Italy's oldest populations are expanding unevenly, and new regional data reveal how disease burden, diet, obesity, and southern longevity hotspots may shape the future of healthy aging. This study, published in the journal Nutrients, explores temporal trends and regional patterns in extreme longevity and population aging in Italy, shedding light on the complex interplay between demographics, health, and nutrition. The findings offer valuable insights for tailoring healthy-aging strategies to specific regions while emphasizing the need for further research to establish individual-level causal relationships.
The research team analyzed demographic, metabolic, and nutritional data from 1982 to 2025, focusing on age-standardized mortality rates (ASMRs) for five noncommunicable diseases (NCDs) and various longevity indicators. They found a steady increase in the proportion of people aged 65 and older, with the central and northern regions experiencing more advanced aging profiles. The Liguria region stood out for its highest aging tendency in 2025, followed by Emilia-Romagna and Tuscany. Conversely, Calabria and Campania exhibited lower aging tendencies.
The study also highlighted significant regional variations in longevity indicators. Liguria, Marche, and Molise showed substantial gains in the 85+ population, while Liguria, Tuscany, Emilia-Romagna, and Trentino-Alto Adige had the highest proportions of people aged 90 and older. Molise, Calabria, and Friuli Venezia Giulia led in the centenarity index (CI%), and Liguria recorded the highest longevity index (LI%). These findings underscore the complex interplay between regional demographics, health, and nutrition.
One intriguing aspect of the study was the pronounced survival advantage in females across time points and regions. The female-to-male ratio (F/M) was highest in Valle d'Aosta, Lombardy, and Friuli-Venezia Giulia and lowest in Basilicata and Calabria in 2025. This gender disparity in longevity warrants further investigation to understand its underlying causes.
The research also revealed substantial regional heterogeneity in total mortality rates among people aged 65 and older. Lombardy and Basilicata had the lowest and highest rates, respectively, at 4,026 and 67,672 per 100,000 in 2025. The study noted that smaller, older populations may exhibit more variable crude mortality rates due to denominator effects.
In terms of NCD mortality, there was an overall reduction in ASMRs between 1990 and 2023, with regional variations. Ischemic heart disease and neoplasms had higher rates in the central and northern regions at earlier time points, while cerebrovascular disease and diabetes mellitus maintained higher rates in the Islands and southern regions. Lower long-term mortality from diabetes mellitus and cerebrovascular diseases showed strong regional correlations with higher LI% and CI%.
The study also identified a North-South gradient for most behavioral and nutritional indicators. The central and northern regions had higher proportions of vegetable consumers and those reporting adequate breakfast consumption. Fish intake was higher in the southern and central regions, while the southern regions had a higher prevalence of overweight and obesity. Interestingly, LI% was positively correlated with vegetable intake and negatively correlated with obesity and overweight.
The findings of this study have significant implications for healthy aging strategies. They illustrate a profound demographic transition toward extreme longevity in Italy, characterized by regional heterogeneity and varying burdens of vascular and metabolic disease. Central and northern regions generally showed advanced aging profiles and many of the highest LI% values. Meanwhile, specific southern areas, including the Cilento, showed promising survival into extreme old age, with indicators comparable to Sardinia and above the Campania regional average.
However, the study emphasizes the need for caution in interpreting these findings as individual-level causal evidence. The behavioral and nutritional indicators do not represent life-course exposures of centenarian cohorts. Therefore, while these findings may inform regionally tailored healthy-aging strategies, they should be considered hypothesis-generating rather than definitive proof of individual-level causal effects.
In conclusion, this study provides valuable insights into the complex relationship between demographics, health, and nutrition in Italy's aging population. It highlights the importance of considering regional variations in healthy aging strategies and underscores the need for further research to establish individual-level causal relationships. As Italy continues to experience demographic changes, understanding these regional patterns will be crucial in promoting healthy aging and improving public health outcomes.
