Is Tony Soprano still alive? Last week Vox reported that HBO’s antihero had survived the ambiguous 2007 finale of his eponymous drama. It attributed this claim to “Sopranos” creator David Chase. But Chase disputed the article, saying his remarks were misconstrued. Whether the New Jersey crime boss survived eating onion rings with his family is “a spiritual question,” Chase said, and any attempt to answer it would be “fruitless.”
Spiritual it may be, but there’s a related medical question: If Tony outlived the controversial black screen, how likely would it be that he’s still alive today? Or to put it another way: What’s the life expectancy of an orphaned, overweight, sedentary mobster with a cigar habit, a drinking problem, multiple sex partners, marital difficulties, sky-high job stress and armed enemies who want him dead?
Tony’s portrayer, James Gandolfini, died last year at age 51. But he had little in common with Tony besides physical appearance. And anyway, the question we’re seeking to answer is a statistical one. It can’t be answered by studying one person’s life, but we can study hundreds of thousands of other people’s lifespans, and the behaviors and traits that might have influenced their length. If there were 100,000 Tony Sopranos, how many would be living today?
We created a medical file for the Tony we knew in the series finale: a 6-foot-1, 275-pound, 48-year-old white man. A high-school graduate who lives in New Jersey, made $5 million last year and expects to be married for most of his life. He’s in the least-fit quintile. He hasn’t been diagnosed with diabetes, but has a diastolic blood pressure of 95 mmHG. He smokes cigars and consumes four or more alcoholic drinks daily. He travels 5,000 miles annually by a man-driven (sometimes drunk-driven) car that regularly exceeds the speed limit — but he does wear a seat belt. His father had a non-manual job and he does, too, which keeps him sedentary (though his first job was manual). He now works in the finance/real estate industry and has a lot of stress. He gets more than 10 percent of his calories from fat. He is among the 15 percent of the population that is most depressed. He has had 10 sexual partners in the past 12 months, usually doesn’t use a condom and sleeps six hours a night.
You’ll notice a crucial detail missing from the medical file: the specific nature of Tony’s work. Rival bosses and dissatisfied underlings could try to off him at any time. Unless someone has done a rigorous study of crime bosses like Tony — and I couldn’t find one — we won’t be able to account for this directly.
Several online life-expectancy calculators, based on studies of hundreds of thousands of people, take inputs of people’s vital stats and output their expected lifespans. These calculators aren’t perfect — for instance, they often don’t incorporate the latest research — but they provide a solid, quick prediction.
Walter and I entered Tony’s grim health profile into a life-expectancy calculator developed by University of Pennsylvania researchers. We learned that Tony had a 75 percent chance of living at least 56.2 years, which would take him into 2015. His median expected lifetime was 65 years, and his life expectancy — the mean lifespan of 100,000 Tony Sopranos — was 66.1 years. (Enter your own medical file for Tony — or for anyone else, for that matter — and let us know in the comments what you get.)
Dean Foster, a co-creator of the calculator, said in an email that the human body is pretty hardy, even with a lifestyle as risky as Tony’s. “A friend of mine tried to kill off a fictional person on my web calculator,” said Foster, who recently joined Yahoo Labs. “He put in everything that he could to try to kill him off. But still, the person lived for several years.”
I also sent Tony’s medical file to Thomas T. Perls, the founding director of the New England Centenarian Study and creator of the Living to 100 Life Expectancy Calculator. Perls, a professor of medicine and geriatrics at the Boston Medical Center and Boston University School of Medicine, emailed a detailed reply. The gist of it was that if Tony isn’t assassinated, he should live until 2027. The thinking behind that gist — starting with the healthiest American male lifestyle and peeling off years for Tony’s vices — is worth a read. Here are edited excerpts from Perls’s prognosis for Tony Soprano:
We should begin with the assumption that men generally have the genetic makeup, in the presence of optimal health-related behaviors, to live to about 86 years. This assumption is based upon findings from a Seventh-day Adventist health study, in which followers of this religion are asked to be vegetarian, not smoke, not drink alcohol, exercise every day and spend significant time with family and their religion (likely decreases stress). On average, Seventh-day Adventist men live to 86 years (women live to age 89).
Taking a more traditional actuarial approach, we would look up the Social Security Administration’s predicted average life expectancy for an average American male born in 1959 and still alive in 2007 (and therefore age 48) and from the table, he would have about another 33 years, or a life expectancy of 81 years. A different table from the National Center for Health Statistics states that a 50-year-old white male alive in 2006 will live on average another 29 years or 79 years. So about 81 seems about right. If we used only these data, then Tony would live until somewhere between 2038 to 2040.
