on its website: “to invalidate” Calment’s record. It lauds the research done by Zak, among others.

They showed how much the freedom of scientific thought and the level of Russian knowledge sometimes surpasses Western science,” it said.

..."
https://www.washingtonpost.com/world/2019/01/12/how-madame-calment-worlds-oldest-person-became-fuel-russian-conspiracy-theory/?noredirect=on

Edited by Ron Put
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The Russian attacks on the credibility of Jean Calment are built on innuendo and suggest a vast conspiracy of local townspeople and Western researches who have repeatedly verified her age.

I'm not a conspiracy theorist but the cynical side of me thinks that someone would claim this because it'd would be the best way to get her DNA.

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5 hours ago, TomBAvoider said:

... "Put me down as deeply suspicious of the whole hype about Blue Zones. Because I think it's a natural human tendency to try to find and believe in good news. I am very, very skeptical about the integrity of statistics and demographic data coming from any of these places, including Okinawa which saw extreme WWII action, and whose pension system (and all its weaknesses and temptations) is Japanese. ...

...

As I said in that post, the only possibly useful demographic data of that type comes from Scandinavia. And to be fair, one of the Blue Zones is Loma Linda, with presumably better data integrity. But all the other claims I think belong in the wastebasket. Needless to say, the whole concept of "blue zones" is something that is promoted by various hypesters and moneyspinners with books to sell and articles to peddle and so on and so forth. As always with fraud and exaggerated claims you will find the pickpockets and three card monty operators, and so it is with the "blue zone" hype....

Suspicious is fine, if based on facts. But we have rather good facts about Japan. Despite the anecdotal evidence found in Japan, Checking on Its Oldest, Finds Many Gone, the rather poorly written NYT article, which pointedly offers not a single statistic, instead relying on a handful of sensational individual stories to weave a claim of an epidemic. 🙂

Japan has actually been quite bureaucratic for some time now and its statistics are better than those in the US or Canada, and I would make an educated guess, better than those in Scandinavia of a century ago. Japan is the only non-European country currently where centenarian data is currently classified as "good." https://www.demogr.mpg.de/Papers/Books/Monograph1/start.htm

The is in fact quite a bit information on the quality of Japanese demographic data, but here is something which relates specifically to Okinawan longevity:

They Really Are That Old: A Validation Study of Centenarian Prevalence in Okinawa

https://academic.oup.com/biomedgerontology/article/63/4/338/625612


And to address the claims of poverty and illiteracy among the very old in places like Okinawa: It's true that there is a correlation between income and educational attainment, and longevity in the developed industrialized countries. But this is due largely to the fact that the better educated and the wealthier are more likely to engage in healthy behavior and more likely to take advantage of advanced medicine. The poor in places like the US or the UK are actually wealthy enough to afford to frequent "all you can eat" establishments, fast food restaurants and chug pints of beer to wash down the greasy pub food. And to be able to afford all the soft drinks and packaged snacks they want. Also, their work environment is often conducive to stress and keeping them immobile.

The average Okinawan in the early 20th century had no access to such goods and no means to afford them. In fact, the theory is that they effectively practiced CR, not necessarily by choice, but because there was no other option (notably, diet in Okinawa has changed dramatically since the late 1970s). Similarly with the average Italian or Greek island villager in the 1940s. Being a shepherd in Sardinia likely paid a lot less than being a factory worker in Liverpool, but was also less stressful, kept one more mobile and even if both populations smoked, the number of environmental pollutants in Sardinia was likely considerably lower. And while the Sardinian may have been illiterate, the opportunities to engage in bad health habits in the village were much more limited compared to the opportunities of the factory worker in Liverpool.

OK, I am done 🙂

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If you wanted to get her DNA and sequence it, you'd need to create a reason or scenario to have her body exhumed for DNA testing. Claiming that she was a fraud and not even who she says she was would be what you'd probably need to do. I don't think the claims by the Russian guy were taken seriously anyway. I know that sounds kinda crazy, but it's what I thought after reading his paper. 😄

 

Edited by Matt
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Suspicious is fine, if based on facts. But we have rather good facts about Japan. Despite the anecdotal evidence found in Japan, Checking on Its Oldest, Finds Many Gone, the rather poorly written NYT article, which pointedly offers not a single statistic, instead relying on a handful of sensational individual stories to weave a claim of an epidemic. 🙂

Yeah, no. My scepticism was based on a different source, which I provided in my post which I linked to:

https://www.bbc.com/news/world-asia-pacific-11258071

And there certainly was a number given in my article, right up front:

"More than 230,000 elderly people in Japan who are listed as being aged 100 or over are unaccounted for, officials said following a nationwide inquiry."

