To investigate survival factors in healthy aging among rural Japanese elderly residents, a nested case-control study was conducted. Subjects who answered questionnaires in 1985 were followed for 10 years. Cases comprised 124 men and 109 women who, in 1995, were 75 years old or over, and whose activities of daily living were active enough to cope for themselves. Controls were selected from subjects who died between 1987 and 1994. One control per case was randomly selected, and matched to each case for sex and birth-year (+/- 2 years). The survival odds ratio (sOR) was calculated by using a conditional multiple logistic regression model. An sOR greater than 1.0 was observed for frequent intake of eggs, regular daily routine, adaptability to changes, leisure time exercise and a health examination at least once within 3 years. In both men and women present or past history of heart disease, cerebrovascular disease and diabetes, family history of hypertension, and in women, smoking were negatively associated with survival. By multivariate analysis, adaptability to change in men, and regular daily routine and health examinations in women were positively associated to survival. Smoking and history of chronic disease were negatively associated with survival, in both men and women. In conclusion, it is suggested that psychological factors and recent health examinations were positively associated to survival in healthy aging, and habitual smoking and chronic disease contributed negatively to survival. These results require further careful evaluation to determine whether the factors are associated with cause or effect.