{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T14:48:16Z","timestamp":1780930096458,"version":"3.54.1"},"reference-count":49,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2020,10,1]],"date-time":"2020-10-01T00:00:00Z","timestamp":1601510400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["MOST 102-2410-H-006-047-MY2"],"award-info":[{"award-number":["MOST 102-2410-H-006-047-MY2"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Changes in lifestyle behaviors may effectively maintain or improve the health status of individuals with chronic diseases. However, such health behaviors adopted by individuals are unlikely to demonstrate similar patterns. This study analyzed the relationship between the heterogeneous latent classes of health behavior and health statuses among middle-aged and older adults with hypertension, diabetes, or hyperlipidemia in Taiwan. After selecting 2103 individuals from the 2005 and 2009 Taiwan National Health Interview Survey (NHIS), we first identified heterogeneous groups of health behaviors through latent class analysis (LCA). We further explored the relationship between each latent class of health behavior and health status through ordered logit regression. We identified the following five distinct health behavior classes: the all-controlled, exercise and relaxation, healthy diet and reduced smoking or drinking, healthy diet, and least-controlled classes. Regression results indicated that individuals in classes other than the all-controlled class all reported poor health statuses. We also found great magnitude of the coefficient estimates for individuals who reported their health status to be poor or very poor for the least-controlled class. Therefore, health authorities and medical providers may develop targeted policies and interventions that address multiple modifiable health behaviors in each distinct latent class of health behavior.<\/jats:p>","DOI":"10.3390\/ijerph17197196","type":"journal-article","created":{"date-parts":[[2020,10,1]],"date-time":"2020-10-01T09:04:12Z","timestamp":1601543052000},"page":"7196","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Health Behaviors and Health Status among Middle-Aged and Older Adults with Chronic Diseases in Taiwan"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9631-6816","authenticated-orcid":false,"given":"Wei-Hua","family":"Tian","sequence":"first","affiliation":[{"name":"Department of Economics, National Cheng Kung University, Tainan 701, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph J.","family":"Tien","sequence":"additional","affiliation":[{"name":"Department of Risk Management and Insurance, Tamkang University, New Taipei City 251, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1016\/0091-7435(72)90014-X","article-title":"Relationship of physical health status and health Mortality, lifestyle and socio-economic status practices","volume":"1","author":"Belloc","year":"1972","journal-title":"Prev. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/0091-7435(80)90042-0","article-title":"Persistence of health habits and their relationship to mortality","volume":"9","author":"Breslow","year":"1980","journal-title":"Prev. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1124","DOI":"10.2105\/AJPH.76.9.1124","article-title":"The relationship between vitamin C, general health practices, and mortality in Alameda County, California","volume":"76","author":"Enstrom","year":"1986","journal-title":"Am. J. Public Health"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Fuchs, V. (1982). Time preference and health: An exploratory study. Economic Aspects of Health, University of Chicago Press.","DOI":"10.7208\/chicago\/9780226267944.001.0001"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1002\/hec.4730040103","article-title":"Should you eat breakfast? Estimates from health production functions","volume":"4","author":"Kenkel","year":"1995","journal-title":"Health Econ."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2207","DOI":"10.1001\/jama.1993.03510180077038","article-title":"Actual causes of death in the United States","volume":"270","author":"McGinnis","year":"1993","journal-title":"J. Am. Med Assoc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1001\/archinte.164.4.370","article-title":"Dietary fiber and risk of coronary heart disease: A pooled analysis of cohort studies","volume":"164","author":"Pereira","year":"2004","journal-title":"Arch. Intern. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2435","DOI":"10.1161\/01.CIR.0000066906.11109.1F","article-title":"Physical activity in relation to cardiovascular disease and total mortality among men with type 2 diabetes","volume":"107","author":"Tanasescu","year":"2003","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/0091-7435(80)90056-0","article-title":"Lifestyle and future health: Evidence from the Alameda County study","volume":"9","author":"Wiley","year":"1980","journal-title":"Prev. