Associations of Living Environment and Lifestyle Factors with Sub-Health Status: A Population-Based Cross-Sectional Study in Urban China

Background: Sub-health status (SHS) is an increasingly concerned issue with a high prevalence worldwide. Although some factors of lifestyle and environment has been study, few studies have determined comprehensively the associations of lifestyle and living environmental factors with general, physical, mental and social SHS. Methods: A cross-sectional face-to-face survey (Sep 2017 to Sep 2018) was conducted via questionnaire among 6,750 urban residents aged 14 years and above randomly selected from five Chinese cities. There were 5,881 valid questionnaires with a response rate of 87%. General linear model and structure equation model were developed to quantifying the effects of lifestyle behaviors and living environmental factors on SHS. Results: Detection rates of general SHS, physical SHS, mental SHS and social SHS were 66.7%, 67.0%, 65.5% and 70.0%, respectively. Significant association of general SHS, physical SHS, mental SHS and social SHS had been found in smoking, bad dietary habits, breakfast consumption, physical exercise, sleep duration, air, neighbor harmony and living convenience, instead of noiseless. However, associations of general SHS, physical SHS, mental SHS and social SHS were different for second-hand smoking influence, alcohol consumption, sunshine, Bedtime before 11pm, surfing the internet, greenery, air, pleasant housing, spacious rooms and fitness facility. Good lifestyle behaviors and favorable living environment factors positively affected SHS ( P <0.001). Lifestyle behaviors had the largest effect on physical SHS ( β =-0.418), but the least on social SHS ( β =-0.274). Living environmental factors had the largest effect on mental SHS ( β =0.286), but the least on physical SHS ( β =0.225). Conclusions: Lifestyle behaviors and living environmental factors were important influencing factors of SHS. Physical SHS was more associated with lifestyle. Lifestyle and living environment were similarly associated with mental and social SHS.