Key lifestyles and health outcomes across 16 prevalent chronic diseases: A network analysis of an international observational study

Jiaying Li, Daniel Yee Tak Fong, Kris Yuet Wan Lok, Janet Yuen Ha Wong, Mandy Man Ho, Edmond Pui Hang Choi, Vinciya Pandian, Patricia M. Davidson, Wenjie Duan, Marie Tarrant, Jung Jae Lee, Chia Chin Lin, Oluwadamilare Akingbade, Khalid M. Alabdulwahhab, Mohammad Shakil Ahmad, Mohamed Alboraie, Meshari A. Alzahrani, Anil S. Bilimale, Sawitree Boonpatcharanon, Samuel ByiringiroMuhammad Kamil Che Hasan, Luisa Clausi Schettini, Walter Corzo, Josephine M. De Leon, Anjanette S. De Leon, Hiba Deek, Fabio Efficace, Mayssah A. El Nayal, Fathiya El-Raey, Eduardo Ensaldo-Carrasco, Pilar Escotorin, Oluwadamilola Agnes Fadodun, Israel Opeyemi Fawole, Yong Shian Shawn Goh, Devi Irawan, Naimah Ebrahim Khan, Binu Koirala, Ashish Krishna, Cannas Kwok, Tung Thanh Le, Daniela Giambruno Leal, Miguel Ángel Lezana-Fernández, Emery Manirambona, Leandro Cruz Mantoani, Fernando Meneses-González, Iman Elmahdi Mohamed, Madeleine Mukeshimana, Chinh Thi Minh Nguyen, Huong Thi Thanh Nguyen, Khanh Thi Nguyen, Son Truong Nguyen, Mohd Said Nurumal, Aimable Nzabonimana, Nagla Abdelrahim Mohamed Ahmed Omer, Oluwabunmi Ogungbe, Angela Chiu Yin Poon, Areli Reséndiz-Rodriguez, Busayasachee Puang-Ngern, Ceryl G. Sagun, Riyaz Ahmed Shaik, Nikhil Gauri Shankar, Kathrin Sommer, Edgardo Toro, Hanh Thi Hong Tran, Elvira L. Urgel, Emmanuel Uwiringiyimana, Tita Vanichbuncha, Naglaa Youssef

Research output: Contribution to journalArticlepeer-review


Background: Central and bridge nodes can drive significant overall improvements within their respective networks. We aimed to identify them in 16 prevalent chronic diseases during the coronavirus disease 2019 (COVID-19) pandemic to guide effective intervention strategies and appropriate resource allocation for most significant holistic lifestyle and health improvements. Methods: We surveyed 16 512 adults from July 2020 to August 2021 in 30 territories. Participants self-reported their medical histories and the perceived impact of COVID-19 on 18 lifestyle factors and 13 health outcomes. For each disease subgroup, we generated lifestyle, health outcome, and bridge networks. Variables with the highest centrality indices in each were identified central or bridge. We validated these networks using nonparametric and case-dropping subset bootstrapping and confirmed central and bridge variables' significantly higher indices through a centrality difference test. Findings: Among the 48 networks, 44 were validated (all correlation-stability coefficients >0.25). Six central lifestyle factors were identified: less consumption of snacks (for the chronic disease: anxiety), less sugary drinks (cancer, gastric ulcer, hypertension, insomnia, and pre-diabetes), less smoking tobacco (chronic obstructive pulmonary disease), frequency of exercise (depression and fatty liver disease), duration of exercise (irritable bowel syndrome), and overall amount of exercise (autoimmune disease, diabetes, eczema, heart attack, and high cholesterol). Two central health outcomes emerged: less emotional distress (chronic obstructive pulmonary disease, eczema, fatty liver disease, gastric ulcer, heart attack, high cholesterol, hypertension, insomnia, and pre-diabetes) and quality of life (anxiety, autoimmune disease, cancer, depression, diabetes, and irritable bowel syndrome). Four bridge lifestyles were identified: consumption of fruits and vegetables (diabetes, high cholesterol, hypertension, and insomnia), less duration of sitting (eczema, fatty liver disease, and heart attack), frequency of exercise (autoimmune disease, depression, and heart attack), and overall amount of exercise (anxiety, gastric ulcer, and insomnia). The centrality difference test showed the central and bridge variables had significantly higher centrality indices than others in their networks (P < 0.05). Conclusion: To effectively manage chronic diseases during the COVID-19 pandemic, enhanced interventions and optimised resource allocation toward central lifestyle factors, health outcomes, and bridge lifestyles are paramount. The key variables shared across chronic diseases emphasise the importance of coordinated intervention strategies.

Original languageEnglish
Article number04068
Pages (from-to)4068
Number of pages1
JournalJournal of Global Health
Publication statusPublished - Apr 12 2024

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health


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