Association between Neighborhood Built Environment and Body Mass Index among Chinese Adults: Hierarchical Linear Model

Obesity is becoming a global health problem. With the living standards of residents have improved rapidly in China, the problem of obesity becomes a serious threat to people’s health. Although obesity effected by many factors, the role of the built environment in relation to obesity among population should be taken into consideration. This paper examines the association of built environment and body mass index with the hierarchical linear model, based on the data from 2016 China Labor-force Dynamics Survey (CLDS), which involves 29 provinces in China and investigates 401 villages or communities as well as 14226 families. In this paper, the village or community is used as the basic analysis unit, and the body mass index of the residents is used as the dependent variable, and neighborhood built environment (e.g. density of exercise facilities, square or park and distance to them) is as independent variables, socioeconomic status (e.g. age, gender, education, marital status, income and employment status) and health and exercise characteristics (e.g. self-rated health, average weekly exercise time and frequency) are as control variables. Participants are adults aged 15-65 years (n = 21086; 63.30% rural vs urban). With the independent variables from both individual and residential levels, hierarchical linear model is applied respectively to examine how body mass index is affected. Additionally, samples are classified by age group, urban/rural neighborhood and we figure out which factor mainly effected different groups. We explore that BMI is higher in high- vs. low-facility density neighborhoods but not significantly differ by neighborhood income. Overweight/obesity (BMI >= 25) is lower in high-developed districts. Physical fitness is higher in high-income neighborhoods but unrelates income. We conclude that living in walkable neighborhoods is associated with more physical activity and lower overweight/obesity but not with other benefits. Adults in higher-income neighborhoods have lower BMI and higher mental condition. These findings have important implications for urban planning and the corresponding improvement strategy is proposed.