{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T19:51:57Z","timestamp":1783799517517,"version":"3.55.0"},"reference-count":43,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2020,5,21]],"date-time":"2020-05-21T00:00:00Z","timestamp":1590019200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Gobierno de Arag\u00f3n and the European Regional Development Fund","award":["B01_20R"],"award-info":[{"award-number":["B01_20R"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>This study aims to describe the clinical course, drug use, and health services use characteristics during the last year of life of elders who die being centenarians and to identify key aspects differentiating them from elders who die at an earlier age, with a particular focus on sex differences. We conducted an observational, population-based study in the EpiChron Cohort (Arag\u00f3n, Spain). The population was stratified by sex and into three age sub-populations (80\u201389, 90\u201399, and \u2265100 years), and their characteristics were described and compared. Multimorbidity was the rule in our elders, affecting up to 3 in 4 centenarians and 9 in 10 octogenarians and nonagenarians. Polypharmacy was also observed in half of the centenarian population and in most of the younger elders. Risk factors for cardiovascular disease (i.e., hypertension, dyslipidaemia, diabetes), cerebrovascular disease and dementia were amongst the most common chronic conditions in all age groups, whereas the gastroprotective drugs and antithrombotic agents were the most dispensed drugs. Centenarians presented in general lower morbidity and treatment burden and lower use of both primary and hospital healthcare services than octogenarians and nonagenarians, suggesting a better health status. Sex-differences in their clinical characteristics were more striking in octogenarians and tended to decrease with age.<\/jats:p>","DOI":"10.3390\/jcm9051563","type":"journal-article","created":{"date-parts":[[2020,5,21]],"date-time":"2020-05-21T11:31:18Z","timestamp":1590060678000},"page":"1563","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Do Centenarians Die Healthier than Younger Elders? A Comparative Epidemiological Study in Spain"],"prefix":"10.3390","volume":"9","author":[{"given":"Mercedes","family":"Clerencia-Sierra","sequence":"first","affiliation":[{"name":"Aragon Health Service (SALUD), EpiChron Research Group, 50009 Zaragoza, Spain"},{"name":"Red de Investigaci\u00f3n en Servicios de Salud en Enfermedades Cr\u00f3nicas (REDISSEC), 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6518-749X","authenticated-orcid":false,"given":"Ignatios","family":"Ioakeim-Skoufa","sequence":"additional","affiliation":[{"name":"EpiChron Research Group, IIS Arag\u00f3n, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5119-5093","authenticated-orcid":false,"given":"Beatriz","family":"Poblador-Plou","sequence":"additional","affiliation":[{"name":"Red de Investigaci\u00f3n en Servicios de Salud en Enfermedades Cr\u00f3nicas (REDISSEC), 28222 Madrid, Spain"},{"name":"EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Arag\u00f3n, Miguel Servet University Hospital, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisca","family":"Gonz\u00e1lez-Rubio","sequence":"additional","affiliation":[{"name":"Aragon Health Service (SALUD), EpiChron Research Group, 50009 Zaragoza, Spain"},{"name":"Red de Investigaci\u00f3n en Servicios de Salud en Enfermedades Cr\u00f3nicas (REDISSEC), 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercedes","family":"Aza-Pascual-Salcedo","sequence":"additional","affiliation":[{"name":"Aragon Health Service (SALUD), EpiChron Research Group, 50009 Zaragoza, Spain"},{"name":"Red de Investigaci\u00f3n en Servicios de Salud en Enfermedades Cr\u00f3nicas (REDISSEC), 28222 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00f3nica","family":"Mach\u00f3n","sequence":"additional","affiliation":[{"name":"Red de Investigaci\u00f3n en Servicios de Salud en Enfermedades Cr\u00f3nicas (REDISSEC), 28222 Madrid, Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria Biodonostia, Grupo de Atenci\u00f3n Primaria, 20014 San Sebasti\u00e1n, Spain"},{"name":"Instituto de Investigaci\u00f3n en Servicios de Salud Kronikgune, 48902 Barakaldo, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5440-1710","authenticated-orcid":false,"given":"Antonio","family":"Gimeno-Miguel","sequence":"additional","affiliation":[{"name":"Red de Investigaci\u00f3n en Servicios de Salud en Enfermedades Cr\u00f3nicas (REDISSEC), 28222 Madrid, Spain"},{"name":"EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Arag\u00f3n, Miguel Servet University Hospital, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5704-6056","authenticated-orcid":false,"given":"Alexandra","family":"Prados-Torres","sequence":"additional","affiliation":[{"name":"Red de Investigaci\u00f3n en Servicios de Salud en Enfermedades Cr\u00f3nicas (REDISSEC), 28222 Madrid, Spain"},{"name":"EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Arag\u00f3n, Miguel Servet University Hospital, 50009 Zaragoza, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,5,21]]},"reference":[{"key":"ref_1","unstructured":"United Nations Department of Economic and Social Affairs (2015). World Population Prospects: The 2015 Revision, Key Findings and Advance Tables, United Nations Department of Economic and Social Affairs."