However, I like beginning with the Seventh-day Adventist average because the Social Security estimate is an average that includes both men who take excellent care of themselves and have longevity in their families and men who do everything wrong.
I’d like to get more specific. As with the Living to 100 calculator, we can start with a person with optimal health behaviors and add or subtract years based upon their health-related behaviors.
What Tony has (had?) going for him is that he didn’t smoke cigarettes. Smoking cigarettes is absolutely the worst thing an average person can do and it clearly greatly increases your risk for numerous different lethal cancers, but especially lung cancer. The vast majority of lung cancers are in people who smoke cigarettes. Tony’s father died of emphysema, which was most certainly due to smoking. So Tony no doubt had some significant exposure to second-hand smoke, which is also a risk factor for cancer and asthma, but we have no idea how much exposure he had. Various studies show that smoking cigarettes reduces average life expectancy by 10 years. If I see someone in the hospital dying in their 60s or 70s, I find that 9 times out of 10 I am correct in assuming they were or are an avid smoker.
Unfortunately for Tony, though, he did smoke cigars. According to the American Cancer Society, regular cigar smokers are at 4-to-10 times greater risk of lung, oral, esophageal and larynx cancers compared to non-cigar smokers. Cigar-smoke inhalers are also at increased risk of pancreatic and bladder cancers. A 2007 study shows that, on average, cigar smokers live five years less than non-cigar smokers do. So we need to subtract five years in considering Tony’s case.
The Seventh-day Adventists are vegetarians and Tony is certainly not. Furthermore, he frequently goes out for his meals that likely consist of red meat and lots of calories. Red meat is by far and away the major source of iron in our diets. Except for oysters and clams (other foods Tony probably liked), there are few other iron-rich foods in our diet. Iron plays a key role in several chemical reactions that take place in our cells that produce highly reactive oxygen-free radicles. These molecules play important roles in plaque formation in our blood vessels and therefore increase our risk for heart disease and stroke as well as likely cancer and Alzheimer’s disease. I would say that Tony’s diet and the resultant moderate obesity are as bad for him as his cigar smoking, so off comes another five years.
Tony apparently drinks quite a bit of alcohol, but it is unclear to me how much and how often. Like smoking, in terms of increasing one’s risk for diseases, what counts is the amount per day and how long the habit has gone on for. Regarding alcohol, the type of alcohol also matters (i.e. beer, wine or hard liquor). I am guessing that Tony has more than one shot’s worth of hard liquor per day, and this puts him at increased risk of liver disease and damage to his brain. Assuming he is not drinking enough to cause cirrhosis and eventually liver failure, I will be kind and take just a year off for his drinking.
Tony had a number of affairs, of which one I believe was with an escort. My guess is, especially when he had too much to drink and was not using his best judgment, he had numerous episodes of unprotected sex. Here Tony has placed himself at markedly increased risk of some very bad diseases, including Hepatitis C and HIV. With current drug therapies, people are living much longer with these diseases. Hepatitis C even has the potential of being cured with a currently available very expensive medication, but people definitely die from these diseases, especially when in combination with Tony’s other medical risk factors. Tony’s philandering will cost him at least five years (and I am once again being kind).
Tony is also very high-strung and stressed out. After all, he is managing the largest crime syndicate in New Jersey. Though he seems to love animals, likes to fish and attends sporting events, it seems to me he does not manage his stress well, often has temper tantrums and stress seems to physically affect him. I am sure his panic attacks don’t help. The key here is not so much how much stress a person experiences but rather how they manage or deal with their stress. Stress can be a risk factor for high blood pressure, stroke and heart disease. In fact, Tony’s mother had a stroke, which may be an indication of his own increased risk for a stroke. People usually know what helps them shed stress rather than hold on to it. This can entail strategies like exercise, meditation, tai chi, yoga and stretching. Tony doesn’t seem to benefit from stress reduction, and so he gets docked off another two years.
Of note, Tony doesn’t seem to be participating in any healthy behaviors that could counter the effects of his bad health habits. These healthy behaviors would be daily exercise (that does not include chasing someone down the street), regular adequate sleep, a diet conducive to a healthy weight, and, again, no smoking or drinking. Tony’s mother had a stroke and his father died of emphysema so there is no evidence of longevity in his family (though I have no idea about his grandparents and how old his dad would have lived to be had he not smoked). But at least we can’t give Tony any extra years for longevity in his family.
So, adding up the above deficits, we subtract 18 years from 86 years and get a life expectancy of 68 years, which would allow Tony to live to 2027. I think short of getting knocked off by an adversary, he would indeed still be alive today!