DRAFT Projected lifespan and healthspan of Joe Biden and Donald Trump before the 2020 election Authors S. Jay Olshansky, PhD, corresponding author, Professor of Public Health, University of Illinois at Chicago, Chicago, Illinois, [email protected] Hiram Beltrán-Sánchez, PhD, UCLA Yang Claire Yang, PhD, University of North Carolina at Chapel Hill Yi Li, PhD, University of Macao Nir Barzilai, MD, Ingeborg and Ira Leon Rennert Chair in Aging Research, and Director, Institute for Aging Research, Albert Einstein College of Medicine Paola Rode, MD, Former Medical Director of Hematology Oncology, Lahey North Medical Center; and Former Assistant Clinical Professor of Medicine, Tufts School of Medicine Bradley Willcox, MD, Professor and Director of Research, Department of Geriatric Medicine, John A. Burns School of Medicine University of Hawaii The Journal on Active Aging® is releasing this draft special feature early due to the timeliness of its content. This article is in progress. Changes can be expected in a final version published online at a later date. DRAFT DRAFT Projected lifespan and healthspan of Joe Biden and Donald Trump before the 2020 election by S. Jay Olshansky, PhD; Hiram Beltrán-Sánchez, PhD; Yang Claire Yang, PhD; Yi Li, PhD; Nir Barzilai, MD; Paola Rode, MD; and Bradley Willcox, MD To be eligible to become president of the leads to the question whether presidential United States one must be a natural born candidates and sitting presidents should be U.S. citizen; a resident for at least 14 years; required (or encouraged) to make their and at least 35 years of age. There is no le- detailed medical records available for pub- gally determined disqualifying upper age lic scrutiny. Such a prerequisite, if required limit to be president. In the forthcoming today, would violate current Health Insur- election an unprecedented event will oc- ance Portability and Accountability Act cur—the person elected president will be (HIPAA) privacy rules involving personal the oldest elected president in American health information.2 history. In this analysis, empirically based estimates The health and longevity of presidential of the lifespan and healthspan of Joe Biden candidates and sitting presidents is import- and Donald Trump are provided based on ant regardless of age. Questions have been personal medical history data from publicly raised as to whether voters should accept a available records. Contained in these re- presidential candidate’s declaration of cords are attributes of both candidates that health at face value.1 A candidate of any age reflect acquired and inherited risk factors that is harboring a lethal known condition for disease and survival that are more de- that is likely to lead to death while in office, tailed and personalized relative to generic or a high risk for cognitive impairment that assessments previously published for both could influence the ability to discharge the candidates,3 and which can be used to esti- powers and duties of the office, could influ- mate survival and health with validated ence an election outcome. This concern methods of analysis from epidemiology 2 Special online feature to the Journal on Active Aging September 2020 DRAFT September 2020 Special online feature to the Journal on Active Aging 3 DRAFT Projected lifespan and healthspan of Joe Biden and Donald Trump before the 2020 election and the demographic/actuarial sciences. lant stopped when clots resolved and were Current: Unavailable These records have also been reviewed in- attributed to immobilization from intracra- Medications: Rosuvastatin (Crestor), Ace- dependently by three physicians with ex- nial hemorrhage, subsequent testing re- tylsalicylic Acid (Aspirin), Finasteride pertise in aging for the purpose of assessing vealed no innate hypercoagulability disor- (Propecia), Ivermectin Cream (Soolantra), the prospective survival and health status der; 2014 CT angiogram showed no recur- Multivitamin (Centrum Silver) of both candidates for the next four years, rence of disease. He has also been surgically independent of the assessments of life- treated for benign prostatic hypertrophy See Table 1 for demographic and medi- span and healthspan using risk assessment (BPH); gallbladder was removed in 2003. cal history summaries6,7,8,9 of the two methods from the demographic/actuarial He has also had mild diverticulosis; candidates. sciences. non-cancerous tubular adenoma in 2008. These are benign aging-related conditions. Methods[b] Data[a] Current: Atrial fibrillation (AF): asymp- The methodology used to estimate lifespan Joe Biden tomatic cardiac arrythmia with normal is based on the use of acquired and inherit- Baseline biological, demographic, behav- ventricular response, no medication re- ed attributes of each