Tomini E, Qirjako G, Çumashi R
… +2 more, Hala R, Burazeri G
Eur J Public Health
· 2026 Mar · PMID 41693314
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Supportive family and peer relationships foster healthy development and enhance adolescents' capacity to thrive despite adverse life circumstances. Our aim was to assess the association of family support and peer support...Supportive family and peer relationships foster healthy development and enhance adolescents' capacity to thrive despite adverse life circumstances. Our aim was to assess the association of family support and peer support with selected mental health indices of adolescents, controlling for a wide range of sociodemographic characteristics and behavioural factors. A cross-sectional study, conducted in Albania in 2022, included a nationwide representative sample of 5454 adolescents aged 11, 13, and 15 years (≈52% girls; overall response: ≈96%). Data on mental health indices [Cantril's ladder-based life satisfaction measure, WHO-5 wellbeing index, and GAD-7], family support and peer support, and sociodemographic and behavioural factors were collected. General linear model and binary logistic regression were used to assess the independent associations of family support and peer support with mental health indices. In fully-adjusted models, mean values of all three mental health indices were higher (indicating better mental health) among adolescents with high levels of family support and/or peer support compared with their counterparts without high support levels (P < .001 for all). Furthermore, the odds of 'high life satisfaction', 'good mood', and 'little/no anxiety' were all higher among adolescents who reported high family support and/or peer support compared to those without high support levels (P < .001 for all). High peer support levels and especially high family support levels were strongly and independently associated with better mental health outcomes among adolescents in Albania. Our findings highlight the importance of fostering supportive social environments to promote youth mental wellbeing across diverse sociodemographic and behavioural contexts.
Zheng C, Abubakar E, Keenan K
… +5 more, Halliday K, Dibben C, Guthrie B, Marshall A, Pearce J
Eur J Public Health
· 2026 Mar · PMID 41693313
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Little is known regarding the relationship between the local social environment and multiple long-term conditions (MLTC, also referred to as multimorbidity). We investigated the association between social gifting, the ne...Little is known regarding the relationship between the local social environment and multiple long-term conditions (MLTC, also referred to as multimorbidity). We investigated the association between social gifting, the neighbourhood-level latent willingness to gift time for community reciprocity, and four measures of MLTC presence ('2+ long-term conditions (LTCs)', mental-physical MLTC, '3+ LTCs' and complex MLTC). We further explored variations in these relationships across types of urban-rural settlement. We linked participants of the Scottish Longitudinal Study who participated in Census 2011, aged 40-75, with no MLTC before 2010 (n = 98 296), to their hospitalisation records (2010-19) and an established neighbourhood-level index reflecting social gifting. Two-level logistic regression was used to model the onset of MLTC (2010-19), accounting for the clustered data structure of individuals nested within neighbourhoods. Lower social gifting was associated with increased odds of MLTC in all measures, except for '2+ LTCs', with the strongest association observed for mental-physical MLTC. There was a statistically significant interaction between social gifting and types of urban-rural settlement for mental-physical MLTC but not for other measures of MLTC, suggesting that social gifting was more strongly associated with mental-physical MLTC in urban than other areas. The findings highlight the important role of the local social environment in the development of MLTC. Policies targeted at supporting neighbourhood-level social cohesion and social participation may benefit population health, particularly for mental-physical MLTC in urban areas where observed associations were strongest.
