Personality and All-Cause Mortality: Individual-Participant Meta-Analysis of 3,947 Deaths in 76,150 Adults
Am J Epidemiol.
Systematic Reviews and Meta- and Pooled Analyses Personality and All-Cause Mortality: Individual-Participant Meta-Analysis of 3,947 Deaths in 76,150 Adults
Markus Jokela ) 0 1
G. David Batty 0 1
Solja T. Nyberg 0 1
Marianna Virtanen 0 1
Hermann Nabi 0 1
Archana Singh-Manoux 0 1
Mika Kivimäki 0 1
0 Abbreviations: CI , confidence interval; GSOEP, German Socio-Economic Panel; HILDA, Household, Income and Labour Dynamics in Australia; HR, hazard ratio; MIDUS, Midlife in the United States
1 Author affiliations: Institute of Behavioural Sciences, University of Helsinki , Helsinki , Finland (Markus Jokela)
Personality may influence the risk of death, but the evidence remains inconsistent. We examined associations between personality traits of the five-factor model (extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience) and the risk of death from all causes through individual-participant meta-analysis of 76,150 participants from 7 cohorts (the British Household Panel Survey, 2006-2009; the German Socio-Economic Panel Study, 2005-2010; the Household, Income and Labour Dynamics in Australia Survey, 2006-2010; the US Health and Retirement Study, 2006-2010; the Midlife in the United States Study, 1995-2004; and the Wisconsin Longitudinal Study's graduate and sibling samples, 1993-2009). During 444,770 person-years at risk, 3,947 participants (54.4% women) died (mean age at baseline = 50.9 years; mean follow-up = 5.9 years). Only low conscientiousnessreflecting low persistence, poor self-control, and lack of long-term planning-was associated with elevated mortality risk when taking into account age, sex, ethnicity/nationality, and all 5 personality traits. Individuals in the lowest tertile of conscientiousness had a 1.4 times higher risk of death (hazard ratio = 1.37, 95% confidence interval: 1.18, 1.58) compared with individuals in the top 2 tertiles. This association remained after further adjustment for health behaviors, marital status, and education. In conclusion, of the higher-order personality traits measured by the fivefactor model, only conscientiousness appears to be related to mortality risk across populations. meta-analysis; mortality; personality; psychology; survival analysis Editor's note: An invited commentary on this article appears on page 676.
Personality is associated with various health outcomes
(1–4), and some studies suggest that personality differences
may also predict mortality risk (5–8). Personality represents
enduring individual dispositions in domains of emotional
reactivity, behavioral tendencies, and cognitive styles (9, 10).
Mortality risk, in turn, quantifies the total illness burden that
accumulates from multiple health risk factors. Thus,
investigating associations between personality traits and mortality may
provide insight into the most important links between
personality and overall health (9, 11).
However, as illustrated by a recent literature review on
personality and mortality (10), few studies have examined
mortality risk by using all the major dimensions of personality
variation at the same time. With some notable exceptions (6,
12–14), these studies have been based on nonrepresentative
and relatively small samples (10, 15) (i.e., data that are
particularly vulnerable to chance findings and publication bias).
Given these limitations, currently available evidence is not yet
sufficient for evaluating the public health relevance of
personality dimensions in explaining mortality differentials.
To undertake an assessment of the association between
personality and mortality, we pooled individual-participant
data from 7 cohort studies and performed a meta-analysis to
examine whether personality traits of the five-factor model
predict all-cause mortality. The five-factor model is a widely
accepted and validated conceptualization of personality (16),
and it includes 5 higher-order personality traits—extraversion,
neuroticism, agreeableness, conscientiousness, and openness to
experience—that are assumed to capture the main dimensions
of personality variation among individuals.
MATERIALS AND METHODS
We searched the data collections of the Inter-University
Consortium for Political and Social Research (http://www.icpsr.
umich.edu/icpsrweb/ICPSR/) and the Economic and Social
Data Service (http://ukdataservice.ac.uk/) to identify eligible
large-scale prospective cohort studies on personality and
mortality. The studies had to include information on participants’
vital status and personality assessed with at least the brief
15item questionnaire based on the five-factor model. We located 7
such data sets, as follows: the British Household and Panel Survey
(n = 13,823) (17); the German Socio-Economic Panel (GSOEP)
Study (n = 20,434) (18); the Household, Income and Labour
Dynamics in Australia (HILDA) Survey (n =11,091) (19); the US
Health and Retirement Study (n =13,900) (20); the Midlife
in the United States (MIDUS) Study (n = 6,259) (21); the
Wisconsin Longitudinal Study graduate sample (n = 6,674); and
the Wisconsin Longitudinal Study sibling sample (n = 3,969)
(22). These are well-characterized, longitudinal cohort studies
with large sample sizes. All of the studies were approved by the
relevant local ethics committees. Associations between
personality and all-cause mortality have been reported previously in
the MIDUS sample (12) but not in the other data sets.
