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How educational inequality among rural residents relates to healthy lifestyle behaviors in later life: evidence from the Northern China lifestyle medicine cohort baseline
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  • Published: 31 March 2026

How educational inequality among rural residents relates to healthy lifestyle behaviors in later life: evidence from the Northern China lifestyle medicine cohort baseline

  • Yudong Miao1,
  • Jinxin Cui1,
  • Lei Yin2,
  • Zhanlei Shen1,
  • Dongfang Zhu1,
  • Jingbao Zhang1,
  • Jiajia Zhang1,
  • Mingyue Zhen1,
  • Xinran Li1,
  • Lingxiao Mou1,
  • Yixi Wang1,
  • Jiaxin Han1,
  • Jingwei Qin1,
  • Jingming Wei3,
  • Clifford Silver Tarimo4,
  • Qiuping Zhao5,
  • Rongmei Liu5,
  • Nengguang Dai6 &
  • …
  • Qingyong Lu1 

Humanities and Social Sciences Communications (2026) Cite this article

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We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Diseases
  • Health care
  • Medical research
  • Risk factors

Abstract

Educational inequality affects health, but its link to healthy lifestyles among older adults in low-resource rural settings remains unclear. This study utilized baseline data from the Northern China Lifestyle Medicine Cohort (July 2023–January 2024). Adults aged 65 and older with hypertension or diabetes in the National Basic Public Health Service program were included. A composite Healthy Lifestyle Score (HLS, range 0–7) was constructed from seven behavioral indicators. We employed linear/logistic regression and propensity score matching (PSM) to analyze associations between educational attainment and lifestyle outcomes. Among 10,459 adults (57.2% female), 34.0% were illiterate. The mean HLS was 4.69 (SD = 1.24). Each educational attainment increase added 0.17 points to HLS (95% CI: 0.14–0.20). Higher education was positively linked to a healthy diet (OR = 1.15, 95% CI: 1.10–1.21), adequate sleep (OR = 1.17, 95% CI: 1.11–1.23), physical activity (OR = 1.18, 95% CI: 1.11–1.24), and leisure activity (OR = 1.34, 95% CI: 1.27–1.41), but negatively with non-drinking (OR = 0.82, 95% CI: 0.77–0.88). After PSM adjustment, illiterate participants had a significantly lower HLS (4.59, 95% CI: 4.55–4.63) than non-illiterate counterparts (4.89, 95% CI: 4.84–4.93), a net difference of 0.30 points. These findings highlight that higher educational attainment is consistently associated with healthier lifestyle choices among older adults in resource-limited rural areas. Strengthening rural education and integrating health literacy into public health strategies could be pivotal for promoting healthy aging.

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Data availability

Upon reasonable request, data may be obtained from the corresponding author.

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Acknowledgements

This work was funded by The Henan Provincial University Philosophy and Social Science Innovation Talent Support Plan (number 2023-CXRC-06) and The National Science and Technology Major Project of China (number 2024ZD0526801).

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Authors and Affiliations

  1. College of Public Health, Zhengzhou University, Zhengzhou, China

    Yudong Miao, Jinxin Cui, Zhanlei Shen, Dongfang Zhu, Jingbao Zhang, Jiajia Zhang, Mingyue Zhen, Xinran Li, Lingxiao Mou, Yixi Wang, Jiaxin Han, Jingwei Qin & Qingyong Lu

  2. The Seventh People’s Hospital of Zhengzhou, Zhengzhou, China

    Lei Yin

  3. Institute of Mental Health, Peking University Sixth Hospital, Beijing, China

    Jingming Wei

  4. Department of Science and Laboratory Technology, Dar es Salaam Institute of Technology, Dar es Salaam, United Republic of Tanzania

    Clifford Silver Tarimo

  5. Henan Key Laboratory for Health Management of Chronic Diseases, Central China Fuwai Hospital, Zhengzhou, China

    Qiuping Zhao & Rongmei Liu

  6. Health Commission of Henan Province, Zhengzhou, China

    Nengguang Dai

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  1. Yudong Miao
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Contributions

Conceptualization: Miao Y, Lu Q, Yin L, Shen Z, Zhao Q; Data curation: Lu Q, Yin L, Zhang J, Mou L; Formal analysis: Miao Y, Lu Q, Yin L, Shen Z, Zhu D, Zhang J; Funding acquisition: Miao Y; Investigation: Miao Y, Lu Q, Cui J, Zhen M, Wang Y, Han J, Qin J, Liu R, Dai N; Methodology: Miao Y, Lu Q, Yin L, Shen Z, Wei J; Project administration: Miao Y; Resources: Miao Y, Yin L, Zhao Q, Liu R, Dai N; Software: Lu Q, Zhu D, Li X; Writing—original draft: Miao Y, Lu Q, Yin L, Shen Z; Writing—review and editing: Miao Y, Shen Z, Wei J, Tarimo CS.

Corresponding author

Correspondence to Qingyong Lu.

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The authors declare no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Zhengzhou University Life Science Ethics Review Committee on February 14, 2023, covering all aspects of the research (Number: ZZU2023-318).

Informed consent

During the data collection period (July 2023 to January 2024), face-to-face interviews were conducted by well-trained public health students and township public health professionals. To ensure clear communication, they were assisted by general practitioners from each village. All participants were informed about the voluntary nature, purpose, anonymity, and purely academic use of the survey, as well as the absence of associated risks. Non-illiterate participants signed the written informed consent form themselves. For those who were illiterate, after their verbal consent was obtained, a family member provided written informed consent on their behalf.

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Miao, Y., Cui, J., Yin, L. et al. How educational inequality among rural residents relates to healthy lifestyle behaviors in later life: evidence from the Northern China lifestyle medicine cohort baseline. Humanit Soc Sci Commun (2026). https://doi.org/10.1057/s41599-026-06907-8

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  • Received: 09 July 2025

  • Accepted: 26 February 2026

  • Published: 31 March 2026

  • DOI: https://doi.org/10.1057/s41599-026-06907-8

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