Sánchez-García Á, Proietti Mercuri C, Schutte N
… +7 more, Estupiñán-Romero F, Tellería-Orriols C, Doñate-Martínez A, García-Gómez JM, Bernal-Delgado E, Sáez C, On Behalf Of Quantum
Eur J Public Health
· 2026 Mar · PMID 41689848
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The European Health Data Space (EHDS) promotes health data sharing and secondary use across Europe. The QUANTUM project focuses on labelling data quality (DQ), utility, and maturity to support EU-wide standards within th...The European Health Data Space (EHDS) promotes health data sharing and secondary use across Europe. The QUANTUM project focuses on labelling data quality (DQ), utility, and maturity to support EU-wide standards within this context. This study examines current DQ assessment practices in European Data Holder institutions to inform the design of a labelling tool for the EHDS. The study explored institutional practices for DQ assurance and assessment through a survey of EU-wide Data Holders and a literature search on open-source health DQ tools with potential for labelling. The survey targeted QUANTUM partners and external institutions, addressing DQ practices and tools. The literature review followed PRISMA guidelines and combined PubMed, AI-based queries, and known sources. We obtained survey responses from 27 Institutions across 13 European countries. The results showed a high variety and heterogeneity in DQ practices and tools used, including in-house developed tools, open-source tools, commercial products, and manual procedures. Most practices allowed customization of DQ dimensions and export of DQ analyses. The systematic review identified 66 DQ tools, 53% specific to data types such as electronic health records, omics or imaging, and 47% general-purpose. The diverse DQ institutional practices and tools emphasize the need for an interoperable self-assessment DQ labelling tool that guides the measurement and completion of consolidated metrics aligned with the EHDS regulations. Based on these findings, the QUANTUM project is developing this tool to support DQ labelling of Data Holders' datasets candidate to publication at EU Health Data Access Bodies.
Jendly M, Cullati S, Wagner C
… +3 more, Braggion A, Santschi V, Chiolero A
Eur J Public Health
· 2026 Mar · PMID 41678585
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BACKGROUND: Ensuring equitable healthcare provision is key in ageing societies, yet it may be hindered by financial barriers. We assessed trends and socioeconomic disparities in cost-related forgone medical care among Sw...BACKGROUND: Ensuring equitable healthcare provision is key in ageing societies, yet it may be hindered by financial barriers. We assessed trends and socioeconomic disparities in cost-related forgone medical care among Swiss adults aged 65 years and older between 2017 and 2024. METHODS: We used data from the 2017, 2021, and 2024 waves of the 'International Health Policy Survey', a population-based study of randomly sampled adults aged 65 or older (n = 2570, 1888, and 1948, respectively). Participants reported whether they had forgone medical prescriptions, consultations, medical tests, treatments or follow-up consultations, and dental visits due to cost. Weighted prevalence estimates were computed for services covered by the basic insurance and for dental care. Disparities by education and income were assessed using stratified analyses and the index of disparity. RESULTS: Participants' characteristics were stable across all waves (mean age 75; 54% women). In 2024, 20% reported forgoing at least one service due to cost (13% forgoing dental care, 13% insurance-covered services). Forgone care was similar in 2017 (21%) and lower in 2021 (16%). Forgone care was more frequent among men and participants aged 65-79 years. The index of disparity showed widening income-related disparities over time, while disparities by education remained stable. Dental care consistently showed the largest disparities. CONCLUSION: Despite Switzerland's compulsory health insurance, one in five older adults still forgo care for financial reasons. Rates of forgone care remained stable, but income disparities have widened since 2017.
Inyangetuk RS, San Sebastián M, Fonseca-Rodríguez O
Eur J Public Health
· 2026 Mar · PMID 41678567
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Sweden faces challenges in improving average health and reducing health inequalities simultaneously. Traditional research methods often measure these aspects separately, posing a dilemma for policymakers. Thus, the Popul...Sweden faces challenges in improving average health and reducing health inequalities simultaneously. Traditional research methods often measure these aspects separately, posing a dilemma for policymakers. Thus, the Population Health Performance Index (PHPI) has been proposed as a summary measure that integrates both aspects. This study aimed to determine the PHPI for self-rated health (SRH) by income and education in Sweden across its 21 regions. Data were obtained from the 2021 Health on Equal Terms survey, a population-based cross-sectional study from Sweden. This survey included 17 538 participants aged 16-84 years. The outcome was poor SRH, stratified by the highest and lowest education and income groups. The PHPI was calculated as a weighted average of the mean and inequality index according to a neutral inequality aversion weight of 0.5. The prevalence of poor SRH was 28.7%, with pronounced disparities between high- and low-income/education groups. Overall, the PHPI by income and educational inequality was closer to zero across regions, albeit small relative differences were observed among the regions compared. The index also revealed substantial spatial disparities between Sweden's northern and southern regions. The PHPI can be a complementary tool for policymakers to monitor social inequalities in health. The findings call for targeted interventions to address socioeconomic and regional disparities to achieve equity in health in Sweden.
