Objective. In this retrospective study of an elderly population cohort living in a defined Swedish rural area, the relationship between occupation and survival as a measure of objective health was investigated. The cohort has been followed for 25 years.

Method. On the basis of the baseline socioeconomic interview from assessments performed when the participants were 67 years of age, an index of active participation in daily occupation was devised. The index was used to investigate the covariation between generic everyday occupation and long-time survival.

Results. For the female participants, Kaplan-Meier curves demonstrated differences in survival between the “less active” and “more active, ” and Cox regression survival analyses resulted in a significant covariance between occupation and survival. For the male participants, no such differences were found.

Conclusion. The significant results for the women implied support for the core assumption of occupational therapy that a relationship exists between occupation and health. The lack of differences in survival among more active and less active men demonstrates the complexity of studying occupation.