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Background <p>With the rapid progression of population aging in China, gastrointestinal (GI) diseases have become one of the most common chronic conditions among middle-aged and older adults, substantially impairing quality of life and increasing healthcare burdens. However, evidence regarding the combined effects of multiple living environment factors and their potential interactions on GI health remains limited.</p> Methods <p>This study used data from the China Health and Retirement Longitudinal Study from 2011 to 2020, including 10,032 middle-aged and older adults. The living environment quality (LEQ) was assessed based on building type, temperature comfort, water source, heating and cooking fuel, and PM<sub>2.5</sub> exposure. Logistic regression and Cox proportional hazards models were applied to examine cross-sectional and longitudinal associations between LEQ and GI diseases.</p> Results <p>The results showed that each one-point increase in LEQ score was associated with a higher risk of GI diseases in both cross-sectional analysis (OR = 1.05, 95% CI: 1.01–1.08, <i>P</i> = 0.013) and longitudinal analysis (HR = 1.06, 95% CI: 1.02–1.10, <i>P</i> &lt; 0.001). Compared with the favorable LEQ group, the unfavorable LEQ group showed significantly higher odds and risks of GI diseases in cross-sectional (OR = 1.18, 95% CI: 1.03–1.35, <i>P</i> = 0.018) and longitudinal analyses (HR = 1.26, 95% CI: 1.10–1.45, <i>P</i> &lt; 0.001), respectively, with a clear dose-response relationship. In longitudinal analyses, non-tap water and dual solid fuel for heating and cooking were significantly associated with an increased risk of GI diseases (all <i>P</i> &lt; 0.05). Kaplan-Meier analysis further showed significant differences in the cumulative incidence of GI diseases across LEQ groups (log-rank <i>P</i> &lt; 0.0001), with poorer LEQ associated with higher cumulative incidence. These associations remained robust in subgroup, interaction, and sensitivity analyses.</p> Conclusions <p>Poorer LEQ may be associated with an increased risk of GI diseases among middle-aged and older adults, with non-tap water use and dual solid fuel use found as important environmental factors.</p>

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Association between living environmental quality and risk of gastrointestinal diseases among middle-aged and older adults: evidence from a national study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • Endian Liu,
  • Yanbin Wei,
  • Minjiao Wang,
  • Yanqing Liu,
  • Xin Yao,
  • Jie Xing

摘要

Background

With the rapid progression of population aging in China, gastrointestinal (GI) diseases have become one of the most common chronic conditions among middle-aged and older adults, substantially impairing quality of life and increasing healthcare burdens. However, evidence regarding the combined effects of multiple living environment factors and their potential interactions on GI health remains limited.

Methods

This study used data from the China Health and Retirement Longitudinal Study from 2011 to 2020, including 10,032 middle-aged and older adults. The living environment quality (LEQ) was assessed based on building type, temperature comfort, water source, heating and cooking fuel, and PM2.5 exposure. Logistic regression and Cox proportional hazards models were applied to examine cross-sectional and longitudinal associations between LEQ and GI diseases.

Results

The results showed that each one-point increase in LEQ score was associated with a higher risk of GI diseases in both cross-sectional analysis (OR = 1.05, 95% CI: 1.01–1.08, P = 0.013) and longitudinal analysis (HR = 1.06, 95% CI: 1.02–1.10, P < 0.001). Compared with the favorable LEQ group, the unfavorable LEQ group showed significantly higher odds and risks of GI diseases in cross-sectional (OR = 1.18, 95% CI: 1.03–1.35, P = 0.018) and longitudinal analyses (HR = 1.26, 95% CI: 1.10–1.45, P < 0.001), respectively, with a clear dose-response relationship. In longitudinal analyses, non-tap water and dual solid fuel for heating and cooking were significantly associated with an increased risk of GI diseases (all P < 0.05). Kaplan-Meier analysis further showed significant differences in the cumulative incidence of GI diseases across LEQ groups (log-rank P < 0.0001), with poorer LEQ associated with higher cumulative incidence. These associations remained robust in subgroup, interaction, and sensitivity analyses.

Conclusions

Poorer LEQ may be associated with an increased risk of GI diseases among middle-aged and older adults, with non-tap water use and dual solid fuel use found as important environmental factors.