Viskari T, Appelqvist-Schmidlechner K, Ståhl T
… +2 more, Vaara JP, Fröjd S
Eur J Public Health
· 2026 Mar · PMID 41678564
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Growing evidence emphasizes the crucial role of schools in promoting both physical activity (PA) and mental health. This study examined the associations of school-based PA promotion measures with mental health among scho...Growing evidence emphasizes the crucial role of schools in promoting both physical activity (PA) and mental health. This study examined the associations of school-based PA promotion measures with mental health among schoolchildren in Finland. The data were extracted from two sources: the Finnish School Health Promotion study providing individual-level data and the Finnish Benchmarking System for Health Promotion Capacity Building providing school-level data. The combined dataset comprised 87 372 schoolchildren from 1662 schools. The PA promotion efforts were measured in four categories. Mental health outcomes included depressive and anxiety symptoms, self-esteem, and prosocial behaviour. Multilevel binary logistic regression was used as a statistical method. In adjusted analyses, enabling the utilization of indoor sports facilities outside of physical education (PE) classes was associated with lower likelihood of low self-esteem (odds ratio [OR]: 0.93, 95% confidence interval [CI]: 0.87-0.99). Furthermore, extended PA breaks were associated with lower likelihood of low self-esteem among boys (OR: 0.91, 95% CI: 0.83-0.99), and enabling the utilization of indoor sports facilities outside of PE classes was associated with a lower likelihood of depressive symptoms among girls (OR: 0.93, 95% CI: 0.87-0.99). The simultaneous implementation of all four PA promotion measures was associated with better prosocial skills (OR: 1.06, 95% CI: 1.01-1.11). School-based PA promotion may enhance children's self-esteem and prosocial skills, and in girls reduce the risk of depressive symptoms, although the observed associations were particularly weak. To support the mental health of schoolchildren, PA should be promoted in schools through a variety of approaches.
Bird PW, Pan D, Trerattanavong K
… +4 more, Martin CA, Holmes C, Gray LJ, Pareek M
Eur J Public Health
· 2026 Mar · PMID 41666012
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Increases in the number of migrants (economic, educational, and involuntary) to Europe from countries with high incidence of communicable diseases [tuberculosis (TB), HIV, and hepatitis B (HBV) and C (HCV)]; has increase...Increases in the number of migrants (economic, educational, and involuntary) to Europe from countries with high incidence of communicable diseases [tuberculosis (TB), HIV, and hepatitis B (HBV) and C (HCV)]; has increased the need for cost-effective early disease diagnosis programmes to improve outcomes. We aimed to synthesize and evaluate current literature on community-based screening (CBS) initiatives in Europe, the diseases being screened for, and acceptance when offered. Database search (OVID Medicine, OBIFD EMCAre, and EMBRACE) of studies between January 2000 and January 2024 investigating CBS of newly arrived migrants for TB, HIV, HBV, and HCV in Europe (PROSPERO ID: 542289). Fifteen studies were included TB only (9/15, 60%), blood borne viruses (BBV) (2/15, 14%), and two or more diseases (4/15 26%). Ten (68%) studies were community-based, 3 (16%) in reception centres, 1 (8%) in primary care, and 1 (8%) mixed setting. Five (33%) studies included community leaders/members in recruitment and two (13%) performed follow-up on participants. Screening acceptance ranged from 41% to 100% (TB 41%-100%, BBV 78.5%-100%, TB/BBV 47.3%-100%) and disease prevalence ranged from 0.09% to 45.1% (TB 0.09%-45.1%, BBV 0.2%-8.7%, TB/BBV 3.2%-28.8%). There are few studies investigating CBS of TB or BBV in migrants in Europe, despite a rise in migration over the last decade. This review shows an urgent need for CBS of migrants for multiple infections that includes community members/leaders to improve acceptance rates and reduce disease mobility and mortality in a vulnerable population.
