Can urban renewal improve the self-assessed health of older adults? Evidence from China

Abstract

Background

With the global acceleration of urbanization and population aging, the growing contradiction between the built environment and the health needs of older adults has become increasingly prominent.

Methods

Based on the micro-data from the 2016, 2018, and 2020 waves of the China Longitudinal Aging Social Survey (CLASS) and the macro-data at the city level, our study selected eight indicators that reflected urban renewal at the household, community, and city levels and empirically investigated their effects on the self-assessed health of older adults.

Results

The study showed that urban renewal has a positive impact on the self-assessed health of older adults at the 1% significance level. The heterogeneity analysis indicated that the impact of urban renewal on the self-assessed health of older adults varied significantly across different geographical areas and age groups. However, further analysis revealed that urban renewal exacerbated the health inequality of older adults.

Conclusions

Our research indicated that urban renewal improved the self-assessed health of older adults, but it also increased health inequalities within this group. These results suggested that urban renewal should be further promoted to effectively enhance the health status of older adults, reduce health inequalities, and achieve the social goal of healthy aging.

Introduction

With the acceleration of global urbanization, urban development has been shifting from incremental expansion to a new phase of stock optimization. Faced with multiple constraints, including land, energy, and environmental issues, achieving sustainable urban development has become a common challenge for all countries. As a significant strategy in the urbanization process, urban renewal has emerged. Urban renewal refers to a long-term and continuous process of changing the economic substance, social services, and living environment of an area through certain government or non-government measures [1,]. Its core objective is to promote high-quality urban development by optimizing resource allocation, enhancing spatial carrying capacity, and improving the quality of urban functions [2]. In this process, various countries and regions has developed distinctive regeneration paths: the United Kingdom and France, representing the European region, has emphasized social inclusiveness and ecological sustainability; the United States has focused on public-private cooperation and community participation; and Japan has combined integrated district regeneration with the goals of social equity and economic growth quality through institutionalized public-private collaboration mechanisms [3]. In China, the main tasks of urban renewal are the renovation of household elderly-friendly facilities, the renovation of old residential communities, the upgrading of infrastructure and environment in cities [4]. From the three dimensions of household, community, and the whole city, urban renewal has injected new impetus into the high-quality development of cities, through a participatory governance approach involving multiple subjects [5, 6].

As a systematic project, urban renewal profoundly influenced the multidimensional aspects of urban life. It has been noted that urban renewal activated economic vitality through industrial upgrading and spatial reconstruction [7], improved the effectiveness of social services by enhancing facilities to address shortcomings and fostering digital empowerment [8], and promoted the innovation of cultural identity through modern design while safeguarding historical and cultural heritage, consequently fostering the high-quality development of the city comprehensively [9]. Throughout this systematic process, health and well-being have still been the core objectives during the urban renewal efforts [10]. The “Healthy China 2030 Strategy” has explicitly called for the systematic integration of health concepts into the public policy framework, aiming for the comprehensive enhancement of residents’ health through the improvement of urban environment quality, upgraded public service facilities, and the promotion of healthy lifestyles [11]. The United Nations SDG 11 Goal also emphasized that building inclusive, safe, resilient, and sustainable urban environments was a crucial pathway to promoting global health and well-being. Studies have shown that optimizing urban environments significantly impacted public health [12]. Specifically, expanding ecological spaces can effectively reduce the incidence of cardiovascular and respiratory diseases by enhancing the microclimate and air quality [13]. Additionally, improving the slow-moving system has increased the frequency of non-motorized trips and boosts daily physical activity among residents [14]. Moreover, age-adapted retrofitting of community public spaces can enhance social interactions, which was particularly beneficial in improving the mental health of low-income groups [15, 16]. This synergistic effect of environmental improvement and health behaviors not only redefined the social and ecological functions of urban space but also advanced the strategic transformation of China’s urban renewal from physical transformation to a focus on health and well-being enhancement. In the twenty-first century, the connotation of urban renewal was closely linked to the initiative of “Age-Friendly Cities and Communities” put forward by the World Health Organization. This initiative emphasized that society needed to have an inclusive and barrier-free environment [17, 18] to improve the mental health and social participation of the elderly, including the transformation of outdoor spaces and housing construction at the micro-level, the improvement of social participation and community support at the meso-level, and the enhancement of the urban livable environment at the macro-level [19].

