Socioeconomic factors outweigh perceived built environmental influences on self-rated health among middle-aged and older adults in western China.

Objective: Previous environmental evidence has demonstrated that supportive environments can improve population health by reducing environmental hazards. However, the extent to which such environments can further enhance health outcomes by promoting physical activity and encouraging proactive health behaviors remains unclear once socioeconomic inequalities are considered. Method: A cross-sectional community survey was conducted among community-dwelling middle-aged and older residents in Nanchong, China. The validated Chinese version of the Neighborhood Environment Walkability Scale-Abbreviated (NEWS-A), the SF-36 General Health subscale, and the Chinese short form of the International Physical Activity Questionnaire (IPAQ-SF) were used to measure perceived built environment, self-rated health and physical activity, respectively. A structural equation model (SEM) was employed to test whether the perceived built environment was associated with self-rated health via physical activity and body mass index. Model estimation utilized the WLSMV method to handle ordinal data, with model fit rigorously assessed using standard indices and a prior confirmatory factor analysis. Direct, indirect, and total effects were estimated with robust standard errors. Results: Among 3,753 participants (mean age 50.1 years; 39.5% men), the final SEM showed excellent fit. After adjustment for socioeconomic and demographic covariates, perceived built environment did not affect self-rated health (all Conclusion: After controlling socioeconomic and demographic characteristics, the perceived built environment showed no independent association with self-rated health. This suggests that social and economic gaps may outweigh and potentially obscure the health benefits of supportive neighborhood environments in similar contexts.