Research report: Living environmental quality and incident cardiometabolic multimorbidity: a prospective cohort study in China

In a prospective cohort study of 6,330 middle-aged and older adults in China, more favorable residential environmental quality at baseline was associated with a lower hazard of developing cardiometabolic multimorbidity during seven years of follow-up. Among participants who were free of the condition at baseline, 482, or 7.6%, developed cardiometabolic multimorbidity. Compared with the high-risk Living Environmental Quality group, the middle-risk group had an adjusted hazard ratio of 0.78 (95% CI 0.64–0.96; P = 0.017), while the low-risk group had an adjusted hazard ratio of 0.51 (95% CI 0.37–0.72; P < 0.001).

The study used data from the China Health and Retirement Longitudinal Study and included adults aged 45 years or older. The researchers constructed a Living Environmental Quality, or LEQ, index to combine multiple dimensions of the residential environment rather than focusing on a single household feature. Cox proportional hazards models estimated hazard ratios and 95% confidence intervals for incident cardiometabolic multimorbidity, with adjustment for sociodemographic, behavioral and clinical covariates.

The observational design supports an association between baseline residential conditions and subsequent events, but it did not establish that changes in housing or other environmental exposures would cause the observed differences. Two individual environmental factors were also associated with lower hazards of incident cardiometabolic multimorbidity. Residence in a multi-storey building was associated with a hazard ratio of 0.56 (95% CI 0.45–0.70; P < 0.001), and access to tap water was associated with a hazard ratio of 0.75 (95% CI 0.62–0.90; P = 0.002).

These estimates apply to the study population and describe associations in the adjusted models; they do not show that either feature alone prevents disease or reveal the effect of changing a participant’s residence or water access. The overall association between LEQ and incident CMM remained generally consistent across the sensitivity analyses conducted by the researchers. The findings suggest that the combination of residential conditions may be relevant to cardiometabolic health among middle-aged and older adults in China.

The authors noted that residual confounding and limitations of the LEQ construct should be considered, and that further studies are needed to confirm the associations. The research was published in BMC Public Health as an early-access article on 6 October 2026, with the accompanying notice stating that the version could undergo further editorial changes before the final Version of Record.

Subject of Research: Associations between residential environmental quality and incident cardiometabolic multimorbidity among middle-aged and older Chinese adults

Article Title: Living environmental quality and incident cardiometabolic multimorbidity: a prospective cohort study in China

Article References: Chen, H., Yue, S., Hou, S., Wu, L., Wang, Y., & Guo, J. (2026). Living environmental quality and incident cardiometabolic multimorbidity: a prospective cohort study in China. BMC Public Health. https://doi.org/10.1186/s12889-026-29751-6

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29751-6

Keywords: cardiometabolic multimorbidity, residential environment, environmental quality, CHARLS, China, older adults, prospective cohort, tap water, housing, public health, Living, environmental