Li Yushen, Feng Zhixin, Liu Ye, Wu Jinghao
Accepted: 2025-03-04
Existing research on the effects of regional urbanization on elderly health often fails to account for key environmental variables and lacks comparative analyses across different spatial scales. To bridge these gaps, this study examines the relationship between regional urbanization and elderly health, identifies critical environmental determinants, and conducts a multiscale spatial analysis.Drawing on data from the seventh national population census, this study employs GIS spatial visualization and Tobit regression models to investigate spatial patterns of elderly health across regions with varying levels of urbanization. The analysis differentiates between city-level and urban district/county-level regions, highlighting disparities in the effects of urbanization and living environments on elderly health while accounting for the confounding influences of multi-dimensional environmental factors.The findings reveal a clear spatial gradient in elderly health, with higher health levels observed in southeastern urban agglomerations compared to central and northern urban clusters. Nationally, the average proportion of selfreported healthy elderly individuals is 87.25%, with only regions exhibiting an urbanization rate above 76% surpassing this benchmark. Additionally, at both city and district/county levels, urbanization rates show a significant positive correlation with elderly health. Several environmental factors, including NDVI, water coverage, land surface temperature, road density, and per capita building area, are identified as positive predictors of elderly health, whereas PM2.5 concentration, the proportion of households without tap water, and the proportion of households without toilets exhibit significant negative associations. Notably, the impact of variables such as hospital bed availability, forest and grassland coverage, land surface slope, and the proportion of households without kitchens varies across spatial scales, underscoring the role of spatial granularity in shaping these relationships. Furthermore, the study finds that the relationship between urbanization and elderly health varies by urbanization threshold. In areas where the urbanization rate is below 45%, higher urbanization is associated with poorer elderly health, suggesting that less urbanized regions may provide more favorable conditions. Conversely, in areas with urbanization rates above 45%, greater urbanization corresponds with improved elderly health outcomes. The study also examines the moderating role of urbanization in the relationship between environmental factors and elderly health, revealing that higher urbanization rates weaken the positive effects of NDVI while mitigating the adverse impact of PM2.5 concentration. The findings highlight the intricate interplay between urbanization, environmental conditions, and elderly health, emphasizing the need for tailored policy interventions. In highly urbanized areas (75%+), strategies should focus on balancing land-use efficiency with green space preservation while addressing housing density to prevent potential health declines among the elderly. In contrast, regions with medium to low urbanization rates should prioritize agefriendly environments by enhancing road infrastructure, improving housing conditions, and ensuring accessible living and transportation facilities for the elderly. This study provides a theoretical foundation and policy framework for fostering environments that promote elderly health.