Cross-sectional trends in healthy lifestyles among the oldest-old in China, 1998-2018.

BACKGROUND: Healthy lifestyle is vital for active aging and increasing life expectancy of older adults. This study aimed to examine a cross-sectional trend in the lifestyles of the oldest-old in China over the past two decades and to identify the major influencing factors. METHODS: After excluding participants with missing data, 19,736 oldest-old (≥80 years old) were analyzed across 1998, 2008, and 2018 three cross-sectional waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS).Healthy lifestyle factors were defined based on the "four cornerstones of health" proposed by the World Health Organization (WHO), including balanced diet, moderate exercise, former/never tobacco and alcohol behavior, and good mental health. Logistic regression models were used to assess associations between sociodemographic factors and healthy lifestyles across different years. RESULTS: The study results revealed that the prevalence of healthy lifestyle factors among the oldest-old Chinese increased from 1998 to 2018 (8.1%, 13.7%, 21.2% in 1998, 2008, 2018, respectively). Trend analyses also showed that the prevalence of balanced diet, former/never smoking and alcohol drinking behavior, and mental health increased from 1998 to 2018 (p trend <0.05), but no significant change in regular exercise. Improved education and non-manual occupation before 60 years were associated with a higher chance of having healthy lifestyles in all three study years, whereas rural residence was associated with a lower chance of having healthy lifestyles. The gap between rural-urban trend has been narrowing from 1998 to 2018, yet a significant disparity remains. CONCLUSION: The findings suggest that targeted interventions are needed to promote physical activity and rural-urban disparities in healthy lifestyles should be addressed among the oldest-old Chinese.