Health-promoting lifestyle profiles among ethnic minority adults with cardiometabolic conditions in Yunnan, China

Abstract Health-promoting lifestyle is important for chronic cardiometabolic disease management, but its heterogeneity among ethnic minority adults remains unclear. This cross-sectional study included 957 ethnic minority adults with hypertension, diabetes, or dyslipidemia in Yunnan, China. Health-promoting lifestyle was assessed using the Health-Promoting Lifestyle Profile-II Revised. Latent profile analysis was conducted using six standardized dimension scores, and models with one to five profiles were compared under equal-volume, equal-shape diagonal (EEI) and varying-volume, varying-shape diagonal (VVI) covariance structures. Posterior-probability multiple-imputation logistic regression using 5,000 pseudo-class draws was used to examine factors associated with the higher health-promoting lifestyle profile while accounting for classification uncertainty. A two-profile EEI solution was retained as the most parsimonious model with adequate class sizes. The lower and higher health-promoting lifestyle profiles included 508 participants (53.08%) and 449 participants (46.92%), respectively. The profiles showed consistently lower and higher scores across all six dimensions. Classification separation was limited (entropy = 0.506), and 184 participants (19.23%) had a maximum posterior probability below 0.70. Modal profile assignment agreed with an empirical median split of the HPLP-II R total score in 95.61% of participants (Cohen’s κ = 0.912), and the continuous total score discriminated modal profile assignment with an area under the receiver operating characteristic curve of 0.995. Supplementary psychometric analyses showed consistent subscale reliability and did not identify substantial measurement non-equivalence across the five major ethnic groups. After accounting for classification uncertainty, older age, meeting the study criteria for two cardiometabolic conditions, and PARS-3 physical activity level were associated with the higher profile; the estimate for three conditions was directionally similar but did not reach statistical significance. Ethnicity-related associations were attenuated after adjustment for geographic region and recruitment source with site-clustered standard errors and should be interpreted as context-dependent contrasts within the sampled sites, without implying independent ethnic effects. PARS-3 total score showed a modest positive correlation with the standardized HPLP-II R physical activity dimension score (Spearman’s ρ = 0.315, 95% CI: 0.258–0.372, P < 0.001). In a sensitivity analysis excluding the HPLP-II R physical activity dimension from the profile indicators, high PARS-3 physical activity remained associated with the higher profile, whereas the association for moderate physical activity was attenuated and no longer statistically significant. Median-split and continuous total-score analyses produced largely concordant association patterns. The selected profiles represented quantitatively ordered levels of health-promoting lifestyle and provided limited incremental information beyond the total score. Profile assignment should therefore be interpreted as an exploratory probabilistic indicator of overall lifestyle engagement.