It was a nationwide inquiry by the Japanese, not a WAG, and they did come up with a number. So I call BS on the claim that somehow Japanese demo stats are reliable either on the mainland or on Okinawa - by their own admission they're far from it. Furthermore, we have no idea how many such shenanigans were going on in the period prior to this inquiry where folks simply dropped the claims once it got to absurd numbers like 150 years or whatnot and people claimed alive who actually perished in the war. I think that data is straight up GIGA. 

The links touting the integrity of Japanese demo data, far from being reassuring are in my mind the exact opposite - quote from the Okinawan link:

"Thus, Japan has long been considered to have among the highest quality data for the oldest-old."

and

"Consistent with these studies, the Japanese government's Annual Centenarian Report ranks Okinawa as having the highest prevalence of centenarians of any prefecture within Japan"

Erm, if Japan is supposedly in the highest category of "good" data, then all it says to me is that the non-good data is even worse than one would have suspected. The reason is extremely simple - Japanese data may be "good" against the garbage that comes from many other countries, but it's not "good" by the standards one would need to feel confident in reaching conclusions about centenarian prevalence - proof being the disastrous conclusions about widespread fraud in the centenarians and older prevalence reached by the Japanese national inquiry - enough said. It's garbage. If the demonstrably catastrophically flawed data is called "good" then it just means that the standards are garbage. If the excess is by the hundreds of thousands, that's systemic, it's not just some fudging at the margins. How good is that "validation" study when such monstrous numbers are fraudulent? Sorry, but the proof is in the pudding. If anything, far from reassuring, these links have me even more sceptical about the demo data integrity coming out of Japan.

Note, that the study touting the validity of the Okinawan data came out in 2008. The article I linked to the Japanese fraud inquiry came out in 2010. Oops! So much for the validity of the Okinawan data - or as I'm fond of saying, another case of hype, hype and more hype... so, sad trombone.

As to the Russians - in general, I'm not susceptible to arguments from authority, nor ad-hominem. I don't care much about the dastardly plots by commies or devious Russians who for some reason really care about debunking Calmet. The case should be settled by the arguments. So far all we see is "Russians are bad". Maybe they are, but the best way of settling the argument on its merits, is by, well, settling the argument on its own merits, not on who is making them. 

 

 

Edited by TomBAvoider
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Haha, I get it now 🙂 Thanks. Actually, they have a blood sample, apparently. This is from Wikipedia:

"After a meeting of the National Institute for Demographic Studies (INED) in Paris on 23 January 2019, French, Swiss and Belgian longevity experts stated that the Russian study provided no proof of an identity substitution, and considered that an exhumation may be needed to settle the controversy.[35] As an alternative to exhumation, senescence researcher Aubrey de Grey stated on 3 May 2019 that certain DNA tests on a preserved blood sample would identify the person deceased in 1997 with "cast-iron evidence", based on the consanguine lineage of Yvonne Calment, who had 12 great-great-grandparents (due to inbreeding) whereas Jeanne had the usual 16.[36]"


I am still inclined to believe it's mostly part of the broad, and at times bizarre, Russian disinformation campaign in its former satellites like Ukraine and the Baltics,  which then expanded to the EU and further (including pushing for Brexit). This from the article above seems to support my suspicion: They showed how much the freedom of scientific thought and the level of Russian knowledge sometimes surpasses Western science...”
 

It is bizarre, in a North Korean kind of way, but also rather effective.

 

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Hype is the name of the game. Nothing new under the sun. It’s basically the same old bullshit recycled over and over again by this person or that person trying to get published or sell a book etc. Yes there are some basic facts like sleep hygiene, eat your veggies, exercise moderate CRON and don’t smoke, and drink moderately. That’s about it folks and the aging process will take its toll and the best we can do at this point ain’t a whole lot! God Bless Michael Rae cause he is realistic on this point and works for a real solution. The rest is weak ass medicine to say the least.