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2392","DOI":"10.1161\/01.CIR.0000067882.00596.FC","article-title":"Active lifestyle and diabetes","volume":"107","author":"Myers","year":"2003","journal-title":"Circulation"},{"key":"ref_11","unstructured":"Antman, E.M., Givertz, M.M., Josephson, M.E., de Lemos, J., Oparil, S., Sacks, F.M., and Saunders, W.B. (2007). Cardiovascular disease and lifestyle modification. Chapter 28, Cardiovascular Therapeutics a Companion to Braunwald\u2019s Heart Disease, Elsevier Health Sciences. [3rd ed.]."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Theodorou, M., Stafylas, P., Kourlaba, G., Kaitelidou, D., Maniadakis, N., and Papademetriou, V. (2012). Physicians\u2019 perceptions and adherence to guidelines for the management of hypertension: A national, multicentre, prospective study. Int. J. Hypertens.","DOI":"10.1155\/2012\/503821"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Busch, V., Van Stel, H.F., Schrijvers, A.J., and de Leeuw, J.R. (2013). Clustering of health-related behaviors, health outcomes and demographics in Dutch adolescents: A cross-sectional study. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-1118"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.ypmed.2006.01.011","article-title":"Clustering of risk behaviors with cigarette consumption: A population-based survey","volume":"42","author":"Chiolero","year":"2006","journal-title":"Prev. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1177\/0898264308321082","article-title":"The prevalence and clustering of four major lifestyle risk factors in Hong Kong Chinese older adults","volume":"20","author":"Chou","year":"2008","journal-title":"J. Aging Health"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Conry, M.C., Morgan, K., Curry, P., McGee, H., Harrington, J., Ward, M., and Shelley, E. (2011). The clustering of health behaviours in Ireland and their relationship with mental health, self-rated health and quality of life. BMC Public Health, 11.","DOI":"10.1186\/1471-2458-11-692"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.amepre.2004.04.017","article-title":"Prevalence of multiple chronic disease risk factors. 2001 National Health Interview Survey","volume":"27","author":"Fine","year":"2004","journal-title":"Am. J. Prev. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/abm\/kay010","article-title":"Trends in Health Behavior Patterns Among U.S. Adults, 2003-2015","volume":"53","author":"Fleary","year":"2019","journal-title":"Ann. Behav. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1007\/s10865-008-9176-1","article-title":"The covariation of multiple risk factors in primary care: A latent class analysis","volume":"31","author":"Funderburk","year":"2008","journal-title":"J. Behav. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Li, Y., Zhang, M., Jiang, Y., and Wu, F. (2012). Co-variations and clustering of Chronic Disease behavioral risk factors in China: China Chronic Disease and Risk Factor Surveillance, 2007. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0033881"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Jentsch, F., Allen, J., Fuchs, J., and von der Lippe, E. (2017). Typical patterns of modifiable health risk factors (MHRFs) in elderly women in Germany: Results from the cross-sectional German Health Update (GEDA) study, 2009 and 2010. BMC Women\u2019s Health, 17.","DOI":"10.1186\/s12905-017-0380-4"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1007\/s11121-009-0140-2","article-title":"Latent class analysis of lifestyle characteristics and health risk behaviors among college youth","volume":"10","author":"Laska","year":"2009","journal-title":"Prev. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1177\/1757913913495780","article-title":"Clustering of modifiable biobehavioral risk factors for chronic disease in US adults: A latent class analysis","volume":"134","author":"Leventhal","year":"2014","journal-title":"Perspect. Public Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.ypmed.2006.10.006","article-title":"The prevalence and clustering of four major lifestyle risk factors in an English adult population","volume":"44","author":"Poortinga","year":"2007","journal-title":"Prev. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.ssmph.2016.12.009","article-title":"Health lifestyle behaviors among U.S. adults","volume":"3","author":"Krueger","year":"2017","journal-title":"SSM Popul. Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1093\/eurpub\/ckn144","article-title":"Optimising lifestyle interventions: Identification of health behaviour patterns by cluster analysis in a German 50+ survey","volume":"19","author":"Schneider","year":"2009","journal-title":"Eur. J. Public Health"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Teh, C.H., Teh, M.W., and Lim, K.H. (2019). Clustering of lifestyle risk behaviours and its determinants among school-going adolescents in a middle-income country: A cross-sectional study. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-7516-4"},{"key":"ref_28","unstructured":"WHO (2020, September 18). Noncommunicable Diseases. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/noncommunicable-diseases."},{"key":"ref_29","unstructured":"WHO (2018, August 28). Cardiovascular Diseases. Available online: http:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cardiovascular-diseases-(cvds)."