Environmental risk factors and pain associated with lower successful-aging likelihood in Chinese cohort

A prospective cohort analysis of 3,756 Chinese adults aged 60 or older found that higher scores for living environmental risk factors and the presence of pain were each associated with a lower likelihood of successful aging. The study used data from the 2011 wave of the China Health and Retirement Longitudinal Study, with follow-up through 2018. The published abstract reports that these relationships remained evident in joint-category and subgroup analyses, although the observational design does not establish that either factor caused the outcomes.

Researchers combined six environmental domains into a living environmental risk factors score: outdoor PM₂.₅, household energy sources, water sources, housing type, indoor temperature and relative humidity. Pain was assessed through self-reported questionnaires, while successful aging was defined using the Rowe and Kahn theoretical framework. The investigators analyzed associations with successful aging through Cox regression and used restricted cubic splines to characterize dose-response relationships.

In the Cox models, each higher living environmental risk factors score was associated with a lower hazard of successful aging, with a hazard ratio of 0.80 and a 95% confidence interval of 0.72 to 0.89. Restricted cubic spline analysis indicated a linear inverse association, with a P value of 0.968 for non-linearity. Participants reporting pain had a substantially lower hazard of successful aging than those without pain, with a hazard ratio of 0.44 and a 95% confidence interval of 0.31 to 0.64.

The joint-category analysis showed the lowest hazard of successful aging among participants classified as having higher living environmental risk factors and pain. Relative to the reference group of lower environmental risk with no pain, this group had a hazard ratio of 0.26 and a 95% confidence interval of 0.15 to 0.44. This was a joint-category comparison, not evidence of a statistical interaction between the two factors. The abstract reports that associations were more pronounced among women, people with kidney disease and participants with lower educational attainment, and that sensitivity analyses supported the robustness of the findings.

Because the available source is an abstract of an accepted article whose version of record may undergo further editing, it does not provide enough methodological detail to assess potential confounding, attrition, measurement error or the complete set of successful-aging criteria. The results therefore describe longitudinal associations in the CHARLS cohort rather than causal effects or the likely impact of an intervention. The findings are also specific to the cohort’s population, exposure measures and observation period and should not be interpreted as a universal effect for all older adults.

Subject of Research: Associations of environmental risk factors and pain with successful aging in older Chinese adults

Article Title: Associations of living environmental risk factors and pain with successful aging among older adults in China: longitudinal evidence from the CHARLS cohort

Article References: Liu, F., Luo, H., Huang, Y., Chen, W., Hu, Y., & Zhu, X. (2026). Associations of living environmental risk factors and pain with successful aging among older adults in China: longitudinal evidence from the CHARLS cohort. BMC Public Health. https://doi.org/10.1186/s12889-026-29981-8

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29981-8

Keywords: successful aging, CHARLS, environmental risk factors, pain, older adults, China, prospective cohort, air pollution, Associations, living, environmental, risk