In the context of accelerated population aging, the health problems of older adults have evolved from individual physiology into a complex proposition involving multidimensional synergies across society, institutions, and space. Studies have shown that improving social adaptability, fostering intergenerational interaction, and encouraging participation in social activities can alleviate the psychological alienation and behavioral limitations of older adults, significantly reducing their health risks [20–22]. Social health insurance can effectively improve the utilization rate of medical resources and the health status of older adults by enhancing the accessibility of healthcare services [23]. The institutional synergy formed by the “health savings account” and long-term care insurance has provided an opportunity for healthy aging. This system synergy has established a systematic guarantee for healthy aging [24]. Real-time physiological monitoring achieved through wearable devices and optimal resource allocation via telemedicine has contributed to building an intelligent health service system for older adults [25]. Space was the medium connecting social factors and individual health. Its resource allocation and environmental characteristics were directly related to the satisfaction of the health needs of older adults. As the core carrier of space, the living environment was a key practice area for urban renewal. Its dynamic interaction with the health behaviors of the older directly affected the achievement of the goal of healthy aging. The ecosystem theory happened to provide an overall explanatory framework for this space-health relationship. This theory focused on the interaction between the environment and humans. Its “ecosystem” was regarded as a dynamic behavioral environmental system interacting with humans, which could be divided into three hierarchical systems, namely the micro, meso, and macro levels, that interacted with each other, continuously exchanged matter and information, and constantly influenced individuals [26, 27]. Therefore, as an important ecosystem affecting the external living environment of older adults, urban renewal could rely on this theory to conduct analyses from different levels.

Following the idea of ecosystem divisibility, urban renewal could be divided into three dimensions: household, community, and city, corresponding to the three levels of the microsystem, mesosystem, and macrosystem in the ecological systems theory, respectively. As the microsystem of urban renewal, the living conditions of household were the most important aspect in the daily lives of older adults, directly affecting their physical and mental health [28]. The aging-friendly renovation of residential buildings was the foundation of urban renewal [29]. Among them, renovation measures such as installing toilets, elevators, handrails, and improving indoor lighting could not only enhance the convenience of older adults’ lives but also were key factors affecting their daily living abilities [30], and could more effectively guarantee the health of older adults. As the mesosystem of urban renewal, the community was also an important activity place for older adults. They were highly sensitive to the physical environment, social support, and healthcare services in the community [31]. Updating community activity facilities and community service projects was a strong guarantee for urban renewal [32]. Adding community activity rooms and outdoor activity venues for aging-friendly renovation and providing regular home visits and service hotlines helped meet the diverse needs of older adults, relieve their depressive emotions and inconveniences in daily life, and promote their physical and mental health [30]. In addition, as the macrosystem, the improvement of the overall environment at the city level had become the top priority of urban renewal. The health benefits brought by urban renewal and construction had become a hot topic of concern in multiple disciplines such as geography, urban planning, and public health in recent years. The overall improvement of the livable urban environment and the application of technological means in urban governance lowered the threshold for older adults to participate in urban public life, enabling them to access public services and participate in social activities more conveniently, and enhancing their adaptability to the overall urban living environment [33]. The positive effect of the improvement of social adaptability on the health of older adults had also been confirmed by many studies [34, 35]. When the social adaptability of older adults was enhanced, their psychological loneliness was relieved, and their willingness and initiative to participate in social activities were improved. By increasing their participation in daily activities, they could improve their physical and mental health and enhance their sense of well-being [36].

Existing studies still had many controversies and deficiencies in the association between urban renewal and the health of older adults. Some studies showed that by optimizing physical space, urban renewal was conducive to improving the health of older adults and narrowing the health gap [37–39]. However, other studies found that with the acceleration of urbanization, the gap in infrastructure between urban and rural areas gradually widened, further exacerbating health inequalities among older adults [40, 41]. Therefore, the impact of urban renewal on health inequalities still needed further exploration. At the same time, most studies used mixed-age samples and relied on a single indicator to measure the level of urban renewal [42]. There were relatively few studies specifically targeting older adults, and there were significant differences in the research results on aging in place and the health of older adults [43]. Some studies pointed out that the “gentrification” effect of urban renewal would reduce the accessibility of health resources for elderly indigenous people by increasing the cost of living and replacing inclusive health facilities [44, 45]. On the contrary, other studies showed that in the case of implementing supporting policies such as rent control mechanisms and community medical services, aging-related renovations were more effective in improving the self-rated health status of older adults [46]. Therefore, it was urgent to measure the level of urban renewal through comprehensive indicators and explore its impact on the health of older adults and the potential mechanisms through empirical research.