Eur J Public Health
· 2026 Mar · PMID 41656926
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Mental health issues are highly prevalent among precarious workers, often leading to prolonged sickness absence and unemployment. A worker's perceptions and attitudes about return-to-work are important determinants of wo...Mental health issues are highly prevalent among precarious workers, often leading to prolonged sickness absence and unemployment. A worker's perceptions and attitudes about return-to-work are important determinants of work resumption and can be categorized into three modes: an expectant, an ambivalent-uncertain, and an active return-to-work mode. To support professionals in identifying these modes, we developed the REturn-to-work MODe Evaluation (REMODE) tool. This study evaluated REMODE's inter-rater agreement, inter-item consistency, content validity, and usability. In a vignette study, 71 occupational health professionals from a Dutch social security institute viewed six videos of consultations between insurance physicians and precarious workers. They then used REMODE to assess the worker's return-to-work mode and need for occupational support. Participants also rated REMODE's validity and usability with 5-point Likert scale questions based on the Content Validity Index and System Usability Scale. We used a generalized linear mixed model to analyse inter-rater agreement and inter-item consistency. The professionals highly agreed on the REMODE-score [ICC 0.87 (95% CI 0.63-0.97)] and corresponding return-to-work mode [ICC 0.83 (0.54-0.95), Κω 0.75 (0.74-0.75)]. Their agreement on need for occupational support was moderate [ICC 0.65 (0.30-0.89), Κω 0.57 (0.56-0.57)]. REMODE's internal consistency demonstrated excellence (Cronbach's alpha 0.92), and the content validity index (0.83) and system usability scale (76) were acceptable. REMODE is a promising tool for occupational health professionals as it supports identification of the return-to-work mode of precarious workers with mental health issues. We propose a refined version of RE-MODE for use in occupational healthcare and research.
Lehtola TSM, Korhonen P, Wasenius N
… +2 more, Kautiainen H, Laine MK
Eur J Public Health
· 2026 Mar · PMID 41656916
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The effects of sport participation (SP) are typically assessed over relatively short time frames, with limited information regarding long-term impacts. The aims of this study were to evaluate the relationship of SP durin...The effects of sport participation (SP) are typically assessed over relatively short time frames, with limited information regarding long-term impacts. The aims of this study were to evaluate the relationship of SP during childhood or adolescence with physical activity (PA) and health-related quality of life (HRQoL) in adulthood. We performed an observational cross-sectional study. A population survey was conducted in two rural Finnish towns during 2005-7. Apparently healthy cardiovascular risk subjects aged 45-70 years were identified, and information regarding current PA and HRQoL (36-item Short Form Health Survey) and childhood or adolescent SP were gathered using questionnaires. Current PA was measured in metabolic equivalent hours per week (MET-h/week). Participants (n = 2503; mean age 58 years) were divided into three groups based on their SP levels during childhood or adolescence: none (n = 338), hobby (n = 1713), and competitive (n = 452). The mean level of current PA was 8.1 (SD 6.8) MET-h/week in none group, 9.2 (7.1) in hobby group, and 10.4 (7.8) in competitive group (P < .001). Participants in the competitive group reported significantly better HRQoL compared to other groups (P < .001). Childhood or adolescent SP modified the relationship between adulthood PA and HRQoL. Individuals with high levels of SP during childhood or adolescence were more likely to remain active in adulthood. SP in early life modified the association between adulthood PA and HRQoL and was also associated with better HRQoL in adulthood especially in mental health-related domains. These findings highlight the importance of promoting PA from an early age.