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1 hour ago, TomBAvoider said:

...Yeah, no. My scepticism was based on a different source, which I provided in my post which I linked to:

https://www.bbc.com/news/world-asia-pacific-11258071

And there certainly was a number given in my article, right up front:

"More than 230,000 elderly people in Japan who are listed as being aged 100 or over are unaccounted for, officials said following a nationwide inquiry."

... So I call BS on the claim that somehow Japanese demo stats are reliable either on the mainland or on Okinawa....

 

Tom, your BS meter is a bit off in this particular case and pointing in the wrong direction 🙂

Perhaps it should have stopped and question a headline which states that 230000 centenarians are MISSING....

It should have considered the total population of Japan and what exactly it would mean to have 230000 centenarians MISSING.

But this is how disinformation works: seed doubt in enough folks to in the long term undermine trust in institutions and authority, scientific or political. It's a crude but efficient way to put reason and common sense on the defense. It's another way of asking "When did you stop beating your wife?" It's why the Russian troll brigades support the antivaxers, conspiracy theorists and fringe movements, too.

Here is a more sane headline (no guarantee it would pass your BS meter) 🙂

Aging Japan now has 65,692 centenarians
https://www.japantimes.co.jp/news/2016/09/13/national/aging-japan-now-65692-centenarians/

Of course, those are the ones left after the 230,000 went missing....

Edited by Ron Put
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From the same article I linked to:

"Last year's Health Ministry report said Japan had 40,399 people aged 100 or older with known addresses."

That's about a 25,000 difference in 10 years or so. 

Meanwhile, even by the most conservative estimates, there's a close to 7% discrepancy in some prefectures - as an example, Hyogo at 6.6%. That is a huge and meaningful number. Any number of research orgs can be cited, but the Ministry of Justice is the best we have, unfortunately - I'm not claiming it is perfect by any means.

Going by demographic research org, there have been multiple axis along which the numbers came up, for example, the 230,000 number is actually 234,354 and it comes from the investigation sources being the Family Register System  - Kosek - referenced by the very Willcox study you linked to, but obviously done after the Wilcox study (August to September 2010). A total of 47,439,848 out of 52,572,916 or 90% of family registers, which include individuals aged 100 and over without a list of changes in address, were checked - which clearly is not all of the records. Who knows what else is hiding in the rest of the registers. Still, the investigation concluded that there were 234,354 missing centenarians, many of whom would be at the very extreme and beyond of supposed human lifespan. If you have a quarrel with that, take it up with the Ministry of Justice. 

If you are unhappy about the 230,000 number, and don't trust the BBC or other supposedly misinformation outlets, maybe you'll be more comfortable with the American NPR, given that at least in this case, the explanation is given in great detail with direct quotations from the relevant individuals in Japan, so straight from the horse's mouth, explaining what went wrong with that number - and not that the number is illegitimate:

https://www.npr.org/templates/story/story.php?storyId=129992827

Executive summary: it is indeed down to the koseki records so beloved by Willcox, and which were only partially computerized, by the way - in the opinion of their top people, the whole system ought to be dumped:

"I was so shocked, it's unbelievable. It's a kind of nightmare," Takako Sodei, a gerontologist and professor emeritus at Ochanomizu University in Tokyo.

Sodei says it's high time to dump household registers and adopt an individual ID system. She warns that the missing-seniors revelations are just the tip of the iceberg.

"If the local government tried to find the whereabouts of people over 70 or 75, the number will be doubled or maybe sometimes three times," Sodei says."

In other words, the rot goes much deeper than simply fraud driven by pension payouts - there are structural issues with the data so the integrity in question extends to much younger than even centenarians! The whole koseki system needs to go, pronto. 

I think my BS detector is in fine shape, thank you. Maybe there's a need to tune up those BS detectors that credulously swallow all official statistics everywhere. 