Methodological details of the cohorts are provided in the Web
Appendix, available at http://aje.oxfordjournals.org/.
In all studies, personality was assessed by using
standardized questionnaire instruments based on the five-factor model
of personality (16). The instruments measure 5 higher-order
personality traits that sum up individual variation in several,
more specific, lower-order personality dispositions.
Extraversion reflects characteristics such as social assertiveness,
sociability, and sensitivity to positive emotions; neuroticism is
associated with low emotional stability, sensitivity to
negative emotions, and anxiety proneness; agreeableness measures
cooperativeness, altruism, and trust toward other people;
conscientiousness is expressed as self-control, orderliness, and
adherence to social norms; and openness to experience
correlates with curiosity, broad-ranging interests, and
Covariates included in the analyses were ethnicity/nationality
(0 = white or non-Hispanic and 1 = other; except in the HILDA
Survey and the GSOEP Study, in which 0 = native born and
1 = non–native born); education (0 = primary level/less than
high school, 1 = secondary level/high school, and 3 = tertiary
level/higher degree); marital status (0 = married/cohabiting
and 1 = single); leisure-time physical inactivity (0 = moderate
or high physical activity and 1 = low or no physical activity);
current smoking (0 = nonsmoker and 1 = smoker); heavy
alcohol consumption ( frequent alcohol consumption or alcohol
problems, depending on the study); and obesity (body mass
index (weight (kg)/height (m)2) ≥30 calculated from
selfreported height and weight).
Associations between personality traits and mortality were
estimated by using Cox’s proportional hazards model. On the
basis of Schoenfeld residuals, we found no violation of the
proportional hazards assumption for any personality trait in
any cohort (all P > 0.08). Hazard ratios were calculated for both
continuously coded standardized personality scores (mean = 0;
standard deviation, 1) and for personality scores categorized
into quintiles. Personality traits were examined both separately
and after mutual adjustment, and all models were further adjusted
for sex, age at baseline, and ethnicity/nationality. To examine
the combined roles of smoking, physical inactivity, alcohol use,
and obesity, we created a categorical sum score of the 4
dichotomous indicators of these variables and used this in the
analysis. Analyses including other covariates were carried out with
slightly smaller sample sizes because of missing covariate data.
To explore potential sources of heterogeneity in the
associations, we undertook the proportional hazards models in
different subgroups separately in each cohort, and the results from
these subgroup analyses were then pooled. Although
exploratory, these analyses were not adjusted for multiple testing.
In sensitivity analyses, we fitted proportional hazards models
by using cubic splines to examine potential nonlinear
associations between personality traits and mortality risk in more
detail than was allowed by categorization of personality scores.
Each trait modeled with cubic splines was examined
separately, adjusting for the other 4 personality traits (coded as
linear covariates), as well as sex, age, and ethnicity/nationality.
The pooled analysis for these models was carried out with
1-step meta-analysis, that is, by first pooling the data and then
fitting the models, stratified by study. Cubic splines with 3,
4, and 5 knots were examined; the results are presented for
the 3-knot models because additional knots did not
substantially improve the model fit.
All models were first fitted separately within each cohort,
and the results from the individual cohorts were then pooled
by using random-effects meta-analysis. Standard errors in
cohorts based on household sampling were calculated by using
a robust estimator method to take into account the
nonindependence of individuals from the same households.
Heterogeneity in the effect sizes was examined on the basis of
I2 estimates. Meta-analysis was conducted by using the metan
package of Stata, version 12.1, software (StataCorp LP, College
fairly consistently, albeit not in all studies. In the pooled
analysis, a conscientiousness score 1 standard deviation below
the mean was associated with a 14% higher mortality risk
(hazard ratio (HR) = 1 / 0.88 = 1.14). When not adjusted for the
other personality traits, lower extraversion, higher neuroticism,
and lower agreeableness were also associated with elevated
mortality risk (model 1 in Web Table 3). Neuroticism and
agreeableness were no longer associated with mortality when
adjusted for conscientiousness (model 2 in Web Table 3), and
only conscientiousness remained associated with mortality when
all personality traits were included in the model (Figure 1; model
3 in Web Table 3). Adjustment for baseline health behaviors
and obesity accounted for one-fifth of the association between
low conscientiousness and mortality risk (Table 1), whereas
education and marital status attenuated the association by less
than 10%. Together, the covariates attenuated the hazard ratio
of conscientiousness by 31%.
