International Journal of Public Health · Sep 25, 2026

Joint trajectories of health behaviors and their associations with healthcare utilization and expenditure

By Yang JM, Kim JM, Jang TS et al.

OBJECTIVES: This study identified sex-specific trajectories of key health behaviors among middle-aged and older adults and examined their longitudinal associations with healthcare utilization and expenditure. METHODS: We analyzed 167,343 Korean adults aged 40-79 years from 2002 to 2019 using the National Health Insurance Service Health Screening Cohort. Group-based multi-trajectory modeling identified joint trajectories of smoking, alcohol consumption, physical activity, and BMI. Associations with healthcare outcomes were assessed using generalized estimating equations stratified by sex and age group. RESULTS: Six distinct health behavior trajectories were identified in both sexes. Among men, the higher moderate-risk trajectory showed fewer outpatient visits but longer hospital stays. Among women, the higher severe-risk trajectory was associated with increased expenditures and higher healthcare utilization. Age-stratified analyses revealed stronger associations for severe-risk trajectories in men aged <65 years and lower severe-risk trajectories in those aged ≥65 years. CONCLUSION: Sex- and age-specific behavioral trajectories were differentially associated with healthcare utilization and expenditure, underscoring the importance of multidimensional behavioral patterns in developing preventive strategies to reduce healthcare burdens.

doi.org/10.3389/ijph.2026.1609686 Open access PubMed 42889673 Populations