Health behavior concordance in middle-aged and older Chinese couples: longitudinal analysis from the China Health and Retirement Longitudinal Study (CHARLS)

Spousal concordance in health has implications for couple-based interventions, yet evidence on health behavior concordance in couples has been limited. This study examined cross-sectional and longitudinal spousal associations for seven health behaviors among middle-aged and older Chinese couples. Data came from 6,579 couples (13,158 individuals) in the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018). Behaviors included obesity, physical inactivity, social inactivity, short/long sleep, extended napping, current smoking, and heavy drinking. Generalized estimating equations (GEE) was used to estimate cross-sectional spousal associations. Cross-lagged panel models (CLPM) tested longitudinal directional influences, and joint Wald tests assessed whether directional effects differed significantly by sex. Significant cross-sectional spousal associations emerged for all seven health behaviors. Longitudinally, bidirectional spousal influence was observed for short/long sleep (wife-to-husband OR=1.17; husband-to-wife OR=1.19), heavy drinking (wife-to-husband OR=2.78; husband-to-wife OR=2.29), social inactivity (wife-to-husband OR=1.14; husband-to-wife OR=1.11), and extended napping (wife-to-husband OR=1.55; husband-to-wife OR=1.28). Obesity showed a significant husband-to-wife path (OR=1.30). Physical inactivity and smoking showed no significant longitudinal influence in either direction. Formal testing found no statistically significant difference in magnitude between wife-to-husband and husband-to-wife paths for any behavior. Spousal concordance was moderate to strong for health behaviors, and longitudinal analyses revealed genuinely bidirectional mutual influence. These findings suggest that couple-based behavioral change interventions may be more effective than individual-focused approaches to benefit both members in the couple.