Objective To investigate the adherence to four healthy lifestyle factors–nonsmoking, no or moderate alcohol consumption, adequate physical activity, and a healthy diet–among residents aged 35–75 years in Gansu province and to identify the influencing factors, providing a reference for promoting healthy lifestyles among residents.

Methods Data were collected from December 2015 to December 2022 as part of the Early Screening and Comprehensive Intervention Program for High-Risk Cardiovascular Disease Populations. The study included 27 436 residents aged 35–75 years from 10 project sites in Gansu province: Baiyin district of Baiyin city, Anding district and Tongwei county of Dingxi city, Huating city of Pingliang city, Qingcheng county of Qingyang city, Qingshui county of Tianshui city, Gaotai county and Shandan county of Zhangye city, Liangzhou district of Wuwei city, and Yongjing county of Linxia Hui autonomous prefecture. The dataset included demographic information, adherence to the four healthy lifestyle factors (nonsmoking, no or moderate alcohol consumption, adequate physical activity, and healthy diet), and was complete with no history of CVD or cancer. Adherence to the four healthy lifestyle factors was analyzed, and a multifactorial unconditional logistic regression model was used to analyze the influencing factors.

Results Among the 27 436 residents aged 35–75 years included in the analysis, 20 777 (75.7%), 27 183 (99.1%), 5 838 (21.3%), and 3 917 (14.3%) adhered to nonsmoking, no or moderate alcohol consumption, adequate physical activity, and a healthy diet, respectively. Only 713 residents (2.6%) adhered to all four healthy lifestyle factors. Multifactorial unconditional logistic regression analysis showed that being female, aged 65–75 years, and having a college degree or higher were positively associated with nonsmoking. Being aged 45–54 years, having a junior high school education, and having a history of hypertension or diabetes were negatively associated with nonsmoking. Being female, aged 55–75 years, and having a history of myocardial infarction or stroke were positively associated with no or moderate alcohol consumption, while having a junior high school education or higher was negatively associated. Being female, aged 45–75 years, having a junior high school education or higher, and having a history of hypertension, diabetes, myocardial infarction, or stroke were positively associated with adequate physical activity. Being female, having a junior high school education or higher, and having a history of hypertension, diabetes, myocardial infarction, or stroke were positively associated with a healthy diet, while living in rural areas was negatively associated. Being female, aged 55–75 years, having a junior high school education or higher, and having a history of hypertension or diabetes were positively associated with adherence to all four healthy lifestyle factors.

Conclusions The adherence rate to all four healthy lifestyle factors was low among residents aged 35–75 years in Gansu province. Sex and education level were common influencing factors for adherence to the four healthy lifestyle factors.