Once a person approaches the maximum limit of longevity, are the causes of death the same as in people who died at younger ages?
This is a short paper based on an investigation I’ve made on cause of death in people who died at the age of 108 or above in Indiana, one of the 50 US states. Why Indiana? Well, it has publicly available death records up until 2017 available on Ancestry.com that include cause of death. While representing only a select few of all exceptionally old in the US, we can still gain some understanding of what the oldest old die from.
Background
People who live exceptionally long may differ from those who are younger in mortality profiles and health trajectories. While cardiovascular disease and infectious disease are prominent causes of death in the oldest old (age 85+) it may not necessarily be the same for the exceptionally old (age 108+).
Previous research on centenarians has found that most are affected by some sort of chronic morbidity (Lindberg et al., 2025). Evans et al. (2014) studied cause of death in English centenarians over a 10-year period between 2001-2010 and found that the most common causes of death related to pneumonia (17.7%), old age (28.1%), and cerebrovascular events/stroke (10.0%). Cardiovascular disease was divided into ischaemic heart disease and circulatory, representing approximately 18.4% of all deaths. Meslé & Vallin (2020) found that at very old ages, including for supercentenarians, dying from cancer is rarer in the exceptionally old, compared to younger people. Similarly, dying from respiratory and infectious disease is more common in the exceptionally old, while cardiovascular disease is stable over age ranges. The authors further argue that few deaths in the exceptionally old can be attributed to precise underlying causes, with death more often being related to an overall worsening of the person’s physical condition.
To understand cause of death in people who lived to be 108 years or older in the state of Indiana, a state with accessible death records for the public, this study was conducted.
Aim
To investigate cause of death in the oldest old (108+) in Indiana who were born between 1880-1907.
Methods
Death records for all people born between 1880-1907 who died in the US state of Indiana were obtained through Ancestry.com and data on name, birth date, death date, place of birth, sex, race, and cause(s) of death were extracted into an Excel document. Superficial age validation was performed, which included confirming that the person had a document from within the first twenty years of their life that confirmed their age. People who did not possess such documentation were excluded. Causes of death were grouped into overarching categories (e.g., coronary artery disease and arteriosclerosis were grouped into “Cardiovascular disease.”) Data in the Excel document were analysed using descriptive statistics.
Results
Demography
A total of 139 (129 women, 10 men) people who died at the age of 108 or more in Indiana could be verified. The number of people who died at age 108 or more varied from two to ten people per year (Figure 1), with no visible increase in the number of people aged 108+ over time. Of the 139 included people, 26 lived to be supercentenarians, with the oldest person dying at age 115. The majority (93.5%) of all people were listed as White or Caucasian, with the remaining people being listed as Black or African American. Of the 139 included people, 94 (67.6%) were born in Indiana, 41 (29.5%) were born in other US states, and four were born in Europe.
Figure 1. Number of people in Indiana, age 108+ by year
Cause of death
While the death records allowed for four entries of cause of death, only the first two entries were used to any great extent. All people had a primary cause of death (Figure 2), with about half (n=67) having a secondary cause of death entered (Figure 3). The majority (52.5%) of all people had a primary cause of death from some form of Cardiovascular disease. The most common forms of Cardiovascular disease were Arteriosclerosis (n=15), Congestive Heart Failure (n=14), and Cardiac Arrest (n=12). The second most common cause of death was Pneumonia (15.1%). Old age was the third most common primary cause of death at 11.5%. Other common causes of death were Dementia (n=12), Cerebrovascular accident/Stroke (n=8), and Sepsis (n=6). Only one person had Cancer as their primary cause of death.
Figure 2. Primary cause of death in people aged 108+ in Indiana
Figure 3. Secondary cause of death in people aged 108+ in Indiana
About half of all people (n=67) had a secondary cause of death listed. The majority (53.7%) had Cardiovascular disease as the secondary cause of death. The second most common cause of death was Dementia (11.9%).
Discussion
The overall findings indicate that cardiovascular disease is the most common cause of death in the exceptionally old in Indiana, with more than half having it as their primary and secondary cause of death. While cardiovascular disease is a broad category, studying the individual causes of death reveals that they are fairly evenly divided between the heart, the circulatory system, and the cerebrovascular system. Given that arteriosclerosis was a common primary cause of death and may result in both cardiac arrest and stroke when plaques loosen and travel throughout the body, it may be that plaque build-up needs to be mitigated in the exceptionally old, if possible. Pneumonia was a common cause of death, indicating that the person may have been too weak to combat an infection. Thus, while pneumonia shortened the hypothetical maximum lifespan of the individual (as it was not a bodily system or organ that wore out), the person was likely already in a highly weakened state rendering them susceptible to infection. The findings from this short paper are relatively consistent with previous findings that indicate the high prevalence of cardiovascular disease and pneumonia in the exceptionally old. Cancer was a rare cause of death in the present study, aligning well with previous research (Meslé & Vallin, 2020).
Limitations
Given that Indiana represents only one out of 50 US states, and is relatively low-populated with only seven million inhabitants as of 2026, the sample size is rather low, which may affect generalizability. Further, the amount of information available and the way cause of death was entered varied by physician, which may have affected the overall categorization of causes of death.
Conclusion
The exceptionally old in Indiana primarily die from cardiovascular disease, with infectious disease and old age also being common causes of death.
References
Evans, C. J., Ho, Y., Daveson, B. A., Hall, S., Higginson, I. J., Gao, W., & GUIDE_Care project (2014). Place and cause of death in centenarians: a population-based observational study in England, 2001 to 2010. PLoS medicine, 11(6), e1001653. https://doi.org/10.1371/journal.pmed.1001653
Lindberg, J., Zhang, Y., Murata, S., Kåreholt, I., & Modig, K. (2025). Swedish centenarian health – a nationwide, observational study on care utilization, drug use, morbidity, and mortality among Swedish centenarians in 1990 to 2022. BMC geriatrics, 25(1), 1011. https://doi.org/10.1186/s12877-025-06798-5
Meslé, F., Vallin, J. (2021). Causes of Death at Very Old Ages, Including for Supercentenarians. In: Maier, H., Jeune, B., Vaupel, J.W. (eds) Exceptional Lifespans. Demographic Research Monographs. Springer, Cham. https://doi.org/10.1007/978-3-030-49970-9_7
Feature photo depicts Edna Parker (1893-2008) and Bertha Fry (1893-2007), the two oldest people ever from Indiana.
