Dynamic cross-lagged effects between healthy lifestyles and multimorbidity among middle-aged and older adults in China
Abstract Background While healthy lifestyles mitigate the risk of multimorbidity (≥ 2 chronic diseases), their temporal dynamics in aging populations, particularly in low- and middle-income countries undergoing rapid demographic structure transition, remain understudied. Methods Using longitudinal d...
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2025-06-01
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| author | Xuan Zhu He Ma Hangjing Zhang Yuting Zhang Shangfeng Tang Juyang Xiong |
| author_facet | Xuan Zhu He Ma Hangjing Zhang Yuting Zhang Shangfeng Tang Juyang Xiong |
| author_sort | Xuan Zhu |
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| description | Abstract Background While healthy lifestyles mitigate the risk of multimorbidity (≥ 2 chronic diseases), their temporal dynamics in aging populations, particularly in low- and middle-income countries undergoing rapid demographic structure transition, remain understudied. Methods Using longitudinal data (2014–2020) from 6,852 Chinese adults (aged ≥ 45 years) in the China Family Panel Studies, we used the subgroup analysis to investigate high risk groups in the chronic diseases status, employed alluvial diagrams to visualize diseases status transition and random intercept cross-lagged panel model to quantify the lagged effect between healthy lifestyles (sleep, physical exercise, smoking, drinking) and chronic diseases status (without diseases, single, multimorbidity). Results Compared to male, urban and middle-aged individuals, female, rural and older adults demonstrated more severe chronic diseases status (P < 0.05). The proportion of people with multimorbidity increased over time, from 9.2% in 2014 to 29.1% in 2020. A total of 37.8% of participants experienced diseases status transition, and more than half of whom progressed to multimorbidity. Disease trajectories disproportionately progressed toward multimorbidity. The direction and size of the cross-lagged effects are dynamic. Healthier lifestyles predicted reduced disease severity from 2014 to 2018 (β1=-0.106, P 1 < 0.001; β2=-0.111, P 2 < 0.001), but this protective effect reversed post-2018, with multimorbidity predicting lower probability of choosing healthy lifestyles (β3=-0.160, P 3 < 0.001). Conclusions Our study demonstrates dynamic cross-lagged effect exists between healthy lifestyles and chronic diseases status in middle-aged and older Chinese. Disease trajectories and lifestyle-disease interplay reveal critical time-sensitive windows for intervention. Early-stage lifestyle promotion could delay progression, whereas later-stage disease management requires system-level strategies addressing urban-rural healthcare disparities and self-efficacy barriers. These findings directly inform China’s Healthy Aging 2030 priorities. |
| format | Article |
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| issn | 1471-2458 |
| language | English |
| publishDate | 2025-06-01 |
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| series | BMC Public Health |
| spelling | doaj-art-305a047d77af42318fcee61dea4ad5122025-08-20T02:05:39ZengBMCBMC Public Health1471-24582025-06-0125111310.1186/s12889-025-23397-6Dynamic cross-lagged effects between healthy lifestyles and multimorbidity among middle-aged and older adults in ChinaXuan Zhu0He Ma1Hangjing Zhang2Yuting Zhang3Shangfeng Tang4Juyang Xiong5School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & TechnologySchool of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & TechnologySchool of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & TechnologyMelbourne Institute: Applied Economic & Social Research, The University of MelbourneSchool of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & TechnologySchool of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & TechnologyAbstract Background While healthy lifestyles mitigate the risk of multimorbidity (≥ 2 chronic diseases), their temporal dynamics in aging populations, particularly in low- and middle-income countries undergoing rapid demographic structure transition, remain understudied. Methods Using longitudinal data (2014–2020) from 6,852 Chinese adults (aged ≥ 45 years) in the China Family Panel Studies, we used the subgroup analysis to investigate high risk groups in the chronic diseases status, employed alluvial diagrams to visualize diseases status transition and random intercept cross-lagged panel model to quantify the lagged effect between healthy lifestyles (sleep, physical exercise, smoking, drinking) and chronic diseases status (without diseases, single, multimorbidity). Results Compared to male, urban and middle-aged individuals, female, rural and older adults demonstrated more severe chronic diseases status (P < 0.05). The proportion of people with multimorbidity increased over time, from 9.2% in 2014 to 29.1% in 2020. A total of 37.8% of participants experienced diseases status transition, and more than half of whom progressed to multimorbidity. Disease trajectories disproportionately progressed toward multimorbidity. The direction and size of the cross-lagged effects are dynamic. Healthier lifestyles predicted reduced disease severity from 2014 to 2018 (β1=-0.106, P 1 < 0.001; β2=-0.111, P 2 < 0.001), but this protective effect reversed post-2018, with multimorbidity predicting lower probability of choosing healthy lifestyles (β3=-0.160, P 3 < 0.001). Conclusions Our study demonstrates dynamic cross-lagged effect exists between healthy lifestyles and chronic diseases status in middle-aged and older Chinese. Disease trajectories and lifestyle-disease interplay reveal critical time-sensitive windows for intervention. Early-stage lifestyle promotion could delay progression, whereas later-stage disease management requires system-level strategies addressing urban-rural healthcare disparities and self-efficacy barriers. These findings directly inform China’s Healthy Aging 2030 priorities.https://doi.org/10.1186/s12889-025-23397-6Healthy lifestylesMultimorbidityDynamic cross-lagged effectsProactive healthHealthy aging |
| spellingShingle | Xuan Zhu He Ma Hangjing Zhang Yuting Zhang Shangfeng Tang Juyang Xiong Dynamic cross-lagged effects between healthy lifestyles and multimorbidity among middle-aged and older adults in China BMC Public Health Healthy lifestyles Multimorbidity Dynamic cross-lagged effects Proactive health Healthy aging |
| title | Dynamic cross-lagged effects between healthy lifestyles and multimorbidity among middle-aged and older adults in China |
| title_full | Dynamic cross-lagged effects between healthy lifestyles and multimorbidity among middle-aged and older adults in China |
| title_fullStr | Dynamic cross-lagged effects between healthy lifestyles and multimorbidity among middle-aged and older adults in China |
| title_full_unstemmed | Dynamic cross-lagged effects between healthy lifestyles and multimorbidity among middle-aged and older adults in China |
| title_short | Dynamic cross-lagged effects between healthy lifestyles and multimorbidity among middle-aged and older adults in China |
| title_sort | dynamic cross lagged effects between healthy lifestyles and multimorbidity among middle aged and older adults in china |
| topic | Healthy lifestyles Multimorbidity Dynamic cross-lagged effects Proactive health Healthy aging |
| url | https://doi.org/10.1186/s12889-025-23397-6 |
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