Associations of environmental factors with elderly health and mortality in China.

OBJECTIVES We examined the effects of community socioeconomic conditions, air pollution, and the physical environment on elderly health and survival in China. METHODS We analyzed data from a nationally representative sample of 15 973 elderly residents of 866 counties and cities with multilevel logistic regression models in which individuals were nested within each county or city. RESULTS After control for individual-level factors, communities' gross domestic product per capita, adult labor force participation rate, and illiteracy rate were significantly associated with physical, mental, and overall health and mortality among the elderly in China. We also found that air pollution increased the odds of disability in activities of daily living (ADLs), cognitive impairment, and health deficits; more rainfall was protective, reducing the odds of ADL disability and cognitive impairment; low seasonal temperatures increased the odds of ADL disability and mortality; high seasonal temperatures increased the odds of cognitive impairment and deficits; and living in hilly areas decreased the odds of ADL disability and health deficits. CONCLUSIONS Efforts to reduce pollution and improve socioeconomic conditions could significantly improve elderly health and survival.