Abstract / Description
Background and objectivesIdentifying factors associated with survival beyond age 90 is essential for understanding healthy aging trajectories. This study sought to investigate the associations between biological, socioeconomic, and lifestyle factors and survival in individuals aged ≥90 years.Research design and methodsSystematic review with meta-analysis. Cohort studies reporting information on lifestyle, socioeconomic, and biological determinants of survival in individuals aged ≥90 years (nonagenarians, centenarians, and supercentenarians) were searched in the MEDLINE, EMBASE, and Web of Science databases up to June 2025. Random effects meta-analyses via the empirical Bayes method generated pooled hazard ratios (HRs). Meta-regression and sensitivity analyses were conducted.ResultsTwenty-three studies were included. Being a woman (HR = 0.83; 95% confidence interval [CI], 0.80-0.86), having normal cognition (HR = 0.55; 95% CI, 0.40-0.76), having activities of daily living (ADL) independence (HR = 0.69; 95% CI, 0.63-0.76), having high handgrip strength (HR = 0.69; 95% CI, 0.48-0.99), not smoking (HR = 0.83; 95% CI, 0.74-0.93), and alcohol abstinence (HR = 0.88; 95% CI, 0.78-0.99) were associated with lower mortality. Education level was not significantly associated with survival. Meta-regression revealed no modifying effect of age or follow-up length. Multivariate meta-analysis confirmed the independent contribution of each factor and ranked ADLs (p