Perceived Neighborhood Trust, Health Behaviors, and Metabolic Syndrome Among Middle-Aged and Older Chinese Adults: A Cross-Sectional Study

Metabolic syndrome (MetS) is rising rapidly in China. Perceived neighborhood trust may be associated with MetS through health behaviors, but evidence is limited. Using baseline data from 15,512 adults aged ≥45 years from the Chongqing sub-cohort of China Multi-Ethnic Cohort, we examined the association between perceived neighborhood trust and MetS and explored potential indirect associations through smoking, alcohol consumption, and leisure-time physical activity. Compared with low perceived neighborhood trust, medium trust (OR = 0.78, 95% CI: 0.63–0.96) and high trust (OR = 0.79, 95% CI: 0.65–0.96) were associated with lower odds of MetS, whereas very high trust was not. Exploratory mediation analyses showed a small inverse indirect association for smoking status (high vs. low trust: OR = 0.988, 95% CI: 0.974–0.998) and for smoking pack-years (medium vs. low: OR = 0.989, 95% CI: 0.976–0.999; high vs. low: OR = 0.985, 95% CI: 0.971–0.995; very high vs. low: OR = 0.985, 95% CI: 0.970–0.996) in the total sample. Subgroup analyses suggested similar small inverse indirect associations for smoking among men and adults aged 45–59 years, while alcohol consumption and leisure-time physical activity showed no indirect associations. These findings highlight the potential relevance of neighborhood trust to metabolic health and suggest that future prevention strategies in China may need to consider broader social and contextual factors beyond individual health behaviors.