Does where you live matter to your health? Investigating factors that influence the self-rated health of urban and rural Chinese residents: evidence drawn from Chinese General Social Survey data

Background: China's rapid urbanization over the past decades has exacerbated the problems of environmental degradation and health disparities. However, few studies have analysed the differences between urban and rural residents in relation to how environmental quality impacts health outcomes. This study examines the associations between Chinese people's perceptions of environmental quality and their self-rated health, particularly focusing on differences between rural and urban residents in environment-health relationships. Methods: Using a logistic regression model and data from the 2013 Chinese General Social Survey (CGSS), a representative sample of data for 3,402 urban residents (46 +/- 16 years) and 2,439 rural residents (48 +/- 15 years) was analysed. The dependent variable used for the logistic regressions was whether or not respondents reported being healthy. Independent variables included respondents' evaluations of the living environment, and how frequently they participated in physical activities. Interaction terms were employed to measure the moderating effects of physical exercise on the relationship between perceived environmental quality and health. Results: The percentage of healthy urban residents was significantly larger than that of healthy rural respondents (70.87% versus 62.87%). Urban respondents living in areas with sufficient green space were more likely to report good health (OR = 0.749, CI = [0.628, 0.895]), while rural respondents without reliable access to fresh water were more likely to report poor health (OR = 0.762, CI = [0.612, 0.949]). Urban respondents who were exposed to green spaces and exercised frequently were 21.6 per cent more likely to report good health than those who exercised infrequently (OR = 1.216, CI = [1.047, 1.413]). Those who lived in areas with insufficient green space and exercised frequently were 19.1 per cent less likely to report good health than those who exercised infrequently (OR = 0.805, CI = [0.469, 1.381]). No evidence suggested that physical exercise exerted a moderating effect on the relationship between exposure to air pollution and health. Conclusions: On average, urban residents have better health than rural residents. Among four indicators for low environmental quality (air pollution, lack of green spaces, water pollution, uncertain access to freshwater resources), green space was an important determinant of urban residents' health status, while unreliable access to fresh water harmed rural residents' health. Physical exercise moderated the effects of exposure to green spaces on urban residents' health.