Based on this, this study comprehensively utilized the data from the Chinese Longitudinal Aging Social Survey (CLASS) and the micro-data at the city level, and employed the fixed-effects model to conduct research and analysis on the following four questions: 1) Has urban renewal improved the self-assessed health of older adults? 2) Have these effects differed across geographic regions and age groups? 3) Has social adaptability played a mediating role in this relationship? 4) Has urban renewal widened or narrowed health inequalities among older adults?

Methods

Data source

The micro-data used in this study come from the China Longitudinal Aging Social Survey (CLASS). CLASS was a national social tracking survey project hosted by the China Survey and Data Center of Renmin University of China, mainly targeting the elderly aged 60 and above [47]. The first national baseline survey of this project was carried out in 2014, followed by three tracking surveys in 2016, 2018, and 2020, respectively. The survey employed a stratified multi-stage probability sampling method, covering 23 provinces (autonomous regions and municipalities directly under the Central Government), 293 prefecture-level cities, 7 regions, 30 autonomous prefectures, and 3 leagues in the country. At the first stage, counties (or urban districts) are stratified by region and urban/rural status. From this frame, primary sampling units (PSUs) are randomly selected. Villages and neighborhood committees are then selected within these PSUs, followed by the random selection of households and ultimately the target respondent aged 60 years and older within each household.

The reasons for using the CLASS database in this paper are as follows: First, the CLASS database provides relevant variables such as the basic information, family status, physical health and home environment of older adults, which helps to analyze the impact of urban renewal on the self-assessed health of older adults; Second, CLASS has city-level codes, providing necessary conditions for accurately identifying the cities where the samples are located and constructing treatment and control groups; Third, A large number of studies have used the CLASS database to conduct research on the environment, health, and social adaptability [36, 48].

This study utilized data from 2016, 2018 and 2020, with a follow-up response rate of 80% over the three years. Among them, 7,218 respondents participated in all three waves of the survey (2016, 2018, and 2020 waves of CLASS). After excluding respondents with missing key variables, the final analytical sample comprised 21,654 observations from the pooled cross-sections of older adults. In addition, the macro data at the city level used in this study come from the China Urban Statistical Yearbook and the China City Yearbook of 2016, 2018 and 2020.

Variables

Dependent variables: the self-assessed health of older adults

The dependent variable in this study was the self-assessed health of older adults. Existing studies have revealed that self-assessed health effectively portrays an individual’s health status [49, 50]. Drawing on existing measurement methods of mental health and combining the variables in the CLASS database, this study used the question “How do you feel about your current health?” to measure the self-assessed health of older adults. The responses of “very healthy, relatively healthy, Fair, relatively unhealthy, and very unhealthy” were assigned values of 5, 4, 3, 2 and 1, where a higher score the better self-assessed health of older adults.

