Living Environment, Built Environment and Cognitive Function among Older Chinese Adults: Results from a Cross-Sectional Study

Background Many studies have addressed the relationship between environmental factors and cognitive function; however, evidence from China is very rare. Objectives To discuss the relationship between the living and built environment and cognitive function among older Chinese adults. Design The Anhui Healthy Longevity Survey (AHLS) was used to investigate the ability to control major non-communicable diseases through behavioural techniques among adults aged 60 or older dwelling in Anhui Province. A multistage sampling strategy was used to obtain a representative sample. Cross-sectional data were collected for the analyses. Setting The included participants were recruited from four selected cities in Anhui Province, China. Participants The participants were adults aged 60 or older and resided in the selected urban or rural communities. Measurements The Mini Mental State Examination was used to measure the cognitive status of the participants. Mild cognitive impairment (MCI) was defined as illiteracy with MMSE scores lower than 18, MMSE scores lower than 21 among those educated for 0-6 years, or MMSE scores lower than 25 among those with 6 or more years of education. The living environment was assessed by asking the participants about their daily living conditions. The distances between the participants' dwellings and the nearest facilities and the proportions of green/blue spaces within 800 m buffers were calculated based on the textural address to indicate the built environment. Results The male participants who lived in a non-dusty environment had higher MMSE scores (beta=0.828, 95% CI: 0.240, 1.416, p=0.006) and lower risks of mild cognitive impairment (MCI) (OR=0.651, 95% CI: 0.488, 0.868, p=0.003), and the male participants with no access to recreation spaces had lower MMSE scores (beta=-1.107, 95% CI: -1.531, -0.684, p<0.001) and higher risks of MCI (OR=1.403, 95% CI: 1.134, 1.737, p=0.002). The female participants who lived far from a supermarket had significantly lower MMSE scores (Q3:beta=-0.750, 95% CI: -1.266, -0.233, p adjusted=0.036; Q4: beta=-1.184, 95% CI: -1.745, -0.624, p adjusted<0.001) than those who lived near a supermarket (Q1). Conclusions The living environment and built environment might have sex-specific associations with cognitive function among older adults.