Neighborhood Built Environment and Self-Rated Health among Community-Dwelling Adults: The Mediating Role of Sleep Quality and the Moderating Role of Socioeconomic Status

Abstract

Background: Built environments are recognized as essential factors influencing health outcomes among older adults. However, the extent to which such environments can further enhance health outcomes by promoting sleep quality remains unclear. This study explored whether sleep quality mediates the relationship between neighborhood-built environment and self-rated health among community-dwelling adults in Sichuan, China, and examined the conditional effects of socioeconomic status (SES) and residency.
Methods: A cross-sectional survey was conducted among 422 residents in Gaoping District, Nanchong. Moderated mediation analysis was applied using regression-based models to examine direct, indirect, and conditional pathways.

Results: Analysis revealed a negative correlation between the built environment and sleep quality (p < 0.001). Sleep quality serves as a significant mediator in the relationship between the built environment and self-rated health across all measured dimensions. The aesthetics and traffic safety dimension exhibited the strongest overall total effect (β=0.372, P<0.05) and direct effect (β=0.270, P<0.05). The analysis confirmed that this mediation is highly conditional: the strongest indirect effect was found among urban residents with high socioeconomic status (β=0.219, P<0.05), whereas the pathway was non-significant for rural residents with low socioeconomic status. Furthermore, the impact of poor sleep on health was significantly strongest in the high socioeconomic status group (β=-0.411, P<0.05).

Conclusion: Improving the built environment, particularly the aesthetics and traffic safety, contributes to enhancing adults' health outcomes by promoting better sleep quality. Interventions may yield the greatest benefits for urban populations with higher socioeconomic status.