Age-Friendly Communities and Mortality Risk Among Older Adults in China: A Study Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS)

Background: With the progression of aging and urbanization, the relationship between the external environment and health has gained increasing attention. This study examined the association between comprehensive community environments and mortality risk among older adults from a macro-level perspective.Methods: We used longitudinal data from the 2014-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), which includes information on community environments. Guided by the World Health Organization's framework for age-friendly communities, we constructed five domains: natural environment, medical support, living security, public education, and community support. Multilevel binary logistic regression models were used to examine the associations between these age-friendly community characteristics and mortality risk among older adults in 2018.Results: Among 3810 older adults (aged 60-117), a better natural environment (OR: 0.78 and 95% CI: 0.60-1.02) and stronger living security (OR: 0.41 and 95% CI: 0.26-0.65) were significantly associated with reduced mortality risk. Specifically, in communities with better medical support, older adults who were ethnic minorities, lived alone, or had higher household incomes exhibited a lower risk of mortality. Living security was particularly effective in reducing mortality risk among those living with a spouse. However, drinkers in communities with stronger community support showed a higher mortality risk.Conclusion: Mitigating environmental degradation and ensuring equitable service provision are essential for building age-friendly communities. While enhancing the health and wellbeing of all older adults is important, particular attention should be given to vulnerable groups, such as those with lower incomes or limited family support.