Social disparities in the association between lifestyle and ageing well: evidence from three waves of the European Health Interview Survey in Greece, using a repeated cross-sectional study

Abstract Aim The current study aimed to examine 10-year trends in the association between healthy lifestyle behaviors and healthy ageing, stratified by population groups, during a period of austerity in Greece, identifying how socioeconomic changes disrupt traditional predictors of healthy ageing. Subject and methods Secondary analysis was conducted for three nationally representative, repeated cross-sectional waves of the European Health Interview Survey (EHIS). Data ( n = 21,000 adults, mean age 54.0 (standard deviation, 18.9) years) were used to construct a Healthy Lifestyle Index (HLI) (diet, physical activity, smoking, alcohol, body mass index BMI) and a multidimensional Healthy Ageing Index (HAI). Time trends in HLI were determined for the total sample and in the association between HLI and HAI for persons aged ≥ 65 years, adjusted for sociodemographic variables. Stratified analyses were conducted to identify how the associations varied across different socioeconomic groups. Results HLI scores declined significantly over the decade, with the sharpest reductions observed among adults 45–59 years, and those with primary education, low income, and rural residence. While a higher HLI was associated with greater odds of healthy ageing in 2009 (odds ratio OR 1.69 95% confidence interval (CI) 1.43–1.99) and 2019 (OR 1.22 95% CI 1.11–1.34), this predictive validity was lost in 2014, during the crisis peak. Conclusion Greece serves as a critical case study of other ageing European countries. Findings suggest that the association between healthy lifestyles and sustainable healthy ageing may be moderated by socioeconomic changes. Thus, lifestyle interventions should be part of a broader framework that addresses social inequalities, with special emphasis on groups that are often neglected by prevention initiatives. Multinational EHIS data could offer a vital tool for informing resilient, evidence-based health systems across Europe.