Beyond the Blue Zones: Healthy Aging and Extreme Longevity in Italy (1982-2025)-An Ecological Analysis of Demographic, Metabolic, and Nutritional Correlates.

Background/Objectives: Italy is among the countries with the highest life expectancy and extreme longevity worldwide, yet marked regional disparities persist. This nationwide ecological study examined temporal trends in population aging and extreme longevity across the 20 Italian regions (1982-2025) and explored regional correlates non-communicable disease (NCD) mortality and contemporary behavioral/nutritional indicators, with attention to emerging southern hotspots such as Cilento. Methods: Longevity indicators (Aging Tendency, Longevity Index [LI%], Centenarity Index [CI%], 85+ and 90+ ratios) were derived from ISTAT demographic data. Age-standardized mortality rates for five major NCDs (1990-2023) were obtained from WHO HFA-DB. Behavioral and nutritional indicators for adults aged ≥65 years (2024) were extracted from HFA-Italy. Regional associations were assessed using Spearman correlations within an ecological, hypothesis-generating framework. Results: All longevity indicators increased steadily from 1982 to 2025, with northern and central regions showing the highest values. Lower long-term mortality from diabetes mellitus and cerebrovascular diseases showed the strongest regional correlations with higher LI% and CI%. Nutritional profiles were generally more favorable in northern regions. The Cilento area emerged as a notable southern hotspot, displaying longevity indicators comparable to Sardinia and above the regional average. Conclusions: Regional patterns of extreme longevity in Italy reflect the interplay of demographic dynamics, NCD mortality burden, and contemporary lifestyle profiles. While northern regions maintain a clear advantage, specific southern areas such as Cilento demonstrate that favorable longevity outcomes can emerge in diverse macro-regional contexts. These findings highlight the value of regionally tailored strategies to promote healthy aging and reduce geographical disparities.