Lewis KM, Nguyen VG, Gilbert R
… +18 more, De Stavola B, Dearden L, Cant A, Downs J, Gimeno L, Farr W, Ford T, Harron K, Lilliman M, Logan S, Matthews J, Rahi J, Saxton J, Blackburn IWWTR, Ruiz M, Jay M, Stone A, Ramzan F
Eur J Public Health
· 2026 Mar · PMID 41653407
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Evidence of disparities in special educational needs and disability (SEND) provision at local authority (LA) level in England is needed to guide policies for equitable provision. We described LA-level variation in record...Evidence of disparities in special educational needs and disability (SEND) provision at local authority (LA) level in England is needed to guide policies for equitable provision. We described LA-level variation in recorded SEND provision using linked health-education records. We used linked hospital-primary school records (ECHILD - Education and Child Health Insights from Linked Data) to create a cohort of 3 729 265 children born in England between 2003/04-2012/13. LA of pupil's residential address and SEND provision [SEND support or Educational Health and Care Plan (EHCP)] were defined at Year 1 (5/6 years old). We compared single-level and multilevel logistic models, adjusting for individual-level sociodemographic, health indicators, and school governance, and stratifying by gestational age. In further multilevel models, we added LA characteristics. After accounting for individual-level characteristics, there was between 2.0% (SEND support compared with no SEND provision) and 5.8% (EHCPs compared with SEND support) residual unexplained variation between LAs across gestational age groups. Adding LA-level income deprivation reduced the between-LA variance for EHCPs by 14%-24% across gestational age groups; less so for other LA characteristics. Under 6% of the differences in school-recorded SEND provision in Year 1 between 2009/10 and 2018/19 was associated with the LA context. We need to carefully disentangle structural factors at the school and individual level to understand inequities in recorded SEND provision.
Eur J Public Health
· 2026 Mar · PMID 41641887
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BACKGROUND: In recent years, several high-income countries have experienced slowdowns in mortality improvements. Prior research has focused on how those changes have impacted life expectancy, but little is known about ho...BACKGROUND: In recent years, several high-income countries have experienced slowdowns in mortality improvements. Prior research has focused on how those changes have impacted life expectancy, but little is known about how they affected lifespan inequality. METHODS: Using data from the Human Mortality Database and World Health Organization Mortality Database, we quantify the contributions of changes in age- and cause-specific mortality to changes in lifespan inequality, measured by life disparity, across 20 high-income countries between 2010 and 2021. RESULTS: On average, life disparity declined by 0.3 years among both females and males between 2010 and 2019, with declines observed in all countries except for Canada and the United States. These declines were largely attributed to reductions in premature mortality, particularly from cardiovascular diseases and malignant neoplasms. Across English-speaking countries, these reductions were partly (e.g. Canada) or entirely (USA) offset by rising premature mortality related to neuropsychiatric conditions-mainly drug and alcohol use disorders. The COVID-19 pandemic was marked by increasing premature and old-age mortality, which partly contributed to the declines in life disparity in several, though not all, countries. CONCLUSION: Mortality dynamics since the 2010s have resulted in distinct changes in lifespan inequality, in addition to life expectancy, across high-income countries. Despite the slowdowns in mortality improvements, lifespans in most countries have become more equal in the decade preceding COVID-19. This trend was interrupted or reversed by the pandemic in many countries. Canada and the United Sates stood out in both periods due to rising premature mortality related to drug and alcohol use.
