Abstract
BackgroundExposure to natural outdoor environments (NOE) has been shown to be beneficial to older adults’ health and functioning, yet this assertion has rarely been tested in China. We investigated the relationships between exposure to NOE and older adults’ self-rated health in Shanghai, China and examined whether these relationships varied by sex, age, education and hukou status.MethodThis cross-sectional study used micro-data sample of the 2010 Shanghai population census, including 7962 older adults nested within 3345 neighbourhoods. Self-rated health was the outcome variable. Four NOE exposure indicators were calculated for each neighbourhood: the amount of surrounding greenness/blueness and proximity to large green/blue spaces. Multilevel logistic regression was employed to explore the association between natural outdoor environment exposure and self-rated health, adjusting for individual-level and neighbourhood-level covariates. Stratified analyses were used to examine variations by sex, age, education and hukou status.ResultsOlder adults living in neighbourhoods with higher surrounding greenness and higher proximity to both green spaces and blue spaces were more likely to report good health. Residential surrounding blueness was not significantly related to self-rated health. Females, those aged 60–69 years, those who had elementary school or junior high school education and those with non-local hukou benefit more from residential surrounding greenness, and those aged 70–79 years and who had elementary school or junior high school education benefit more from residential proximity to blue spaces.ConclusionsHigher residential greenness and proximity to both green spaces and blue spaces were associated with better self-rated health, particularly for females, younger older adults, the low educated and non-local hukou holders. Our findings suggest that urban green spaces and urban blue spaces have different effects on health among Chinese older adults and that the assessment of exposure matters to the investigation of NOE-health relationships.
Highlights
China has the largest number of older people in the world and is currently experiencing rapid population aging
Our findings suggest that urban green spaces and urban blue spaces have different effects on health among Chinese older adults and that the assessment of exposure matters to the investigation of natural outdoor environments (NOE)-health relationships
Participants who reported good health tended to reside in neighbourhoods with higher surrounding greenness/ blueness and closer proximity to green space/blue space
Summary
China has the largest number of older people in the world and is currently experiencing rapid population aging. NOE is associated with better self-reported mental health [7], reduced level of stress and mental disorders [8, 9] and reduction in all-cause mortality [10]. It is positively associated with longevity [11], improved cardiovascular health [12] and increased levels of walking activity [13] among older adults. Exposure to natural outdoor environments (NOE) has been shown to be beneficial to older adults’ health and functioning, yet this assertion has rarely been tested in China. We investigated the relationships between exposure to NOE and older adults’ self-rated health in Shanghai, China and examined whether these relationships varied by sex, age, education and hukou status
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