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Btw. a fundamental problem with demographic data from Japan is the extreme demographic events of not only WWII, but various natural disasters from monster earthquakes, to massive city fires, tsunamis etc. Okinawa itself was actually invaded (unlike the mainland). When you are dealing with the kind of chaos that results from such extreme events, you have structural problems evaluating demographic data - completely apart from any pension based fraud. Fraud is not the main problem, but where you have paper records (if even that) in areas that are subject to extreme destruction (such as Okinawa), you simply cannot guarantee any sensible data integrity.

This is why I prefer to look to Scandinavia - and even there, only in countries that were not active war stages or participants in the last 200 years or so, where Finland and even Norway fall off, leaving Sweden and Iceland. Those regions don't experience much in the way of natural disasters either (at least as far as earthquakes and tsunamis).

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Actually, a quarter million missing is not in the least surprising to me (data via Ministry of Japan), in a region of such extreme events, where just the atomic bombings are conservatively estimated at over 200,000 - estimated, as an exact count has never been determined. By the way, the firebombings of Tokyo and other cities far exceeded that number. No one in Japan even knows how many died in either of those events - why can't they just pull up the records, if those are so exact? It's because the records themselves are missing (now with everything trending to computerization, maybe that can be ameliorated in the future.)

Again, that is why I think it's a fool's errand trying to get at demo data in regions which experienced such catastrophic dislocations that you can't even come up with an exact number of victims, but must estimate with error margins in the hundreds of thousands. That is the reality in Japan. The more you research this issue, the more you realize how bogus those "official" numbers and estimates are. Like I joke with my wife - if you want peace of mind and trust in your professional consultant (medical, legal etc.), the less you know, the better, because as soon as you start digging in you are horrified by the level of sloppiness and uncertainty in a given field.

Edited by TomBAvoider
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Great points everyone. Loma Linda wasn't included in the preprint but the author implied on twitter that it has issues as well: 

Although, we don't need centenarians to prove that the SDAs involved in AHS had excellent health and lived longer than average.

Edited by Mikii
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How depressing. And here I already proclaimed Loma Linda as probably one of the "better data integrity" areas - and now who knows, perhaps I was too generous. No matter how sceptical I am, it appears I'm still not sceptical enough. So, take of Loma Linda off the table for now, until the status becomes more clear. 

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Last night I watched "Brexit" on HBO and remembered this discussion.

How depressing that a "prepublication" snippets from a largely meaningless statistical model spread through social media garners much more views, even here, than many reliable studies. How depressing that people are so willing to believe what are effectively quickly cobbled together conspiracy theories, and doubt well-backed up data and years of work by experts.

Did anyone here look at the methodology of this bombastic nonsense? First, the focus is on 1880-1900, with hard data only for the US and Italy and data for the US obtained from the Gerontology Research Group (not considered nearly as accurate as Medicare records, for instance (those are used in most current studies)). The basic argument, which discusses the US only is that the as statewide birth registration was implemented in the US, the number of purported centenarians dropped. Duh!

For Okinawa and Italy, the argument is even flimsier: Basically, don't believe in the stats, because the super-old are poorer and illiterate, which contradicts modern statistical correlations. But it ignores the fact that today's poor and illiterate have the means to become obese on a diet of Coke and fast food. The Okinawans didn't have access to such "luxuries" (many were living for a good period on US military provided rations, which is part of why there is good data) and were effectively on a CR diet.

There is a lot of reliable information on validation of centenarian status and it does NOT support the broad claims made in the Twitter bait which started this discussion. For instance:

"Age validation is important in studies of extreme longevity because age and birth year misreporting can artificially inflate the number of centenarians. Age misreporting is more likely to occur among the very old due to lack of birth records documenting year of birth (22). Individuals in this study were born close to or after 1900 and are, therefore, more likely to accurately report their birth year (23). Furthermore, birth year was reported accurately by 89% of centenarians (n = 85) and nonsurvivors (n = 932) according to comparisons with birth year information recorded in Medicare data, a reliable administrative source of birth year information (24). Only one centenarian reported a birth year inconsistent with Medicare records. Birth year information could not be verified for the remaining 10 centenarians and 113 nonsurvivors. However, it is likely that centenarians for whom birth year could not be validated reported their year of birth correctly because their individual characteristics are consistent with those who correctly report their birth year: eight were white, six had at least 12 years of education and none were born in the South, where vital statistics systems were not complete until the 1930s."
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311187/

Edited by Ron Put
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