Eur J Public Health
· 2026 Mar · PMID 41632690
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The objective was to study the prospective associations between psychosocial work factors and mental health service use. The study used data from the national French periodical ESPS survey collected in 2010, 2012, and 20...The objective was to study the prospective associations between psychosocial work factors and mental health service use. The study used data from the national French periodical ESPS survey collected in 2010, 2012, and 2014 and linked to the national health insurance database. Psychosocial work factors included quantitative demands, tensions with the public, low freedom at work, low possibilities for learning new things, low colleague support, low recognition at work, low salary satisfaction, job insecurity, temporary contract, and redundancy plan. The number of exposures to these factors was calculated. Mental health service use from the national health insurance database was measured by visits to office- and hospital-based psychiatrists within the 2-year period following each survey wave. The prospective associations between psychosocial work factors and the 2-year incidence of mental health service use were studied using mixed effects Cox proportional hazards models with adjustment for covariates. The study sample included 8576 working men and women without mental health service use within the 6 months preceding survey wave. High quantitative demands, low freedom at work, and low colleague support were predictive of mental health service use. The higher the number of exposures, the higher the incidence of mental health service use. There was no gender-related interaction. The study brought support for the prospective associations between psychosocial work factors and mental health service use. Preventive measures towards psychosocial work factors, including multiple exposure, may help to reduce mental health service use and improve mental health among the working population.
Neufcourt L, Delpierre C, Kelly-Irving M
… +8 more, Farbu EH, Wilsgaard T, Grimsgaard S, Tang D, Vuckovic D, Chadeau-Hyam M, Sandanger TM, Castagné R
Eur J Public Health
· 2026 Mar · PMID 41627053
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Prior research has shown that high composite biological health scores (BHS, based on the allostatic load theory of multisystem physiological dysregulation) are associated with mortality. However, most of this work remain...Prior research has shown that high composite biological health scores (BHS, based on the allostatic load theory of multisystem physiological dysregulation) are associated with mortality. However, most of this work remains cross-sectional and does not explore the implications of long-term biological health changes, although this is an essential perspective for a better understanding of ageing and health span. To explore the relationship between BHS-at two time points and longitudinally-and mortality, we analysed waves six (2007-08) and seven (2015-16) of the Tromsø Study linked with all-cause mortality data from the Norwegian Population Registry up to 2022. Using 10 biomarkers from 8117 individuals, we created 2-category (low/high) Tromsø6-BHS, Tromsø7-BHS, and longitudinal BHS measures. Cox proportional hazard regression analysis adjusted for confounders revealed that both higher Tromsø6-BHS and Tromsø7-BHS were significant predictors of mortality 15 and 7 years later, respectively (Tromsø6-BHS: HR = 1.20 [0.99-1.45]; Tromsø7-BHS: HR = 1.26 [1.05-1.52]), and that the 7-year mortality risk was more pronounced for the longitudinal BHS (1.30 [1.09-1.56]). Corresponding sex- and age-adjusted median survival was lowered by 0.71, 1.69, and 1.84 years in participants with a high versus low Tromsø6-BHS, Tromsø7-BHS and longitudinal-BHS, respectively. These results indicate that both historical elevations of BHS and their cumulation over time play a role in determining mortality risk. Our findings underline the importance of monitoring biological health over the life course as a preventive measure and suggest that individuals with high BHS levels may benefit from dynamic monitoring from mid-adulthood to mitigate the risk of premature mortality.
Vynckier P, Schmidt M, Nayani S
… +3 more, Guariguata L, Devleesschauwer B, Verhaeghe N
Eur J Public Health
· 2026 Mar · PMID 41627052
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Alcohol use is associated with a high burden of disease, resulting in economic consequences. In Belgium, 77% of the population over the age of 15 regularly consume alcohol. Therefore, the objective of this study is to pr...Alcohol use is associated with a high burden of disease, resulting in economic consequences. In Belgium, 77% of the population over the age of 15 regularly consume alcohol. Therefore, the objective of this study is to provide updated estimates of the annual healthcare costs and productivity losses among the Belgian population. Data from the 2018 Belgian Health Interview Survey (BHIS) were linked with health insurance claims data. Healthcare costs were calculated on individuals' alcohol use patterns (current, former, abstainer). Lost productivity costs were calculated by multiplying the number of absence days by the national average wage cost per day. Univariate and multivariable regression analysis with negative binomial distribution and log link were performed to evaluate the average healthcare costs and indirect costs in relation to alcohol use, sociodemographic characteristics, and (behavioural) risk factors. Data from 10 829 individuals were available, of which 47.7% were men. A total of 76% subjects indicated that they currently drink alcohol. Compared to abstainers, significantly lower costs were found for current drinkers (€-470; P = .002). When looking at former drinkers, a significantly higher cost (€889; P = .02) was found compared with individuals who indicated that they never used alcohol. Taking into account that 7% of the Belgian population were former drinkers in 2018, the national costs for former drinkers equates to €711 288 900. Results of our study show that alcohol use has a large economic impact on the Belgian society. Especially former drinkers have a substantial impact on direct medical costs.
