Scientific Reports · Oct 21, 2026
Prevalence and associated factors of multiple unhealthy lifestyle behaviors among older adults in Iran: insights from the STEPS 2021 survey
By Mossavarali S, Azizpour Y, Azadnajafabad S et al.
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.