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Abstract

Background and Objectives

Limited longitudinal study exists on the combined effects of environmental factors and life-course socioeconomic status (SES) on multimorbidity in China. This study aims to explore the cumulative impact of age-friendly neighborhoods on multimorbidity over time, focusing on SES moderation.

Research Design and Methods

Analyzing data from 10,125 participants in the China Health and Retirement Longitudinal Survey (2011-2020), this study assessed multimorbidity through self-reported chronic diseases and evaluated neighborhood environments using eight domains from the Age-Friendly Cities and Communities framework. Childhood and adulthood SES were measured using latent class analysis. Latent growth curve models examined the effects of neighborhood environment, life-course SES, and their interactions on multimorbidity.

Results

The study found a statistically significant increase in multimorbidity over time, with an intercept of 0.514 and a slope of 0.085. Notably, government support showed an independent association with the baseline number of chronic diseases (β = -0.078, p < 0.1). The interaction between government support and childhood SES was also significant (β = -0.183, p < 0.05), suggesting that unfavorable childhood SES could reduce the protective effects of government support. Additionally, adulthood SES interacted with factors such as information infrastructure (β = -0.068, p < 0.001) and neighborly support (β = -0.092, p < 0.1), and transportation interacted with childhood SES (β = -0.028, p < 0.05), all negatively affecting the rate of change in multimorbidity. These findings suggest that individuals with higher SES derive greater benefits from these age-friendly neighborhood environment domains compared to their lower SES counterparts.

Discussion and Implications

Age-friendly neighborhoods with strong government support, neighborly support, and developed infrastructure slow multimorbidity progression. However, these benefits are influenced by life-course SES. Policymakers should consider disadvantaged populations' access to environmental resources and address potential neighborhood socioeconomic health inequalities.

Age-Friendly Cities and Communities, Environmental inequality, Longitudinal study, Latent growth curve modelling
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© The Author(s) 2025. Published by Oxford University Press on behalf of the Gerontological Society of America.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
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ORIGINAL RESEARCH ARTICLE
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    • Supplementary data

    igaf039_suppl_Supplementary_Materials_1 - docx file

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