Achieving Exceptional Longevity: Education Level Associates with Healthy Behaviors Promoting Longer Life

Education strongly influences mortality, but direct associations are often difficult to observe. Vaccines are considered among public health's greatest triumphs and contributed to increased life expectancy in the 20th century. However, association of vaccine receipt with lifespan extension is poorly documented. Utilizing the Mayo Clinic longitudinal records linkage system, we evaluated the association of vaccine receipt with achievement of exceptional survival (ES, defined as reaching age 90 or older) in a historical birth cohort of Olmsted County, Minnesota residents born prior to 1911. 525 ES cases were matched by gender, birthyear, and a proxy of healthcare access/utilization with controls who died at or near life expectancy (LE), defined as expected age at death for the study cohort (approximately 65 years). The association of achieving ES with self-reported receipt of tetanus, influenza, and polio vaccines prior to life expectancy was explored via multivariable conditional logistic regression. While adherence with recommendations for vaccine receipt was insignificantly associated with increased odds of ES for annual influenza vaccine (OR=1.21) and tetanus vaccine (OR=1.05), the odds of achieving ES relative to death at life expectancy were significantly increased with receipt of polio vaccine (OR=1.81, 95% CI=1.06-3.08). Educational attainment was associated with both receipt of polio vaccine and achievement of ES, and the association of polio vaccine with ES was strengthened in the presence of higher educational attainment. Thus, the role of vaccine receipt in facilitating achievement of ES may represent a durable education-mediated benefit beyond simply preventing specific diseases, perhaps associated with greater adherence to other health-promoting behaviors.