Community human settlement and self-rated health among older adults: the mediating role of sleep quality.

Introduction: Against the backdrop of rapid population aging, the community human settlement, as a crucial social environmental factor influencing the health levels of older adults, has increasingly become a focal point in public health research. Methods: Based on survey data from 2,113 older adults in Shanghai, China, this study employed the entropy method to construct a multi-dimensional community human settlement evaluation system encompassing the physical environment, social environment, and service accessibility. Multiple regression, instrumental variable methods, and mediation effect models were utilized to systematically analyze the pathways of influence and mechanisms of the community human settlement on the self-rated health of older adults. Results: The quality of the community human settlement was significantly positively correlated with the self-rated health levels of older adults, with community convenience and neighborhood support playing particularly prominent roles. Sleep quality exerted a significant mediating effect in this relationship, explaining 46% of the total effect. Among different groups, older adults with low income, those not married, and those with higher education levels were more sensitive to changes in the community human settlement, exhibiting stronger heterogeneity in health responses. Discussion: From the perspectives of ecological systems theory and the social determinants of health, this study reveals the psycho-physiological mechanism through which the community environment influences the health of older adults via sleep quality. It identifies environmentally sensitive high-risk groups, providing a theoretical basis and practical pathways for precise interventions in the construction of age-friendly communities.