There was moderate to large heterogeneity in the effect
sizes across studies for conscientiousness (I2 = 73%),
extraversion (I2 = 65%), neuroticism (I2 = 54%), and
agreeableness (I2 = 65%). The initial heterogeneity for openness to
experience (I2 = 70%) was reduced to 0% when the GSOEP
cohort was excluded from the analysis. To examine whether
interaction effects between different personality traits accounted
for any of the heterogeneity, we examined all the possible trait
combinations (e.g., whether the association between
extraversion and mortality risk was dependent on the other 4
personality traits). Of the 70 interaction effects tested, only 5 were
statistically significant at conventional levels (data not shown),
and none of these was sufficiently consistent across studies.
We did not pursue these exploratory analyses further because
we had no specific hypotheses regarding trait interactions.
Subgroup analyses indicated that the association between
higher conscientiousness and lower mortality risk did not differ
by sex, ethnic/national majority versus minority, age,
educational level, number of behavior-related health risks, or
selfreported general health at baseline (Web Table 4). For the other
4 personality traits, the above subgroup analyses also suggested
no systematic sources of heterogeneity in the effect sizes (Web
Table 4). Of the 40 interaction tests undertaken, only 2 were
statistically significant (P < 0.05), and both involved geographical
location; conscientiousness was not associated with mortality
in the Australian sample (HR = 1.00, 95% CI: 0.87, 1.14),
although higher extraversion was associated with lower
mortality in the Australian sample (HR = 0.86, 95% CI: 0.75,
0.98) but not in the European or US samples. However, these
results need to be interpreted in light of the fact that the
Australian estimate was based on only 1 study, and that 38 other
interactions were tested at the same time with no adjustment
for multiple testing.
Tests for nonlinearity
In the pooled analysis based on quintiles of personality scores
(Figure 2), low conscientiousness was the only personality trait
independently associated with higher mortality risk.
Compared with individuals in the highest quintile of
conscientiousness, individuals in the lowest quintile had 1.52 (95% CI: 1.15,
1.96) times higher mortality risk (note that, in Figure 2, the
lowest quintile is the reference group). Differences in
mortality risk were largest when comparing individuals who scored
below versus above the mean of conscientiousness and were
smaller among individuals scoring above the mean;
categorization of individuals into low (the lowest tertile) versus high
(2 of the highest tertiles) conscientiousness in each cohort
indicated a pooled hazard ratio of 1.37 (95% CI: 1.18, 1.58)
higher mortality risk in participants with low compared with
high conscientiousness in the total sample.
Regression analyses based on cubic splines suggested that
scores for extraversion, conscientiousness, and openness to
experience that were below the mean level, and scores for
neuroticism and agreeableness that were above the mean level, might
be more strongly related to mortality risk than the results based
on overall linear association across the total range of personality
scores (Web Figures 2–6). When assessed with linear models
that allowed the associations to vary below versus above the mean
level of personality score, the association for
conscientiousness was slightly stronger below the mean (HR = 0.85, 95%
CI: 0.78, 0.92) than above the mean (HR = 0.92, 95% CI:
0.86, 1.00) of conscientiousness (P for difference = 0.09) (Web
Table 5). Higher neuroticism (HR = 1.10, 95% CI: 0.99, 1.22)
and higher agreeableness (HR = 1.08, 95% CI: 1.00, 1.17) above
the respective mean levels for each trait were weakly
associated with higher mortality risk, whereas no associations were
observed for neuroticism and agreeableness scores below the
mean level (P for difference of below vs. above the mean = 0.07
for both personality traits; Web Table 5).