Liang R, Laverty AA, Feliu A
… +4 more, Martinez C, Peruga A, Vardavas C, Filippidis FT
Eur J Public Health
· 2026 Mar · PMID 41603344
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We conducted a secondary analysis of Eurobarometer survey data from 27 European countries, collected in 2017 (n = 28 300) and 2023 (n = 26 358), to assess changes in public support for standardised tobacco packaging. In...We conducted a secondary analysis of Eurobarometer survey data from 27 European countries, collected in 2017 (n = 28 300) and 2023 (n = 26 358), to assess changes in public support for standardised tobacco packaging. In the pooled analysis, support remained unchanged in the 19 MS without relevant legislation (adjusted Prevalence Ratio [aPR]=0.94, 95% Confidence Interval: 0.86-1.03), whereas the 8 MS that had implemented the policy by 2023 were significantly more likely to experience an increase in support (interaction term: aPR = 1.28, 1.17-1.41). The increase in support offers reassurance to policymakers advocating for tobacco packaging regulations and encourages MS to consider the adoption of similar policies.
Yang Z, Zhao Y, You J
… +15 more, Carcel C, Li Y, Xiang S, Kang J, Zhang W, Li Z, Zhang Y, Wang L, Xing P, Yang P, Feng J, Liu J, Zhou Y, Cheng W, Zhao Y
Eur J Public Health
· 2026 Mar · PMID 41589838
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Cardiovascular disease (CVD) is a major contributor to disability and the leading cause of global mortality. This study aims to perform a population-based prospective cohort study to examine the combined impact of multip...Cardiovascular disease (CVD) is a major contributor to disability and the leading cause of global mortality. This study aims to perform a population-based prospective cohort study to examine the combined impact of multiple lifestyle factors on CVD risk and examine the differences in the relationships across sociodemographic groups. We used data from the UK Biobank. Exposures include seven lifestyle behaviors (smoking, physical activity, alcohol consumption, diet, sleep duration, sedentary behavior, and social connection) and combined multiple behaviors. The lifestyle score was subsequently categorized as favorable (5 to 7 healthy lifestyle factors), intermediate (2 to 4 healthy lifestyle factors), and unfavorable (0 to 1 healthy lifestyle factor) lifestyle classes. Cox proportional hazards models were used to estimate hazard ratios (HRs) for incident CVD and its subtypes. This study showed a significant association of favorable lifestyle with incident CVD (HR = 0.58, 95% CI: 0.54-0.63), myocardial infarction (HR = 0.58, 95% CI: 0.54-0.64), and ischemic stroke (HR = 0.56, 95% CI: 0.48-0.65). Similarly, there was a significant association of intermediate lifestyle with incident CVD (HR = 0.69, 95% CI: 0.64-0.75), myocardial infarction (HR = 0.70, 95% CI: 0.64-0.77), and ischemic stroke (HR = 0.66, 95% CI: 0.57-0.77). The protection effect of lifestyle was more pronounced in the midlife group, females, and those individuals with high Townsend deprivation index levels. Adherence to a broad range of healthy lifestyle factors was associated with a significantly lower risk of CVD and subtypes. Lifestyle modification through multifactorial approaches should be prioritized for preventing and delaying onset of CVD.