Independent variables: urban renewal

The independent variable in this study was urban renewal at the household, community, and city levels. Based on existing policy practices and literature reviews [28–32], the indicators at the household level included whether there is a bathroom, a sitting toilet, and an indoor lavatory within the home, using the questions: “Is there a bathroom in the house where you currently live?” “Is the toilet you usually use a sitting toilet?”, and “Does the house where you currently live have an indoor toilet?”. The indicators at the community level included the availability of daily care facilities, sports fitness equipment, and entertainment venues, using the question: “Is there a senior activity room in the community where you live?” “Is there a fitness venue/facility in the community where you live?”, and “Is there a community activity space in the community where you live?”. The above indicators were constructed from specific questions in the CLASS questionnaire, which was administered through face-to-face interviews. The variables are coded as “yes = 1” and “no = 0”. The indicators at the city level included China’s City Livability Index and City Sustainable Competitive Ability. The China’s City Livability Index evaluates the quality of urban living environments and residents’ well-being, covering multiple dimensions including economic development, social governance, quality of livelihood, and ecological environment. The index calculates the comprehensive scores of cities at and above the prefecture level using the geometric method. The City Sustainable Competitive Ability assesses the long-term sustainable development capacity of cities. Using equal-weight comprehensive method, this index synthesizes 10–15 specific indicators across six sub-dimensionsto generate an objectively weighted sustainable competitiveness score for each city. Both indices are derived from officially published data of the China Urban Statistical Yearbook in 2016, 2018, and 2020, with their survey samples including 286 cities at or above the prefecture level across 30 provinces, municipalities, and autonomous regions of China. In addition, the control variables are presented in Table 1 and are not elaborated here.

Table 1.

Description of variables

Variables	Definition
Dependent variables
Self-assessed health	Very healthy = 5, Relatively healthy = 4, Fair = 3, Relatively unhealthy = 2, Very unhealthy = 1
Independent variables
Urban renewal	Continuous variables, principal component analysis method
Control variables
Gender	Male = 1，Female = 0, respondents selecting “other” were excluded from the analysis due to insufficient sample size
Age	Continuous variables
Education	Undergraduate and above = 7, Professional training College = 6,Senior high school = 5, Junior secondary schools = 4, Secondary schools = 3, Private schools/Literacy classes = 2, Illiterate = 1
Marital status	Married = 1，Otherwise = 0
Hukou	Urban = 1，Rural = 0
Residence status	Otherwise = 1, Live alone = 0
Family income	Continuous variables
Social security	The total amount of each type of social security benefit, in logarithmic values
Number of children	Continuous variables
Financial support from children	Continuous variables
Internet access frequency	Everyday = 5，At least once a week = 4，At least once a month = 3，Several times a year = 2，Never = 1
Instrumental variables
the number of urban renewal policies in 2016, 2018, and 2020	Continuous variables, from http://www.pkulaw.cn/
Intermediary variables
Social adaptability of older adults	Not at all = 5，Falling short = 4，Fair = 3，Fairly consistent = 2，Fully in line with=1

To comprehensively reflect the level of urban renewal, this study purposefully applied the principal component analysis method to construct the aforementioned eight indicators into a composite index, as shown in Table 2. The principal component analysis method synthesized the indexes based on the contribution rate of the composite factors, requiring the cumulative contribution rate to be above 75% to ensure more objective, consistent, and reasonable evaluation results [51]. Among the three extracted factors, factor 1 has a high score in the three indicators of bathroom, a sitting toilet, and an indoor laboratory at the household level of urban renewal. Therefore, factor 1 is named the principal component of urban renewal at the household, and the higher the score, the higher the urban renewal at the household. Factor 2 has a high load in the three indicators of daily care facilities, sports equipment, and entertainment venues at the community level of urban renewal. So factor 2 is named as the comprehensive factor of urban renewal at the community level. Factor 3 has a high score in China’s city livability index and city sustainable competitive ability. Therefore, factor 3 is named the comprehensive factor of urban renewal at the city level, and the higher the score, the higher the level of urban renewal at the city level. The three factors extracted from the eight indicators provide a good explanation for the urban renewal at the household, community, and city levels. Finally, the variance contribution rates of principal components 1, 2, and 3 are used as weights for weighted averaging to obtain the comprehensive score of urban renewal.

Table 2.

Predicted values of principal component factors for each variable of urban renewal level

Variables	Factor 1	Factor 2	Factor 3
Bathrooms	0.925	0.172	0.088
Sitting toilets	0.883	0.137	0.321
Indoor lavatories	0.822	−0.208	0.432
Daily care facilities	−0.158	0.835	−0.107
Sports equipment	−0.163	0.749	−0.533
Entertainment venues	0.145	0.823	−0.184
City livability index	0.217	−0.272	0.796
City’s sustainable competitive ability	0.227	−0.271	0.732

Instrumental variable

To address potential endogeneity concerns, we employed an instrumental variable (IV) approach. The instrumental variable is the number of urban renewal policies implemented at the provincial level. The data were manually collected from the Peking University Law Database, which is the most comprehensive and authoritative database for Chinese laws and regulations.

