Living environmental quality and incident cardiometabolic multimorbidity: a prospective cohort study in China
Abstract
Background: Cardiometabolic multimorbidity (CMM) is an increasing public health concern in ageing populations. Although individual residential environmental factors have been linked to cardiometabolic health, the association of multidimensional living environmental quality with incident CMM remains unclear. We aimed to construct a Living Environmental Quality (LEQ) index and examine its association with incident CMM among middle-aged and older adults in China.
Methods: We included 6,330 CHARLS participants aged ≥ 45 years who were free of CMM at baseline. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between baseline LEQ and incident CMM, adjusting for sociodemographic, behavioral, and clinical covariates. Sensitivity and subgroup analyses were performed to assess the robustness and consistency of the results.
Results: During 7 years of follow-up, 482 participants (7.6%) developed CMM. After multivariable adjustment, compared with the high-risk LEQ group, the HRs for incident CMM were 0.78 (95% CI: 0.64–0.96, P = 0.017) in the middle-risk group and 0.51 (95% CI: 0.37–0.72, P < 0.001) in the low-risk group. Among individual environmental factors, residence in a multi-storey building (HR = 0.56, 95% CI: 0.45–0.70, P < 0.001) and access to tap water (HR = 0.75, 95% CI: 0.62–0.90, P = 0.002) were associated with lower hazards of incident CMM. The overall association remained generally consistent across sensitivity analyses.
Conclusion: More favorable residential environmental quality at baseline was associated with a lower risk of incident CMM among middle-aged and older Chinese adults. These findings suggest that multidimensional residential environmental conditions may play a role in cardiometabolic health, although residual confounding and limitations of the LEQ construct should be considered. Further studies are needed to confirm these associations.
Related
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- Routine metabolic–adiposity indices and incident cardiometabolic multimorbidity among adults with CKM stages 0–3: a prospective cohort study
- Estimated cardiorespiratory fitness and incident cardiometabolic multimorbidity: findings from three nationally representative cohorts
- Estimated cardiorespiratory fitness and incident cardiometabolic multimorbidity: evidence from the CHARLS cohort
BibTeX
@article{chen2026living,
title = {{Living environmental quality and incident cardiometabolic multimorbidity: a prospective cohort study in China}},
author = {Hao Chen and Shengnan Yue and Shengyan Hou and Liying Wu and Yiqiang Wang and Jiajuan Guo},
journal = {BMC Public Health},
year = {2026},
month = oct,
doi = {10.1186/s12889-026-29751-6},
url = {https://link.springer.com/10.1186/s12889-026-29751-6},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Living environmental quality and incident cardiometabolic multimorbidity: a prospective cohort study in China
AU - Hao Chen
AU - Shengnan Yue
AU - Shengyan Hou
AU - Liying Wu
AU - Yiqiang Wang
AU - Jiajuan Guo
PY - 2026
DA - 2026/10/06
JO - BMC Public Health
DO - 10.1186/s12889-026-29751-6
UR - https://link.springer.com/10.1186/s12889-026-29751-6
AB - Background: Cardiometabolic multimorbidity (CMM) is an increasing public health concern in ageing populations. Although individual residential environmental factors have been linked to cardiometabolic health, the association of multidimensional living environmental quality with incident CMM remains unclear. We aimed to construct a Living Environmental Quality (LEQ) index and examine its association with incident CMM among middle-aged and older adults in China. Methods: We included 6,330 CHARLS participants aged ≥ 45 years who were free of CMM at baseline. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between baseline LEQ and incident CMM, adjusting for sociodemographic, behavioral, and clinical covariates. Sensitivity and subgroup analyses were performed to assess the robustness and consistency of the results. Results: During 7 years of follow-up, 482 participants (7.6%) developed CMM. After multivariable adjustment, compared with the high-risk LEQ group, the HRs for incident CMM were 0.78 (95% CI: 0.64–0.96, P = 0.017) in the middle-risk group and 0.51 (95% CI: 0.37–0.72, P < 0.001) in the low-risk group. Among individual environmental factors, residence in a multi-storey building (HR = 0.56, 95% CI: 0.45–0.70, P < 0.001) and access to tap water (HR = 0.75, 95% CI: 0.62–0.90, P = 0.002) were associated with lower hazards of incident CMM. The overall association remained generally consistent across sensitivity analyses. Conclusion: More favorable residential environmental quality at baseline was associated with a lower risk of incident CMM among middle-aged and older Chinese adults. These findings suggest that multidimensional residential environmental conditions may play a role in cardiometabolic health, although residual confounding and limitations of the LEQ construct should be considered. Further studies are needed to confirm these associations.
SN - 1471-2458
ER -