candidate that are ioral risk factor, and family history of lon- quired for rate or rhythm control, on documented in the scientific literature to gevity is contained in a publicly available chronic anticoagulation for AF stroke risk; influence lifespan and survival in a U.S. medical record published on December 15, history of hyperlipidemia; gastroesophage- population.10 These covariates or risk fac- 2019, by Biden’s personal physician (see al reflux; seasonal allergies. tors include well established biological, Appendix A; summarized in Table 1). It is Medications: Eliquis; Crestor; Nexium; social and behavioral determinants of assumed that there has been no change in Dymista and Allergan health and longevity such as blood bio- Biden’s health status since this medical re- markers, physical activity, income, educa- cord summary was published; the data Donald Trump tion, marital status, smoking status, obesity, made available are accurate; and the surviv- The medical records for Trump are publicly etc., that have mortality risk ratios estimat- al estimate is based on the candidate’s age available and provided by his personal phy- ed from U.S. population based samples.11 A as of last birthday. A full medical history sician following his 2018 and 2019 annual personalized summary risk ratio based on summary—including past and current physical exams (summarized in Table 1). all of the observed attributes of each candi- medical conditions and current prescrip- Additionally, baseline biological, demo- date (see Table 1) was created and applied tion and non-prescription medications— graphic, behavioral risk factor, and family to a base complete U.S. period life table along with biomarkers drawn from blood history of longevity data are publicly avail- drawn from national vital statistics for the and urine, are contained in this source. able for Trump because the personal and resident male population of the U.S. (e.g., These data also serve as the source of infor- family history of sitting presidents is heavi- Human Mortality Database; resident pop- mation used by the physicians to evaluate ly scrutinized by the media. Other relevant ulation observed in 2017)12 matching the survival and health status of Biden in- health statistics have been revealed during Trump or Biden’s age at last birthday. The dependent of baseline demographic data. press conferences following annual health result is a personalized complete life table Provided below is a summary of Biden’s exams.4,5 It is assumed that there has been for each candidate that yields expected re- reported disease history and current no change in Trump’s health status since his maining years of life and annual survival medications. vital statistics contained in the medical probabilities to all subsequent ages based record were last made public; the data on the unique combination of health risk Disease history made available are accurate; and the surviv- factors documented to exist for each candi- Past: Cerebral aneurysm in 1988, repaired al estimate is based on the candidate’s age date and their established influence on surgically; second aneurysm discovered at as of last birthday. Provided below is a sum- survival.13,14 that time and also treated; hospital course mary of Trump’s reported disease history complicated by postoperative hospitaliza- and current medications. Healthy life expectancy (referred to here as tion for a deep vein thrombosis (DVT), ‘healthspan’) is calculated using the Sulli- with subsequent pulmonary embolism, Disease history van method15 as applied to National treated with an inferior vena caval filter and Past: Hypercholesterolemia, rosacea, Health Interview Survey data from 2017, short-term oral anticoagulant; anticoagu- appendectomy at age 11 and based on the white college-educated Footnote [a] Data and results are presented for the candidates in alphabetical order. It is assumed here that the medical records provided by the personal physicians of both candidates are complete and accurate as reported; we acknowledge the possibility that information could be missing and/or unreported. 4 Special online feature to the Journal on Active Aging September 2020 DRAFT Executive summary • Donald Trump and Joe Biden come ability of surviving a full term in office candidates is not a guarantee of an from family histories of exceptional after the election. anticipated survival or health outcome. longevity (e.g., familial longevity). As • Trump does face an elevated familial risk Risk factors for health, longevity and such, there is suggestive evidence that of late onset Alzheimer’s disease (AD) cognitive functioning are subject to both candidates are likely to be “super as this was a major contributor to his modification in either direction by agers”—a subgroup