Key result
Unhealthy lifestyle behaviors affect ~99% of older Iranian adults, clustering heavily with chronic disease.
Why the study?
Unhealthy lifestyle behaviors are major contributors to non-communicable diseases, yet nationally representative evidence on their prevalence, clustering, and determinants among Iranian older adults remained limited.
Cross-Sectional (n=5,650)
Yes
Nearly all Iranian older adults (98.8%) exhibit at least one unhealthy lifestyle behavior and over half (53.4%) have three or more co-occurring behaviors, highlighting an urgent need for integrated, multi-behavioral cardiovascular and NCD prevention strategies in primary care.
High prevalence of clustered unhealthy behaviors among older adults with chronic diseases supports integrated screening; leaves open whether interventions improve outcomes.
Unhealthy lifestyle behaviors (ULBs) are major contributors to non-communicable diseases, yet nationally representative evidence among Iranian older adults remains limited. This study aimed to estimate the prevalence, clustering, and determinants of ULBs in this population. This cross-sectional secondary analysis included 5,650 participants aged ≥ 60 years from Iran’s 2021 STEPS survey. Among 5,960 participants who met the age criterion, 310 were excluded due to missing data on lifestyle or other key variables. This study assessed five ULBs: inadequate fruit/vegetable intake (< 5 mean servings/day), insufficient physical activity (< 150 min/week moderate-to-vigorous activity), current smoking (any use in the past year), current alcohol consumption (any use in the past year), and abnormal BMI (underweight < 18.5 or overweight/obese ≥ 25 kg/m²). The number of ULBs was summed and categorized as 0–1, 2, 3, or ≥ 4. Weighted prevalence estimates were calculated, and sex-stratified multinomial logistic regression models were used to identify factors associated with the number of ULBs. Overall, 98.8% of participants had at least one ULB, and 53.4% had ≥ 3. The most prevalent behaviors were inadequate fruit and vegetable intake (87.3%), insufficient physical activity (77.6%), and abnormal BMI (69.3%). The prevalence of multiple ULBs was higher among individuals with hypertension, diabetes, and cardiovascular diseases. Among females, age ≥ 80 years and a middle wealth index were associated with higher relative risk ratios (RRR) for having both 2 and 3 ULBs versus 0–1 ULBs, while a history of hypertension was associated with a higher relative risk ratio for having 3 ULBs versus 0–1 ULBs. Among males, a history of hypertension was associated with higher RRRs for having both 2 and 3 ULBs versus 0–1 ULBs. Age 70–79 years was associated with lower RRRs for having 3 and ≥ 4 ULBs, while age ≥ 80 years was associated with a lower RRR for having ≥ 4 ULBs. Higher wealth was generally associated with lower RRRs, particularly for ≥ 4 ULBs. ULBs are highly prevalent and frequently co-occur among Iranian older adults, with distinct sex-specific patterns. Integrated, multi-behavioral interventions leveraging existing primary healthcare systems are needed to promote healthy aging.
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Mossavarali et al. (2026) conducted a cross-sectional in Unhealthy lifestyle behaviors and non-communicable disease risk factors in older adults (n=5,650). Sociodemographic and health-related factors (e.g., history of hypertension) vs. Reference categories (e.g., no history of hypertension) and 0–1 unhealthy lifestyle behaviors was evaluated on Prevalence of having at least one unhealthy lifestyle behavior (inadequate fruit/vegetable intake, insufficient physical activity, current smoking, current alcohol consumption, or abnormal BMI) (95% CI 98.5-99.2). Unhealthy lifestyle behaviors affected 98.8% of Iranian adults aged ≥60 years, with 53.4% exhibiting ≥3 co-occurring behaviors and higher prevalence among those with chronic diseases.
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