Abstract
BACKGROUND: Chronic lung disease (CLD) imposes substantial health burdens on Chinese adults. While prior studies have focused on isolated environmental factors, this study comprehensively evaluated the synergistic effects of living environmental risk factors (LEFs), including indoor fuel type, water source, exposure to fine particulate matter (PM2.5), housing conditions, and indoor temperature/humidity, on CLD development. METHODS: Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2018), cross-sectional (n = 12,318) and longitudinal (n = 8,516) analyses were conducted. LEFs score were derived from multi-domain environmental metrics. Logistic regression was used to identify baseline associations between LEFs and CLD, while Cox proportional hazards models were used to estimate longitudinal risks. Adjusted covariates included sociodemographic, lifestyle, comorbidities, and regional factors. RESULTS: Poor quality of the living environment was significantly correlated with CLD prevalence (cross-sectional OR: 1.14, 95% CI: 1.03-1.27) and incidence (longitudinal HR: 1.25, 95% CI: 1.10-1.42) after full adjustment. Key risk factors included indoor solid fuel use, unsuitable indoor temperature, and excessive humidity. Subgroup analyses highlighted stronger associations among rural residents and individuals with comorbidities. CONCLUSION: Integrated assessment of environmental risks is critical for CLD prevention. Mitigating indoor air pollution, optimizing thermal conditions, and improving housing quality may reduce disease burden. Public health policies should prioritize multifaceted environmental interventions for high-risk populations.