The construction of the instrumental variable followed a two-step procedure. First, for each province in 2016, 2018, and 2020, we searched for policy documents containing the keywords “urban renewal” or “old residential community renovation” in their titles or main text. The raw count of these policies was recorded for each province-year observation. Second, to account for the heterogeneity in provincial administrative scale, we divided the raw policy count by the number of prefecture-level cities in each province. The resulting variable is the average number of urban renewal policies per prefecture-level city in each province, which is a continuous variable.

Intermediary variables

The mediating variable in this study was the social adaptability of older adults. “Do you agree that society is changing too fast and it is difficult for me to adapt to such changes,” “Social changes nowadays are becoming more and more unfavorable to older adults,” and “I feel that I am still useful to society.” were selected from the CLASS database to measure the social adaptability of older adults, with each question assigned a value of very satisfied = 5, relatively satisfied = 4, average = 3, relatively dissatisfied = 2, and very dissatisfied = 1. The higher the scores, the greater the social adaptability of older adults.

Control variables

To control for confounding factors that may affect the self-rated health of older adults, we selected control variables from both individual and social levels based on the CLASS data. We selected the following variables at the individual characteristic level: gender (“What is your gender?”), age (“How old are you?”), education (“What is your educational attainment?”), marital status (“What is your current marital status?”) and hukou (“What type of hukou do you have?”); at the social characteristic level, we included residence status (“Which people are eating and living together with you?”), family income (“What was your family income in the past year”), social security(“The total amount of each type of social security benefit, in logarithmic values”), number of children(“How many children do you have”), Financial support from children (“In the past year, have your children provided you with financial support, including cash or transfer?”) and Internet access frequency (“How often do you surf the Internet?”).

Model

To test the impact of urban renewal on the self-assessed of older adults, this study constructed a fixed effects model for benchmark regression, and the model was set as follows

1

In Eq. 1, denoted the individual, denoted the year, and the dependent variable was the self-assessed health of older adults. Combining the lagged effects of individual dynamic time change and environmental improvement effects, this study measured urban renewal using a lagged variable model1. With denoted the urban renewal indicator for year in the city where the older adults were located, was the set of control variables, , , and were the coefficients to be estimated, was a time-fixed effect, was an individual fixed effect, and was an error term. It should be noted that the explanatory variable, the self-assessed health, which was assigned a value based on its degree, was ordinal. Studies had shown that when the model was set up correctly, there was no advantage or disadvantage between the OLS and Ordered Logit models when health status was measured as a base utility for individuals in a mobile population [52]. The above analysis was all carried out using Stata 16.0 [53].

Results

Descriptive results

Table 3 presents the demographic characteristics of study population. The average age of the respondents in 2016 was 68. From 2016 to 2020, the proportion of older adults living alone increased from 88.3% to 90.3%. At the same time, the family income of older adults increased from 23,411.91 yuan to 35,418.87 yuan, indicating that the economic situation of older adults’ families has improved. From 2016 to 2020, the level of urban renewal in China has continuously improved, and the average urban renewal is 1.098, 1.170, and 1.332, respectively. However, with the growth of age, the self-assessed of older adults was declining, with the average value falling from 3.316 in 2016 to 3.297 in 2020. The average value of older adults’ social adaptability increased from 8.065 to 8.512, indicating that the social adaptability of this group was significantly improved.

Table 3.

