China is undergoing rapid population aging, with chronic non-communicable diseases (NCDs) becoming the leading cause of death and disability. Taining County, located in a mountainous area of Fujian Province, faces a higher-than-average aging population and a growing burden of hypertension, diabetes, dyslipidemia, and cardiovascular diseases. Early detection and standardized management remain insufficient, and healthcare resources are limited. This study will establish a prospective cohort covering ≥20,000 residents, integrating demographic, lifestyle, clinical, laboratory, and imaging data. Active follow-up will be conducted annually, complemented by passive follow-up through local healthcare and death registry systems. The study will (1) identify epidemiological features and risk factors of common chronic diseases, (2) explore multimorbidity and aging trajectories, and (3) develop a replicable "Taining Model" for chronic disease prevention and management at the county level. The results will provide an evidence base for public health decision-making and chronic disease control strategies in similar rural and mountainous regions.
