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Background <p>Risk perception bias is a widespread psychological phenomenon among the public that influences health-related behaviors. However, its longitudinal association with the onset and progression of various chronic diseases, particularly among middle-aged and elderly populations in China, has yet to be systematically elucidated. This study aims to evaluate the associations between risk perception bias, lifestyle, and the risk of developing 14 chronic diseases among middle-aged and older adults in China.</p> Methods <p>This study established a nationwide prospective cohort comprising 12,326 adults aged ≥ 45 years on the basis of the China Health and Retirement Longitudinal Study (CHARLS). Using multivariable-adjusted Cox proportional hazards models, mediation analysis, and restricted cubic splines (RCSs), we systematically examined the associations between perceived risk bias, lifestyle factors, and the risk of 14 newly diagnosed chronic diseases. The robustness of these findings was validated through comprehensive subgroup analyses.</p> Results <p>The baseline data from 2011 included 12,326 participants, with a mean age of 59.26 years ([SD] 9.46), 52.1% of whom were female. Optimism bias was significantly associated with an increased risk of developing up to 11 chronic diseases. Mediator analysis revealed that lifestyle played a significant mediating role in this association (mediation proportion approximately 10%–25%), but the substantial direct effect of optimism bias itself remained. RCS analysis further revealed that the risk of optimism bias tended to follow a nonlinear accelerating pattern. Subgroup analysis indicated that this association was robust in most populations, but significant effect heterogeneity was observed across different sex and regional subgroups (interaction <i>P</i> values &lt; 0.05).</p> Conclusions <p>This longitudinal cohort study revealed that optimism bias is associated with an increased risk of developing multiple chronic diseases, with this association being partially mediated by lifestyle factors. Further research is needed to explore the dynamic pathways linking optimism bias, lifestyle, and multiple chronic diseases.</p>

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Risk perception bias, lifestyle, and chronic disease risk in the middle-aged and older Chinese population: results of a national prospective longitudinal study

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  • 发表日期：

    2026年1月3日

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  • Yujun Zhong,
  • Jindan Cao

摘要

Background

Risk perception bias is a widespread psychological phenomenon among the public that influences health-related behaviors. However, its longitudinal association with the onset and progression of various chronic diseases, particularly among middle-aged and elderly populations in China, has yet to be systematically elucidated. This study aims to evaluate the associations between risk perception bias, lifestyle, and the risk of developing 14 chronic diseases among middle-aged and older adults in China.

Methods

This study established a nationwide prospective cohort comprising 12,326 adults aged ≥ 45 years on the basis of the China Health and Retirement Longitudinal Study (CHARLS). Using multivariable-adjusted Cox proportional hazards models, mediation analysis, and restricted cubic splines (RCSs), we systematically examined the associations between perceived risk bias, lifestyle factors, and the risk of 14 newly diagnosed chronic diseases. The robustness of these findings was validated through comprehensive subgroup analyses.

Results

The baseline data from 2011 included 12,326 participants, with a mean age of 59.26 years ([SD] 9.46), 52.1% of whom were female. Optimism bias was significantly associated with an increased risk of developing up to 11 chronic diseases. Mediator analysis revealed that lifestyle played a significant mediating role in this association (mediation proportion approximately 10%–25%), but the substantial direct effect of optimism bias itself remained. RCS analysis further revealed that the risk of optimism bias tended to follow a nonlinear accelerating pattern. Subgroup analysis indicated that this association was robust in most populations, but significant effect heterogeneity was observed across different sex and regional subgroups (interaction P values < 0.05).

Conclusions

This longitudinal cohort study revealed that optimism bias is associated with an increased risk of developing multiple chronic diseases, with this association being partially mediated by lifestyle factors. Further research is needed to explore the dynamic pathways linking optimism bias, lifestyle, and multiple chronic diseases.