},{"key":"ref_30","unstructured":"Ministry of Health and Welfare (2018, August 28). Taiwan\u2019s Leading Causes of Death in 2016 and 2016 Statistics of Causes of Death (Table 15 and 23), Available online: https:\/\/www.mohw.gov.tw\/lp-3327-2.html."},{"key":"ref_31","unstructured":"National Health Insurance Administration (NHI) (2018, August 28). Detailed Outpatient and Inpatient Medical Expenses by Gender and Age (Table 117 and 123), Available online: https:\/\/www.nhi.gov.tw\/english\/Content_List.aspx?n=053561BC02D74A95;topn=616B97F8DF2C3614."},{"key":"ref_32","unstructured":"United Nations (UN) (2018, March 10). World Population Prospects: The 2015 Revision. Available online: http:\/\/www.un.org\/en\/development\/desa\/publications\/world-population-prospects-2015-revision.html."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1111\/ggi.12774","article-title":"What factors influence healthy aging? A person-centered approach among older adults in Taiwan","volume":"17","author":"Liu","year":"2017","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1007\/BF00303847","article-title":"An epidemiological model for health policy analysis","volume":"2","author":"Dever","year":"1976","journal-title":"Soc. Indic. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/S0149-2918(97)80104-X","article-title":"The association between body mass and health care expenditures","volume":"19","author":"Heithoff","year":"1997","journal-title":"Clin. Ther."},{"key":"ref_36","unstructured":"Leavell, H.R., and Clark, E.G. (1982). Preventive Medicine for the Doctor in His Community, an Epidemiologic Approach, Blakiston Division, McGraw-Hill."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"387","DOI":"10.2105\/AJPH.85.3.387","article-title":"Preventive services for the elderly: Would coverage affect utilization and costs under Medicare?","volume":"85","author":"Burton","year":"1995","journal-title":"Am. J. Public Health"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1023\/B:REGE.0000008656.82249.3a","article-title":"Optimal price rules, administered prices and suboptimal prevention: Evidence from a Medicare program","volume":"25","author":"Dor","year":"2004","journal-title":"J. Regul. Econ."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"264","DOI":"10.2188\/jea.8.264","article-title":"Relationship between preventive health services and use of inpatient and outpatient care by residents aged 40 or older in 44 municipalities in Osaka Prefecture, Japan","volume":"8","author":"Nakanishi","year":"1998","journal-title":"J. Epidemiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1086\/261105","article-title":"Differential use of medical care by sex","volume":"90","author":"Sindelar","year":"1982","journal-title":"J. Political Econ."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.healthpol.2009.09.012","article-title":"The demand for preventive care and its relationship with inpatient services","volume":"94","author":"Tian","year":"2010","journal-title":"Health Policy"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1016\/S0895-7061(99)00057-6","article-title":"Lifestyle and hypertension","volume":"12","author":"Beilin","year":"1999","journal-title":"Am. J. Hypertens."},{"key":"ref_43","first-page":"173","article-title":"Latent class analysis with multiple latent group variables","volume":"24","author":"Lee","year":"2017","journal-title":"Commun. Stat. Appl. Methods"},{"key":"ref_44","unstructured":"MPLUS Version 6.1. 2010 (2010). Mplus Office, Muth\u00e9n, Muth\u00e9n."},{"key":"ref_45","unstructured":"StataCorp (2015). Stata Statistical Software: Release 14, StataCorp LP."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1086\/428914","article-title":"Toward Some Fundamentals of Fundamental Causality: Socioeconomic Status and Health in the Routine Clinic Visit for Diabetes","volume":"110","author":"Lutfey","year":"2005","journal-title":"Am. J. Sociol."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Wang, J., and Geng, L. (2019). Effects of Socioeconomic Status on Physical and Psychological Health: Lifestyle as a Mediator. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16020281"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"E70","DOI":"10.5888\/pcd13.160054","article-title":"Clustering of Five Health-Related Behaviors for Chronic Disease Prevention Among Adults, United States","volume":"13","author":"Liu","year":"2016","journal-title":"Prev. Chronic Dis."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"igy007","DOI":"10.1093\/geroni\/igy007","article-title":"When Adults Don\u2019t Exercise: Behavioral Strategies to Increase Physical Activity in Sedentary Middle-Aged and Older Adults","volume":"2","author":"Lachman","year":"2018","journal-title":"Innov. Aging"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/19\/7196\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:15:43Z","timestamp":1760177743000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/19\/7196"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,1]]},"references-count":49,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2020,10]]}},"alternative-id":["ijerph17197196"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17197196","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,1]]}}}