Longevity of U.S. Presidents

Ed Uthman, MD

Diplomate, American Board of Pathology

Last updated 2 Sep 2000

Everyone knows that the average life span of humans has increased markedly in the 20th century, but has it increased for everyone? An informal study of U.S. presidents may yield some surprising answers.

My aim is to look at the effect of medical advances over the last two centuries on the longevity of those who are most likely to have access to those advances. I think presidents make an interesting (if small) sample because of their demographic uniformity: all are white male politicians, almost all are military veterans, and presumably all had sufficient wealth and/or prestige to command whatever medical resources were available in their later years.

Of the 41 men who have held the office, 5 are still alive (Ford, Carter, Reagan, Bush, Clinton), 4 were victims of homicide, all from gunfire (Lincoln, Garfield, McKinley, Kennedy)*, and 32 died of natural causes (4 while in office: Harrison, Taylor, Harding, FD Roosevelt). These 32 are listed below by date of death. The "ordinal" figure is the order in which each served as president, Cleveland having served two non-consecutive terms.

NAME	ORD- INAL	YEAR DIED	AGE	CAUSE OF DEATH***
Washington, George	1	1799	67	peritonsillar abscess
Adams, John**	2	1826	90	heart failure, pneumonia
Jefferson, Thomas**	3	1826	83	old age, multiple diseases
Monroe, James	5	1831	73	heart failure, tuberculosis
Madison, James	4	1836	85	old age, multiple diseases

Harrison, William Henry	9	1841	68	pneumonia
Jackson, Andrew	7	1845	78	old age, multiple diseases
Adams, John Quincy	6	1848	80	stroke
Polk, James K.	11	1849	53	cholera
Taylor, Zachary	12	1850	65	food poisoning
Van Buren, Martin	8	1862	79	heart failure, pneumonia
Tyler, John	10	1862	71	"biliousness", bronchitis
Buchanan, James	15	1868	77	pneumonia, pericarditis
Pierce, Franklin	14	1869	64	cirrhosis
Fillmore, Millard	13	1874	74	stroke
Johnson, Andrew	17	1875	66	stroke

Grant, Ulysses	18	1885	63	throat cancer
Arthur, Chester A.	21	1886	56	chronic renal failure, stroke
Harrison, Benjamin	23	1901	67	pneumonia
Cleveland, Grover	22,24	1902	71	multiple diseases
Hayes, Rutherford B.	19	1903	70	heart attack
Roosevelt, Theodore	26	1919	61	heart attack
Harding, Warren G.	29	1923	57	heart attack
Wilson, Woodrow	28	1924	67	multiple diseases
Taft, William Howard	27	1930	60	cardiovascular disease
Coolidge, Calvin	30	1933	60	heart attack
Roosevelt, Franklin D.	32	1945	63	stroke

Hoover, Herbert	31	1964	90	internal bleeding
Eisenhower, Dwight	34	1969	78	congestive heart failure
Truman, Harry S	33	1972	88	old age, multisystem failure
Johnson, Lyndon B.	36	1973	64	heart attack
Nixon, Richard	37	1994	81	stroke

OBSERVATIONS

The first 5 presidents to die did so before 1840, which was pre-anesthesia, pre-germ theory, and pre-just about everything else rational. The median age of death of these 5 was 83.
The last 5 presidents to die did so after 1960, when modern surgical techniques were well established, cardiovascular surgery was rapidly developing, there was a large antibiotic armamentarium, and many cardioactive and and vasoactive drugs were available. The median age of death of these 5 was 81.
Each group consisted of one nonagenarian, two octogenarians, one septuagenarian, and one sexagenarian.
The first half (16 individuals) of the death-by-natural-causes group died between 1799 and 1875. The median age at death was 73.5 years.
The second half of this group died between 1885 and 1994. The median age of death was 65.5 years (!)
Each half contains one individual who clearly died as a result of substance abuse: Pierce from alcoholic liver disease, and Grant from pharyngeal cancer due to his enormous cigar consumption.
Presidents are remarkably immune to cancer death. The only such one I can find is Grant (throat cancer), although Cleveland, Hoover, and Reagan were apparently cured of serious cancers by surgery (Cleveland had verrucous carcinoma of the upper jaw; Hoover and Reagan had intestinal cancers).

OPINION

The figures don't speak very loudly to modern medicine as a prolonger of life, at least for famous old white men, but I think we have to give medicine its due in certain individual cases. Washington died at 67 of quinsy, and I think just about everybody would agree that such deaths are very uncommon in modern times. Three other presidents clearly died before their time: Harrison of pneumonia, Taylor of a "typhoid-like fever," and Polk of cholera. Again, I think most people would agree that these untimely deaths would probably not have occurred in modern times (odd cases like Jim Henson's group B strep sepsis notwithstanding). Possibly ENT surgery could have saved Grant, as it apparently did Cleveland, and colorectal surgey saved Hoover and Reagan. The medicine of the fifties possibly kept Eisenhower's Crohn's disease sufficiently at bay, whereas a similarly afflicted counterpart of the nineteenth century may not have remained hale enough to rise to such high position, likewise for Kennedy and his Addison's disease.

*In addition, at least 3 presidents were survivors of gunshot wounds: Jackson, T Roosevelt, and Reagan (Jackson was shot in a duel prior to becoming president. The other two were victims of assassination attempts while in office [Reagan] or running for same [TR]).

**In one of the interesting coincidences of American history, Thomas Jefferson and John Adams died within a few hours of each other on the 50th anniversary of the signing of the Declaration of Independence, July 4, 1826. James Monroe died five years later, to the day.

***Causes of death of the early presidents are speculative and highly controversial. There was no microbiology to speak of until the last third of the 19th century, so such diagnostic categories as "tuberculosis" and "cholera" are rather suspect. The diagnosis of "biliousness" recurs in pre-modern medicine, and it is difficult to determine what modern diagnoses correlate with this. One could speculate that fatal biliousness could refer to any abdominal catastrophe that causes nausea, vomiting, and distention.