Descriptive results

Variables		2016 Sample(N = 7218)	2018 Sample(N = 7218)	2020 Sample(N = 7218)
		Mean or Proportion	Mean or Proportion	Mean or Proportion
Dependent variables
Self-assessed health		Mean = 3.316	Mean = 3.310	Mean = 3.279
Independent variables
Urban renewal		Mean = 1.098	Mean = 1.170	Mean = 1.332
Control variables
Gender	Male	1 = 50.26%	1 = 50.26%	1 = 50.37%
	Female	0 = 49.74%	0 = 49.74%	0 = 49.63%
Age		Mean = 68.309	Mean = 70.309	Mean = 72.312
Education		Mean = 2.799	Mean = 2.857	Mean = 2.857
Marital status	Married	1 = 75.35%	1 = 71.54%	1 = 70.12%
	Otherwise	0 = 24.65%	0 = 28.46%	0 = 29.88%
Hukou	Urban	1 = 43.79%	1 = 42.87%	1 = 42.30%
	Rural	0 = 56.21%	0 = 57.13%	0 = 57.70%
Residence status	alone	0 = 88.31%	0 = 89.67%	0 = 90.30%
	else	1 = 11.69%	1 = 10.33%	1 = 9.70%
Family income		Mean = 23411.91	Mean = 29790.25	Mean = 35418.87
Social security		Mean = 5.004	Mean = 5.799	Mean = 5.173
Number of children		Mean = 2.516	Mean = 2.484	Mean = 2.456
Financial support from children		9,654	9,931	10,212
Internet access frequency		Mean = 1.103	Mean = 1.662	Mean = 1.847
Intermediary variables
Social adaptability of older adults		Mean = 8.065	Mean = 8.757	Mean = 8.512
Instrumental variables
the number of urban renewal policies in 2016, 2018, and 2020		Mean = 0.103	Mean = 0.156	Mean = 0.358

Note: All N = 21,654. Gender, marital status, hukou, and residence status are expressed as percentages. All reported averages are arithmetic means, and standard deviations are reported to indicate dispersion

Baseline results

Table 4 reports the results of the impact of urban renewal on the self-assessed health of older adults. Model 1 only contained the core explanatory variables. Model 2 added the individual and social characteristics variables based on Model 1. Model 3 further added the time-fixed effect and individual-fixed effects. The results show that urban renewal has a positive impact on the self-assessed health of older adults at the 1% significance level. In terms of personal characteristics, gender, education, and marital status have a significant positive impact on the self-assessed health of older adults at the 1% significance level, while the number of children has a positive impact at the 5% significance level. In terms of social characteristics, social security and the financial support of children have a significant negative impact at the 1% significance level. The impact of other control variables on the self-assessed health of older adults is not significant.

Table 4.

Effects of urban renewal on the self-assessed health of older adults

Variables	Model 1	Model 2	Model 3
Urban renewal	0.076***	0.088***	0.089***
	(0.011)	(0.014)	(0.014)
Gender		0.059***	0.059***
		(0.015)	(0.015)
Age		−0.021***	−0.021***
		(0.001)	(0.001)
Education		0.025***	0.026***
		(0.006)	(0.006)
Marital status		0.111***	0.111***
		(0.020)	(0.020)
Hukou		−0.013	−0.007
		(0.018)	(0.019)
Residence status		−0.063**	−0.064**
		(0.026)	(0.026)
Family income		−0.003	−0.003
		(0.003)	(0.003)
Social security		−0.007***	−0.008***
		(0.003)	(0.003)
Number of children		0.019**	0.020**
		(0.008)	(0.008)
Financial support from children		−0.007***	−0.007***
		(0.002)	(0.002)
Internet access frequency		0.001	0.012
		(0.006)	(0.008)
Fixed Cit−1	no	no	yes
Fixed year	no	no	yes
_Cons	3.217***	4.596***	4.629***
	(0.015)	(0.097)	(0.098)
N	21654	21654	21654
Pseudo R2	0.003	0.040	0.040

Note: The values in brackets are robust standard errors; year represent time-fixed effects, and C_it−1 represent individual-fixed effects; *, **, and *** represent significant levels of 10, 5, and 1%, respectively

Robustness check

Endogeneity test

The self-assessed health of older adults at the micro level can not affect the level of urban renewal at the macro level, and the reverse causality between the two was weak, but it still can not avoid the endogeneity problem caused by omitted variables. To demonstrate the robustness of the results, we used the instrumental variables method. Referring to the practice of Tong et al. (2024) [54], we selected the number of urban renewal policies introduced by each city in 2016, 2018, and 2020 to construct tool variables. As a concentrated manifestation of the responses of various regions to the urban renewal policy, this variable was closely related to urban renewal and had no direct correlation with the self-assessed health of older adults. It met the correlation and exogenous requirements of instrumental variables and could be used as an effective instrumental variable.