Deteriorating health in the years before death might
decrease conscientiousness, and such reverse causal effects
could bias the association between conscientiousness and
subsequent mortality risk. To evaluate reverse causation bias, we
examined whether the hazard ratio of conscientiousness was
affected when deaths occurring near the time of
personality assessment were excluded from the analysis (the MIDUS
cohort was excluded because of lack of information on date
of death). The association remained largely unchanged when
censoring from the analysis all 621 deaths occurring within 1
year (HR = 0.85, 95% CI: 0.79, 0.91), all 1,753 deaths
occurring within 3 years (HR = 0.85, 95% CI: 0.78, 0.91), or all
2,922 deaths occurring within 5 years (HR = 0.90, 95% CI:
0.85, 0.96) of the personality assessment. This finding
provides evidence against bias due to reverse causality.
With a pooled sample of more than 76,000 individuals from
the United States, the United Kingdom, Germany, and
Australia, this is the first individual-participant meta-analysis of
personality and mortality. Our findings suggest that low
conscientiousness is associated with an increased risk of death from
all causes. Individuals in the lowest tertile of conscientiousness
had a 37% higher mortality rate than individuals in the 2 higher
tertiles of conscientiousness. The other 4 personality traits—
extraversion, neuroticism, agreeableness, and openness to
experience—were not consistently associated with mortality
Table 1. Adjusted Associations Between Conscientiousness and Mortality Risk Based on Meta-Analysis of 7
Sex, age, ethnicity/nationality
Additionally adjusted for
All of the above
Base Modelb Adjusted Modelc
Abbreviations: CI, confidence interval; HR, hazard ratio.
a British Household Panel Survey (United Kingdom, 2006–2009), German Socio-Economic Panel Study (Germany,
2005–2010), Household, Income, and Labour Dynamics in Australia (Australia, 2006–2010), Health and Retirement
Study (United States, 2006–2010), Midlife in the United States (United States, 1995–2004), Wisconsin Longitudinal
Study’s graduate sample (United States, 1993–2009), Wisconsin Longitudinal Study’s sibling sample (United States,
b Values are standardized (standard deviation = 1) hazard ratios for conscientiousness derived from Cox’s
proportional hazards models, adjusted for sex, age at baseline, race/ethnicity, and the 4 other personality traits of the
fivefactor model (extraversion, neuroticism, agreeableness, and openness to experience). Because of missing data in
covariates, the number of participants varies across different analyses, and the unadjusted base model is presented
separately for each subsample with data available on the covariate of interest.
c Values are standardized (standard deviation = 1) hazard ratios for conscientiousness adjusted for the base
model covariates and additional covariates shown in the “Adjustment” column.
d The attenuation is calculated as the relative difference between unadjusted and adjusted models. That is,
attenuation = [(HRadjusted − (HRunadjusted / (1 − HRunadjusted)))] × 100.
e A categorical sum score of dichotomous indicators of current smoking, physical inactivity, heavy alcohol use,
risk across studies when all of the personality traits were
mutually adjusted, although some statistically significant associations
were observed in individual studies.
The five-factor model and other detailed frameworks of
personality composition started to receive wider attention only in
the 1990s (16), which is why many long-running cohort studies
have assessed personality with more limited instruments—often
restricted to the traits of extraversion and neuroticism (23). Given
the need for sufficient mortality follow-up, the health
consequences of conscientiousness have received detailed attention
only quite recently (24). The present finding on low
conscientiousness and elevated mortality risk is in agreement with a
previous literature-based meta-analysis of nearly 9,000 individuals
from 20 studies, in which conscientiousness-related traits were
assessed with different measures (15). The present study includes
unpublished studies and is based on a larger sample, adding to
the previous meta-analysis and suggesting that the association
between conscientiousness and mortality risk may be weaker
than previously estimated. The previous meta-analysis (15)
reported a pooled odds ratio estimate of 0.64 (transformed
from a correlation-based effect size of r = −0.11, 95% CI:
−0.17, −0.05), and another literature review reported a similar
pooled estimate of r = −0.09 (equal to an approximate OR of
0.72) between conscientiousness and mortality risk (10). Thus,
the effect magnitude of a hazard ratio of 0.88 (95% CI: 0.82,
0.94) per 1–standard deviation increment in conscientiousness
estimated in our analysis is only about one-half to one-third
of the previously estimated effect magnitudes. This
difference is similar to previously observed discrepancies between
effect sizes in published versus unpublished data in other
domains of psychosocial risks (25).
To test whether biological and behavioral mechanisms
underlie the associations between low conscientiousness and
mortality risk, we adjusted the analyses for current smoking,
physical inactivity, heavy alcohol use, and obesity. The 21%
reduction in mortality risk after this adjustment suggests that
the association of conscientiousness with mortality is mediated
in part via well-established biological and behavioral factors
(26–28). It has been hypothesized that highly conscientious
individuals are more likely to follow social norms and public
health recommendations concerning health behaviors (29).
