Healthy Lifestyle, multimorbidity network, and all-cause mortality among older Chinese: a longitudinal analysis in Chinese longitudinal healthy longevity survey

TL;DR

A healthy lifestyle is linked to lower mortality and more complex disease patterns in older Chinese people, suggesting lifestyle choices impact aging and chronic disease management.

Contribution

This study identifies how lifestyle factors influence multimorbidity networks and mortality in older Chinese populations.

Findings

A favorable lifestyle was associated with a 63% lower mortality risk compared to an unfavorable lifestyle.

Social engagement had the strongest impact on reducing mortality risk.

Favorable lifestyles correlated with denser disease networks, while unfavorable lifestyles showed linear disease progression.

Abstract

With population ageing, multimorbidity has become a major public health concern. Although healthy lifestyles are associated with reduced risks of single chronic diseases and mortality, their relationship with multimorbidity patterns among older Chinese remains insufficiently explored.

Data from 16,820 participants aged 60 and older, from the 2008–2018 waves of the China Longitudinal Healthy Longevity Survey (CLHLS), were analyzed. Participants were categorized into three lifestyle groups (favorable, average, and unfavorable) based on five modifiable lifestyle factors: social engagement, physical activity, smoking, drinking, and diet. Disease progression was assessed using multimorbidity networks, and all-cause mortality was analyzed with Cox proportional hazards models.

Compared to an unfavorable lifestyle, a favorable lifestyle was associated with a lower risk of all-cause mortality (HR = 1.63, 95% CI: 1.50–1.77). Among the five lifestyle factors, social engagement showed the strongest association with mortality (HR for inactive vs. active engagement = 1.36, 95% CI: 1.29–1.43). Multimorbidity networks revealed that individuals with favorable lifestyles exhibited denser, more interconnected disease networks, while those with unfavorable lifestyles showed more streamlined, linear disease progressions, primarily driven by hypertension, cardiovascular disease, and dementia.

A favorable lifestyle was linked to lower mortality and more complex multimorbidity networks, likely due to longer survival and the accumulation of chronic conditions. These findings underscore the need for interventions to reduce premature mortality and manage multimorbidity in aging populations.

The online version contains supplementary material available at 10.1186/s12889-026-26294-8.

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