Do heads of government age more quickly? Observational study comparing mortality between elected leaders and runners-up in national elections of 17 countries
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6424 (Published 14 December 2015) Cite this as: BMJ 2015;351:h6424
- Andrew R Olenski, research assistant1,
- Matthew V Abola, medical student2,
- Anupam B Jena, associate professor1 3 4
- 1Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
- 2Case Western Reserve University School of Medicine, 2109 Adelbert Road, Cleveland, OH 44106, USA
- 3Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- 4National Bureau of Economic Research, Cambridge, MA, USA
- Correspondence to: A B Jena jena{at}hcp.med.harvard.edu
- Accepted 19 November 2015
Abstract
Objectives To determine whether being elected to head of government is associated with accelerated mortality by studying survival differences between people elected to office and unelected runner-up candidates who never served.
Design Observational study.
Setting Historical survival data on elected and runner-up candidates in parliamentary or presidential elections in Australia, Austria, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, New Zealand, Norway, Poland, Spain, Sweden, United Kingdom, and United States, from 1722 to 2015.
Participants Elected and runner-up political candidates.
Main outcome measure Observed number of years alive after each candidate’s last election, relative to what would be expected for an average person of the same age and sex as the candidate during the year of the election, based on historical French and British life tables. Observed post-election life years were compared between elected candidates and runners-up, adjusting for life expectancy at time of election. A Cox proportional hazards model (adjusted for candidate’s life expectancy at the time of election) considered years until death (or years until end of study period for those not yet deceased by 9 September 2015) for elected candidates versus runners-up.
Results The sample included 540 candidates: 279 winners and 261 runners-up who never served. A total of 380 candidates were deceased by 9 September 2015. Candidates who served as a head of government lived 4.4 (95% confidence interval 2.1 to 6.6) fewer years after their last election than did candidates who never served (17.8 v 13.4 years after last election; adjusted difference 2.7 (0.6 to 4.8) years). In Cox proportional hazards analysis, which considered all candidates (alive or deceased), the mortality hazard for elected candidates relative to runners-up was 1.23 (1.00 to 1.52).
Conclusions Election to head of government is associated with a substantial increase in mortality risk compared with candidates in national elections who never served.
Footnotes
Contributors: All authors contributed to the design and conduct of the study; data collection and management; analysis and interpretation of the data; and preparation, review, or approval of the manuscript. ABJ is the guarantor.
Funding: ABJ had support from the Office of the Director, National Institutes of Health (NIH early independence award, grant 1DP5OD017897-01). The research conducted was independent of any involvement from the sponsors of the study. Study sponsors were not involved in study design, data interpretation, writing of the manuscript, or the decision to submit the article for publication.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: ABJ had support from the Office of the Director, National Institutes of Health for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Ethical approval: All data were publicly available and the study was exempt from human subjects review at Harvard Medical School.
Transparency statement: The lead author (the manuscript’s guarantor) affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Data sharing: No additional data available.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.