Association between subjective well-being and the risk of cardiometabolic multimorbidity in older Chinese adults: effect modification by the integrated healthy lifestyle score

This study aimed to ascertain the association between subjective well-being (SWB) scores and the cardiometabolic multimorbidity (CMM) risk, and evaluate the potential modifying effect of integrated healthy lifestyle scores among older Chinese adults. A prospective cohort study was designed based on Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2011to 2014. Participants aged ≥ 65 years and CMM-free at baseline were included. SWB was assessed using an 8-item scale covering three dimensions: life satisfaction, positive affect, and negative affect, and CMM was defined as the coexistence of two or more cardiometabolic diseases, including hypertension, diabetes, heart disease, and stroke. Hierarchical regressions based on modified Poisson regressions were performed to assess the association between SWB and CMM risk. Subgroup analyses were performed by individual healthy lifestyles and overlapping integrated healthy lifestyle scores. Sensitivity analyses were conducted to evaluate the robustness of the observed associations. Among 5,470 participants, 544 (9.95%) developed CMM during follow-up. In the full model, per 1-standard deviation (SD) and 1-point increase in SWB scores was associated with a 14.3% ( RR = 0.857, 95% CI : 0.785–0.935) and 3.5% reduction ( RR = 0.965, 95% CI : 0.946–0.984) in CMM risk, respectively. Sensitivity analyses confirmed the robustness of these results. Subgroup analyses revealed the strongest association was observed in the least healthy lifestyle group (score 0–2), where per 1-SD and 1-point increase in SWB scores was associated with a 33.8% ( RR = 0.662, 95% CI : 0.558–0.784) and 9.2% ( RR = 0.908, 95% CI : 0.873–0.945) risk reduction, respectively. Higher SWB scores is associated with a lower CMM risk in older Chinese adults, with a stronger association observed among those with less healthy lifestyles. These findings suggest that SWB may be a relevant psychosocial factor in CMM risk assessment, particularly among individuals with suboptimal lifestyle behaviors.