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1093\/gerona\/glu130","article-title":"Learning From Leaders: Life-span Trends in Olympians and Supercentenarians","volume":"70","author":"Berthelot","year":"2015","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1046\/j.1532-5415.2001.49180.x","article-title":"Healthy centenarians do not exist, but autonomous centenarians do: A population-based study of morbidity among danish centenarians","volume":"49","author":"Schroll","year":"2001","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"M232","DOI":"10.1093\/gerona\/58.3.M232","article-title":"Morbidity Profiles of Centenarians: Survivors, Delayers, and Escapers","volume":"58","author":"Evert","year":"2003","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1017\/S1041610289000207","article-title":"Health and living conditions of centenarians in Hungary","volume":"1","author":"Beregi","year":"1989","journal-title":"Int. Psychogeriatr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1111\/j.1741-6612.2011.00570.x","article-title":"Morbidity profiles and lifetime health of Australian centenarians","volume":"31","author":"Richmond","year":"2012","journal-title":"Australas. J. Ageing"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1111\/jgs.12613","article-title":"Demographic characteristics and healthcare use of centenarians: A population-based cohort study","volume":"62","author":"Rochon","year":"2014","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1093\/geront\/37.2.200","article-title":"Centenarians: Human longevity outliers","volume":"37","author":"Smith","year":"1997","journal-title":"Gerontologist"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1093\/geronb\/56.3.P134","article-title":"Cognitive functional status of age-confirmed centenarians in a population-based study","volume":"56","author":"Silver","year":"2001","journal-title":"J. Gerontol. B. Psychol. Sci. Soc. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/S0277-9536(00)00141-6","article-title":"Compression or expansion of morbidity? Trends in healthy-life expectancy in the elderly Austrian population between 1978 and 1998","volume":"52","author":"Doblhammer","year":"2001","journal-title":"Soc. Sci. Med."},{"key":"ref_11","first-page":"77","article-title":"Do men and women follow different trajectories to reach extreme longevity? Italian Multicenter Study on Centenarians (IMUSCE)","volume":"12","author":"Franceschi","year":"2000","journal-title":"Aging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1093\/gerona\/61.3.305","article-title":"Functional status of centenarians in Tokyo, Japan: Developing better phenotypes of exceptional longevity","volume":"61","author":"Gondo","year":"2006","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1056\/NEJM198007173030304","article-title":"Aging, Natural Death, and the Compression of Morbidity","volume":"303","author":"Fries","year":"1980","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1177\/089826439100300205","article-title":"Trading Off Longer Life for Worsening Health","volume":"3","author":"Olshansky","year":"1991","journal-title":"J. Aging Health"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2307\/3349592","article-title":"The Failures of Success","volume":"55","author":"Gruenberg","year":"1977","journal-title":"Milbank Q."},{"key":"ref_16","first-page":"68","article-title":"Evaluating compression or expansion of morbidity in Canada: Trends in life expectancy and health-adjusted life expectancy from 1994 to 2010","volume":"37","author":"Steensma","year":"2017","journal-title":"Health Promot. Chronic Dis. Prev. Canada Res. Policy Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"218","DOI":"10.3389\/fmed.2019.00218","article-title":"Health and Well-Being in Late Life: Gender Differences Worldwide","volume":"6","author":"Carmel","year":"2019","journal-title":"Front. Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Suominen-Taipale, A.L., Martelin, T., Koskinen, S., Holmen, J., and Johnsen, R. (2006). Gender differences in health care use among the elderly population in areas of Norway and Finland. A cross-sectional analysis based on the HUNT study and the FINRISK Senior Survey. BMC Health Serv. Res., 6.","DOI":"10.1186\/1472-6963-6-110"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1093\/ije\/dyx259","article-title":"Cohort Profile: The Epidemiology of Chronic Diseases and Multimorbidity. The EpiChron Cohort Study","volume":"47","year":"2018","journal-title":"Int. J. Epidemiol."},{"key":"ref_20","first-page":"1","article-title":"Construction of a deprivation index by Basic Healthcare Area in Aragon using Population and Housing Census 2011","volume":"92","year":"2018","journal-title":"Rev. Esp. Salud Publica"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"(2015). By the American Geriatrics Society 2015 Beers Criteria Update Expert Panel American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J. Am. Geriatr. Soc., 63, 2227\u20132246.","DOI":"10.1111\/jgs.13702"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.3399\/bjgp11X548929","article-title":"Epidemiology and impact of multimorbidity in primary care: A retrospective cohort study","volume":"61","author":"Salisbury","year":"2011","journal-title":"Br. J. Gen. Pract."