Lifestyles, leisure activities, subjective well-being, and long-term survival after age 80 in China: a population-based cohort study

BACKGROUND: Evidence on whether modifiable behaviours, leisure engagement, and subjective well-being jointly shape longevity in the oldest-old (≥80 years) remains limited, especially in China. We aimed to examine the associations between modifiable factors and survival after age 80 in China. METHODS: This study comprised 30,398 participants aged 80 years and over, drawn from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 1998-2018). Lifestyles (smoking status, drinking status, physical activity, and plant-based diet index), leisure activities (mental, physical, productive, and social activity), and subjective well-being were assessed using structured interviews. Median age at death after age 80 was estimated using Laplace regression. RESULTS: During follow-up, 21,648 (71.2%) participants died. Having healthy lifestyles (never smoking [4.2 months], never drinking [1.6 months], engaging in physical activity [3.4 months], eating healthful diet [2.2 months]), engaging in leisure activities (mental: 3.2 months; physical: 8.7 months; productive: 2.0 months; social: 2.8 months), and reporting high subjective well-being (5.4 months), were found to have significantly longer survival times. The median survival of people with a low-risk profile (maintained at least three healthy lifestyles, engaged in at least one leisure activity, and reported medium or high subjective well-being) was 18 months (95% CI 15.5 to 19.8) longer than that of those with a high-risk profile (unhealthy lifestyle, engaged in no leisure activities, and reported low subjective well-being). CONCLUSIONS: The study findings have demonstrated that adopting a healthy lifestyle, engaging in leisure activities, and fostering subjective well-being are associated with longer life expectancy among the oldest old in China.