ArticleBMC public health2025
The structural association between community environment and health vulnerability with the mediation role of sleep quality and social values among middle-aged and elderly adults in China: nationwide cross-sectional study.
Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHealth vulnerability reflects the adverse state of below-normal health of middle-aged and elderly adults in the process of population aging under the influence of internal and external risk perturbations, and is a comprehensive assessment of individual health status. However, there is a lack of clarity about whether and how the community environment influences the health vulnerability of middle-aged and older adults. This study aims to elaborate the complex pathways of sleep quality, social values, and anti-fragile capacity between community environment and health vulnerability, and to provide a scientific basis for promoting healthy aging in China.
methodsThis study was screened to finally include 8,032 middle-aged and older adults who participated in the China Family Panel Studies Database 2020 survey. While controlling for confounders we used structural equation modeling (SEM) to analyze the parallel mediating roles of sleep quality, social values, and anti-fragile capacity in community environment and health vulnerability, and subgroup analyses to explore the heterogeneity of the effects across subgroups of the population.
resultsThe composite index of health vulnerability of Chinese middle-aged and elderly adults was 0.227 (SD = 0.129). Community environment was positively correlated with sleep quality, social values, and anti-fragile capacity (p < 0.05). Community environment, sleep quality, and anti-fragile capacity were negatively correlated with health vulnerability. In addition, after adjusting for confounders, sleep quality, social values, and anti-fragile capacity were able to partially mediate the association between community environment and health vulnerability among middle-aged and olderadults, with mediating effects of 19.50%, 3.06%, and 2.20%, respectively(p < 0.05). Subgroup analyses further showed that the mediating effects of sleep quality, social values, and anti-fragile capacity on community environment and health vulnerability differed across age, gender, and place of residence subgroups.
conclusionsThis study found a complex relationship between community environment, sleep quality, social values, anti-fragile capacity, and health vulnerability in middle-aged and older adults. Various intervention paths should be taken to improve the aging-friendly level of community environments and build home-friendly retirement communities to alleviate the health vulnerability of the middle-aged and elderly groups and promote healthy aging in China. CLINICAL TRIAL NUMBER: Not applicable.
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