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1177\/0091270006292126","article-title":"The Anticholinergic Drug Scale as a Measure of Drug-Related Anticholinergic Burden: Associations With Serum Anticholinergic Activity","volume":"46","author":"Carnahan","year":"2006","journal-title":"J. Clin. Pharmacol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"311","DOI":"10.2217\/1745509X.4.3.311","article-title":"Impact of anticholinergics on the aging brain: A review and practical application","volume":"4","author":"Boustani","year":"2008","journal-title":"Aging Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1093\/ageing\/afr144","article-title":"Drug Use in Centenarians Compared With Nonagenarians and Octogenarians in Sweden: A Nationwide Register-Based Study","volume":"41","author":"Wastesson","year":"2012","journal-title":"Age Ageing"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1111\/jgs.13484","article-title":"Differences in Health at Age 100 According to Sex: Population-Based Cohort Study of Centenarians Using Electronic Health Records","volume":"63","author":"Hazra","year":"2015","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1093\/gerona\/glu124","article-title":"Becoming centenarians: Disease and functioning trajectories of older US Adults as they survive to 100","volume":"70","author":"Ailshire","year":"2015","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1093\/gerona\/62.7.774","article-title":"Morbidity of Tokyo-area centenarians and its relationship to functional status","volume":"62","author":"Takayama","year":"2007","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1089\/pop.2018.0069","article-title":"Recent Patterns of Multimorbidity Among Older Adults in High-Income Countries","volume":"22","author":"Chin","year":"2019","journal-title":"Popul. Health Manag."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Holstege, H., Beker, N., Dijkstra, T., Pieterse, K., Wemmenhove, E., Schouten, K., Thiessens, L., Horsten, D., Rechtuijt, S., and Sikkes, S. (2018). The 100-plus Study of cognitively healthy centenarians: Rationale, design and cohort description. Eur. J. Epidemiol., 33.","DOI":"10.1101\/295287"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1093\/gerona\/60.7.862","article-title":"Do centenarians die healthy? An autopsy study","volume":"60","author":"Berzlanovich","year":"2005","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1161\/HYPERTENSIONAHA.110.163576","article-title":"Inflammation, Immunity, and Hypertension","volume":"57","author":"Harrison","year":"2011","journal-title":"Hypertension"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1056\/NEJM199704033361401","article-title":"Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men","volume":"336","author":"Ridker","year":"1997","journal-title":"N. Engl. J. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1016\/j.neubiorev.2011.10.001","article-title":"Depression and type 2 diabetes: Inflammatory mechanisms of a psychoneuroendocrine co-morbidity","volume":"36","author":"Stuart","year":"2012","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"813","DOI":"10.2337\/diacare.27.3.813","article-title":"Inflammation and Activated Innate Immunity in the Pathogenesis of Type 2 Diabetes","volume":"27","author":"Pickup","year":"2004","journal-title":"Diabetes Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1093\/gerona\/gls187","article-title":"The role of peripheral inflammatory markers in dementia and Alzheimer\u2019s disease: A meta-analysis","volume":"68","author":"Koyama","year":"2013","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_37","first-page":"796","article-title":"Inflammatory Biomarkers Predict Domain-Specific Cognitive Decline in Older Adults","volume":"72","author":"Chi","year":"2017","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1038\/nri2015","article-title":"Systemic infections and inflammation affect chronic neurodegeneration","volume":"7","author":"Perry","year":"2007","journal-title":"Nat. Rev. Immunol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2573","DOI":"10.1210\/jc.2002-021511","article-title":"Increased pulse wave velocity associated with reduced calcaneal quantitative osteo-sono index: Possible relationship between atherosclerosis and osteopenia","volume":"88","author":"Hirose","year":"2003","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_40","first-page":"1218","article-title":"Chronic Inflammation: Accelerator of Biological Aging","volume":"72","author":"Boulanger","year":"2016","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"465","DOI":"10.7861\/clinmedicine.16-5-465","article-title":"The epidemiology of polypharmacy","volume":"16","author":"Payne","year":"2016","journal-title":"Clin. Med."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"B\u00e4hler, C., Huber, C.A., Br\u00fcngger, B., and Reich, O. (2015). Multimorbidity, health care utilization and costs in an elderly community-dwelling population: A claims data based observational study. BMC Health Serv. Res., 15.","DOI":"10.1186\/s12913-015-0698-2"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1007\/s40266-018-0537-3","article-title":"Medications and Prescribing Patterns as Factors Associated with Hospitalizations from Long-Term Care Facilities: A Systematic Review","volume":"35","author":"Wang","year":"2018","journal-title":"Drugs Aging"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/5\/1563\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:31:18Z","timestamp":1760175078000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/5\/1563"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,21]]},"references-count":43,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,5]]}},"alternative-id":["jcm9051563"],"URL":"https:\/\/doi.org\/10.3390\/jcm9051563","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,21]]}}}