Issue: February 2019
January 04, 2019
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Mortality rates lower in Holocaust survivors regardless of comorbidities

Issue: February 2019
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Patients who were Holocaust survivors had higher rates of comorbidities and lower rates of mortality compared with an aged-matched control group, according to a study published in JAMA Network Open.

“The present study may be important in understanding the favorable figures of life expectancy in Israel because the genetic characteristics of Holocaust survivors may be associated with the long-term health of their children,” Naama Fund, MSc, of Maccabi Kahn Institute for Research and Innovation at Maccabi Healthcare Services in Tel Aviv, Israel, and colleagues wrote. “Moreover, the study underscores the paucity of existing information about psychosocial determinants of longevity, such as health literacy and community support.”

Researchers analyzed data from 38,597 patients (mean age, 82 years; 59% women) who were Holocaust survivors and 34,931 patients from the control group (mean age, 78 years; 53% women) from Maccabi Healthcare Services databases. Patients from both groups were found in the databases by birth year (1911 to 1945) and birthplace (Europe vs. Israel, respectively).

The prevalence of chronic illness was assessed through the database and included five types of heart disease, chronic obstructive pulmonary disease, chronic kidney disease, hypertension, diabetes, osteoporosis, cancer, dementia and obesity.

Compared with the control group, patients who were Holocaust survivors had higher rates of obesity (33.3% vs. 26.5%), hypertension (83% vs. 66.7%), cancer (29.5% vs. 27.8%), chronic kidney disease (30.9% vs. 19.8%), ischemic heart disease/non-MI (14.8% vs. 11.8%), dementia (16.6% vs. 9.6%) and MI (9.4% vs. 7.8%). Women who were Holocaust survivors also had higher rates of osteoporotic fractures compared with the control group (28.4% vs. 22.1%).

The overall mortality rate in patients who were Holocaust survivors was lower compared with patients in the control group (25.3% vs. 41.1%; P < .001). The mean age at death was higher in the survivor group vs. the control group after adjusting for confounders (84.8 years vs. 77.7 years; P < .001).

“There may be other factors among Holocaust survivors that have not been appropriately quantified but that may be associated with improved ability to survive,” Fund and colleagues wrote. “It can be argued that the subgroup that survived the extreme conditions that many individuals did not survive had coping abilities that rendered them more resilient to comorbidities. For example, chronic stress has been shown to be associated with increased mortality risk among patients with atherosclerosis. It is conceivable that the stress response among Holocaust survivors is different so that these survivors are less sensitive to the consequences of some comorbidities.” – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.