Given that conscientious individuals also have higher levels
of self-discipline, it is reasonable to assume that they are also
more likely to adhere to health and treatment recommendations
provided by health professionals (30). The adjusted covariates
in the present study did not fully explain the association, so
several other mechanisms may also underlie the association between
conscientiousness and mortality risk, including mental and
cognitive functioning (31), immune and endocrine system
functioning (32, 33), and genetic liability (34).
The current study places conscientiousness as a risk factor
almost on par with some common health behaviors and
sociodemographic risks for premature death. Heavy smoking more
than doubles mortality risk, whereas light smoking increases
mortality risk by 50% (35, 36). Physical inactivity versus
recommended moderate physical activity has been associated with
an increase in all-cause mortality risk with a relative risk of
1.23 (95% CI: 1.18, 1.32) (37). Having 1 versus none of a
combined list of 5 behavior-related health risk factors (smoking,
physical inactivity, alcohol consumption, obesity, and unhealthy
diet) has been associated with a relative risk of mortality of
1.35 (95% CI: 1.23, 1.49) (38). Compared with individuals
who have a high school education or more, individuals who
have a lower educational level have an average 1.46 (95% CI:
1.33, 1.59) times higher mortality risk (39). Major
depressive disorder, which is related to personality traits of high
neuroticism (r = 0.47), low conscientiousness (r = −0.36), and
low extraversion (r = −0.25) (3) is associated with elevated
mortality risk (relative risk =1.81, 95% CI: 1.58, 2.07) (40).
These relative risks associated with unhealthy behaviors,
education, and depression provide comparative estimates for the
1.37-fold (95% CI: 1.18, 1.58) elevated risk of death observed
in the present analysis among individuals who have low
conscientiousness (the lowest tertile) compared with high
conscientiousness (the 2 highest tertiles).
Assuming that the association between conscientiousness
and mortality was causal, the population mortality rate would
decrease by 11% in the hypothetical absence of low
conscientiousness in the population ( population attributable risk
fraction =[P × (HR – 1)] / [1 + P × (HR – 1)], with P = 1/3 and
HR =1.37). Interventions in children and adolescents have
been effective in increasing self-control, a subcomponent of the
broader conscientiousness trait, by an average of 0.30 standard
deviations (41, 42). Assuming, again hypothetically, that the
long-term effects of such early interventions were 0.20 standard
deviations, and that these interventions were successfully
targeted at the lowest one-third of the conscientiousness
distribution, one could expect the proportion of individuals with low
conscientiousness to drop to approximately one-fourth
(assuming normal distribution) and the mortality rate thereby to
decrease by 2.7% ( proportion shift = [(PA – PB) × (HR – 1)] /
[PA × (HR – 1) + 1], with PA = 1/3, PB = 1/4, and HR = 1.37).
These crude calculations suggest that the decline in the
population mortality rate from reductions in low conscientiousness
would be equal in magnitude to decreasing smoking
prevalence by 3 percentage points (from 20% to 17%) or to
increasing moderate physical activity by 13 percentage points (from
50% to 63%) in current populations. However, evidence on
the feasibility of long-term interventions to change
personality is limited.
Many early theories of personality and health have
emphasized the role of negative emotionality (i.e., high neuroticism)
and interpersonal hostility (i.e., low agreeableness) in
precipitating poor health (1). A literature-based meta-analysis of
personality and all-cause mortality (10) suggested an increased
relative risk of mortality of 1.15 (95% CI: 1.04, 1.26) associated
with 1 standard deviation of difference in negative
emotionality (or high neuroticism) and an increased relative risk of
mortality of 1.14 (95% CI: 1.06, 1.23) associated with 1 standard
deviation of difference in disagreeableness/hostility (or low
agreeableness). Surprisingly, we observed no differences in
mortality risk associated with the overall variation in neuroticism or
agreeableness, so our findings provide little support for these
hypotheses of personality and health with respect to mortality.
However, there was some evidence to suggest that very high
neuroticism may be associated with an elevated risk of death; this
might reflect the heightened mortality risk associated with
clinical depression and other mental health problems (3, 40,
43). Very high agreeableness also had a weak association with
higher mortality, which is in contrast to most previous
findings suggesting that a higher level of interpersonal hostility
(i.e., low agreeableness) might be harmful for health (1, 10).
