To explore the longitudinal evolutionary trajectories of active health behaviors among older adults with multiple chronic conditions, analyze the impact of different evolutionary patterns on healthcare utilization, and provide evidence for formulating healthy aging policies.

Based on the China Health and Retirement Longitudinal Study (CHARLS, 2011—2020), participants who were aged ≥60 years at baseline, had ≥2 comorbid chronic diseases, and provided complete follow-up data were included. A 5-dimensional active health index (AHI), covering physical activity, social participation, and other dimensions, was constructed, and latent transition analysis (LTA) was used to classify the trajectories. Generalized linear mixed models (GLMMs) and multivariable logistic regression were employed to analyze the associations, and subgroup and sensitivity analyses were conducted to verify the robustness of the results.

A total of 96 628 participants were enrolled and categorized into three AHI trajectory groups: 19.9% in the “sustained improvement group”, 32.5% in the “long-term stable group”, and 47.6% in the “gradual decline group”. Compared with the gradual decline group, the sustained improvement group had fewer outpatient visits (negative binomial regression coefficient β=-0.21, P<0.001), a lower hospitalization risk [odds ratio (OR) =0.82, 95% confidence interval (CI) : 0.78-0.86, P<0.001], and reduced annual medical expenses (log-normal regression coefficient β=-0.33, P<0.001). A similar trend was observed in the long-term stable group (outpatient visits: β=-0.13;hospitalization: OR=0.87, 95% CI: 0.83-0.91; medical expenses: β=-0.20;all P<0.001). These associations remained robust after stratified analysis, with slightly stronger effects observed in females and urban residents.

Significant heterogeneity exists in the evolution of active health behaviors among older adults with multiple chronic conditions. Long-term stability or improvement of these behaviors can reduce healthcare utilization and alleviate economic burden. Behavior-based health promotion strategies are feasible approaches to achieve healthy aging and optimize the allocation of medical resources.