Association between living environmental quality and body pain in middle-aged and older adults: a national study in China.

Abstract

Background: Body pain affecting over 30% of China's aging population, imposes significant socioeconomic burdens, yet environmental determinants remain understudied. This national study investigates associations between multidimensional living environments and pain among middle-aged and older adults.

Methods: Using 2011-2020 data from the China Health and Retirement Longitudinal Study (CHARLS), eligible participants were included in cross-sectional and longitudinal analyses. Living environmental quality was assessed via five indicators: building types, household temperatures, water sources, energy sources, and outdoor PM2.5 exposure, categorized into favorable, moderate, and unfavorable. Pain outcomes included upper limb, lower limb, trunk, head and neck, and multisite pain. Logistic and Cox regression models were utilized to examine associations between living environment quality and body pain.

Results: Cross-sectionally, unfavorable environments were linked to higher prevalence of single-site (e.g., lower limb OR: 2.05, 95% CI: 1.78-2.37) and multisite pain (OR: 2.02, 95% CI: 1.77-2.32) versus suitable environments, with significant dose-response relationships (all P-values for trend < 0.001). In longitudinal analyses, unfavorable environments increased 9-year incident pain risks: upper limb (HR: 1.30, 95% CI: 1.20-1.41), lower limb (HR: 1.39, 95% CI: 1.28-1.50), trunk (HR: 1.18, 95% CI: 1.09-1.28), head and neck (HR: 1.20, 95% CI: 1.10-1.31), and multisite pain (HR: 1.31, 95% CI: 1.21-1.42), with consistent dose-response patterns (all P-values for trend < 0.001). Kaplan-Meier curves demonstrated a significant difference in pain incidence across different living environment groups within the entire cohort (all P-values for log-rank test < 0.001).

Conclusions: Cumulative environmental exposures independently predict pain incidence among middle-aged and older adults in China. Targeted upgrades to the living environment could reduce pain burdens, informing healthy aging policies in China and similar settings.