Given this unexpected direction of the association and the
number of tests conducted, the nonlinear pattern for
agreeableness identified by our analysis may represent a chance finding.
The present findings for openness to experience are in contrast
to a recent meta-analysis of 11 published studies (representing
19,941 subjects) (44), which suggested that higher openness
to experience is associated with lower mortality risk with an
odds ratio of 0.88 (transformed from a correlation-based effect
size of r = 0.051). Among the present cohorts, higher openness
to experience was associated with lower mortality risk in only
1 study (HR = 0.85, 95% CI: 0.79, 0.91), and the pooled
estimate suggested no association (HR = 0.99, 95% CI: 0.93,
1.06). In the future, a more detailed analysis comparing the
specific personality measures, their associations with other
predictors of mortality (e.g., socioeconomic status), contextual
factors, and potential publication bias would be helpful to
increase understanding of these discrepancies in findings
Our study does not exclude the possibility that the “Big
Five” personality traits may be associated with more specific
physical and mental diseases even if they are not associated
with mortality risk (1). Our study is also limited by the fact that
personality was assessed by using only the 5 higher-order
personality traits but not their more specific lower-order
subscales (16). It is possible that some of the higher-order traits
are too broad to identify mortality differences associated
with more specific lower-order personality trait subscales.
Literature-based meta-analyses may be subject to publication
bias resulting from selective reporting of positive findings. The
current data were pooled from all eligible large-scale
longitudinal studies that we were able to locate from 2 publicly
available databases before performing any statistical analyses on
the individual cohorts. Thus, our sampling of the studies
minimized publication bias. There was evidence of
heterogeneity in effect sizes across studies, suggesting that some of the
variation in effect sizes may reflect true differences between
studies rather than random sampling error. Stratified
analyses for conscientiousness suggested no effect modification
by sociodemographic characteristics, including sex, age, and
education. It is possible that part of the effect of
heterogeneity was related to the assessment of personality by using
different personality inventories. However, this is an unlikely
source of major heterogeneity because different inventories
assessing the five-factor model personality traits have been
shown to be highly convergent (16, 45–48).
Although many personality dispositions have been
associated with health outcomes (1, 9), the present results suggest
that low conscientiousness is the only higher-order
personality trait of the five-factor model that predicts higher mortality
risk across populations. The magnitude of this association
appears to be weaker than previously estimated (15), which
may reflect heterogeneity in cohort characteristics, differences
in the personality instruments used to assess
conscientiousness, and/or potential publication bias. Although personality
has been considered as a potential target for early-life
interventions (41, 42), more detailed information on the
feasibility, costs, and benefits of such interventions compared with
other interventions directed at specific health behaviors is
needed to further evaluate the significance of personality
variation as an opportunity to improve population health.
Department of Psychology, University of Cambridge,
Cambridge, United Kingdom (Markus Jokela); Department of
Epidemiology and Public Health, University College London,
London, United Kingdom (G. David Batty, Archana
SinghManoux, Mika Kivimäki); Centre for Cognitive Ageing and
Cognitive Epidemiology, Department of Psychology,
University of Edinburgh, Edinburgh, Scotland (G. David Batty);
Finnish Institute of Occupational Health, Helsinki, Finland
(Solja T. Nyberg, Marianna Virtanen); and Centre for Research
in Epidemiology and Population Health, Institut National de
la Santé et de la Recherche Médicale, Villejuif, France (Hermann
Nabi, Archana Singh-Manoux).
This research was supported by the Academy of Finland
(grants 124322, 124271, and 132944); the Bupa
Foundation, United Kingdom; the Medical Research Council (grant
K013351); the National Institutes of Health (grants
R01HL036310 and R01AG034454); the New Occupational
Safety and Health ERA Research Program; and the Finnish
Work Environment Fund. The Centre for Cognitive Ageing
and Cognitive Epidemiology is supported by the
Biotechnology and Biological Sciences Research Council, the
Engineering and Physical Sciences Research Council, the Economic
and Social Research Council, the Medical Research Council,
and the University of Edinburgh as part of the cross-council
Lifelong Health and Wellbeing Initiative. G.D.B. is a
Wellcome Trust Fellow. M.V. is an Academy of Finland Research
Fellow (grant 258598). M.K. is an Economic and Social
Research Council Professor.
The study sponsors did not contribute to the study design
and had no role in data collection, data analysis, data
interpretation, or the writing of the report.
Conflict of interest: none declared.
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