Lifestyle-based community exposure and self-rated health: a multilevel analysis of neighborhood disadvantage in Urban China

Background: Neighborhood socioeconomic disadvantage is a well-established determinant of population health, yet residents living in the same communities often experience unequal health outcomes. Such heterogeneity may reflect differences in lifestyle-based exposure to local environments. However, evidence on whether and how this exposure patterns modify neighborhood health effects remains limited, particularly in rapidly urbanizing contexts such as China. This study examined whether lifestyle-based community exposure moderates the association between neighborhood concentrated disadvantage and self-rated health among urban residents. Methods: Data were obtained from the 2018 China Labor-force Dynamics Survey, including 2105 urban residents nested within 133 communities. Neighborhood concentrated disadvantage was constructed using principal component analysis of community-level socioeconomic indicators. Community exposure patterns were identified via latent class analysis based on five lifestyle-related behaviors: smoking, alcohol consumption, regular physical exercise, neighborhood reciprocity, and community participation. Multilevel logistic regression models were used to estimate the association between neighborhood disadvantage and self-rated health and to test cross-level interaction effects, adjusting for individual sociodemographic and socioeconomic characteristics. Critically, cross-level interaction terms between neighborhood disadvantage and lifestyle typologies were non-significant, indicating that structural and behavioral factors operate as independent, additive determinants of health rather than as a buffering system. Conclusions: In contemporary urban China, neighborhood socioeconomic disadvantage and individual lifestyle patterns function as two parallel and independent risk pathways shaping health outcomes. Reducing urban health disparities therefore requires both structural neighborhood interventions and targeted behavioral strategies, rather than assuming that healthy lifestyles can offset the effects of severe spatial deprivation.