This study investigates the association between a healthy lifestyle and the likelihood of becoming a centenarian among individuals aged 80 years or older in China. Using data from the Chinese Longitudinal Healthy Longevity Survey, a nationally representative cohort, the researchers constructed a healthy lifestyle score (HLS-100) based on smoking, exercise, and dietary diversity. The primary outcome was survivorship to becoming a centenarian by 2018. The sample included 5222 participants, with 1454 identified centenarians and 3768 controls matched by age, sex, and year of entry. During a median follow-up of 5 years, 373 individuals with the lowest HLS-100 (0-2) and 276 individuals with the highest HLS-100 (5-6) became centenarians. The adjusted odds ratio (AOR) comparing the highest vs the lowest HLS-100 groups was 1.61 (95% CI, 1.32-1.96; P < .001 for trend). The findings suggest that adhering to a healthy lifestyle is important even at very advanced ages, highlighting the potential role of strategic plans to improve lifestyle behaviors in promoting healthy aging and longevity.This study investigates the association between a healthy lifestyle and the likelihood of becoming a centenarian among individuals aged 80 years or older in China. Using data from the Chinese Longitudinal Healthy Longevity Survey, a nationally representative cohort, the researchers constructed a healthy lifestyle score (HLS-100) based on smoking, exercise, and dietary diversity. The primary outcome was survivorship to becoming a centenarian by 2018. The sample included 5222 participants, with 1454 identified centenarians and 3768 controls matched by age, sex, and year of entry. During a median follow-up of 5 years, 373 individuals with the lowest HLS-100 (0-2) and 276 individuals with the highest HLS-100 (5-6) became centenarians. The adjusted odds ratio (AOR) comparing the highest vs the lowest HLS-100 groups was 1.61 (95% CI, 1.32-1.96; P < .001 for trend). The findings suggest that adhering to a healthy lifestyle is important even at very advanced ages, highlighting the potential role of strategic plans to improve lifestyle behaviors in promoting healthy aging and longevity.