Table 5 reports the results of instrumental variables. Through two-stage least squares (2SLS) estimation, the results showed that urban renewal still significantly improved the self-assessed health of older adults at the 1% significance level. At the same time, the instrumental variables passed the unidentifiable test and the weak instrumental variable test, which basically considered that the selection of instrumental variables was better.

Table 5.

Instrumental variable regression results

Variables	Stage 1	Stage 2
	Phase I results	Phase II results
The number of urban renewal policies	0.203*** (0.057)	—-
Urban renewal	—-	0.168*** (0.043)
Kleibergen-Paap rk LM	—-	976.30***
Cragg-Donald Wald F	—-	12.67
N	21654	21654
Pseudo R2	0.044	0.060
Fixed Cit−1	yes	yes
Fixed year	yes	yes
Control variable	yes	yes

Note: The values in brackets are robust standard errors; years represent time-fixed effects; *, **, and *** represent significant levels of 10, 5, and 1%, respectively

Replace core independent variables

This study used the city brand Influence index (CBI), a representative indicator of urban renewal, as the core explanatory variable for robustness testing. Table 6 shows the results of the robustness test. In model 1, the city brand Influence index had a positive impact at the 1% significance level, which verifies the benchmark regression results.

Table 6.

Robustness test results

Variables	Model 1	Model 2
	Self-assessed health	Health changes
City brand influence index	0.168***
	(0.040)
Urban renewal		0.125***
		(0.020)
N	21654	21654
Pseudo R2	0.039	0.038
Fixed Cit−1	yes	yes
Fixed year	yes	yes
Control variable	yes	yes

Note: The values in brackets are robust standard errors; years represent time-fixed effects; *, **, and *** represent significant levels of 10, 5, and 1%, respectively

Replace the dependent variables

This study used the health changes of older adults as a substitute for the self-assessed health of older adults for robustness testing. In model 2, urban renewal had a positive impact on the health changes of older adults at the 1% significance level, which is consistent with the benchmark regression conclusion mentioned earlier.

Heterogeneity analyses

This study tested the heterogeneous effects of urban renewal on the self-assessed health of older adults in different geographical areas and ages. As shown in Table 7, from a regional perspective, urban renewal only had a significant positive impact on the self-assessed health of older adults living in the central region at the 1% significance level. From an age perspective, urban renewal had a significant positive impact on the self-assessed health of both middle-aged and young older adults at the 1% significance level. However, it has not had a significant impact on the self-assessed health among individuals aged 79 and above. It can be seen that urban renewal has a differentiated impact on the self-assessed health of older adults with different endowment characteristics.

Table 7.

The results of heterogeneity

Variables	Model 1			Model 2
	Eastern	Central	Western	Age < 70	Age > 69 & Age < 80	Age > 79
Urban Renewal	0.020	0.066***	0.005	0.064***	0.084***	0.038
	(0.027)	(0.020)	(0.021)	(0.016)	(0.025)	(0.053)
N	4454	6576	3406	8522	4650	1264
Pseudo R2	0.076	0.071	0.061	0.153	0.170	0.152
Control variable	yes	yes	yes	yes	yes	yes
Fixed Cit−1	yes	yes	yes	yes	yes	yes
Fixed year	yes	yes	yes	yes	yes	yes

Note: The values in brackets are robust standard errors; years represent time-fixed effects; *, **, and *** represent significant levels of 10, 5, and 1%, respectively. N represents observations with valid lagged values in the dynamic model.

Further analysis of social adaptation ability as a mediating effect

The Person-Environment Fit is based on the complex interaction between individuals and their environment, indicating that when a person’s needs are balanced with the pressures of the surrounding environment, they will achieve an ideal state of health [55]. As an important material resource, can the urban environment improve the self-assessed health of older adults by alleviating their living pressure and enhancing their social adaptability, warrants further investigation. This study drew on the existing research [56, 57], to further verify the mechanism by which urban renewal affects the self-assessed health of older adults. Social adaptability usually refers to the psychological ability and behavioral process through which individuals adjust their own cognition, attitudes and behaviors in social life to meet the requirements of the social environment, establish harmonious relationships with others, effectively cope with social pressure, and achieve a balanced relationship with the social environment [58].

The results are shown in Table 8. The results of model 2 showed that urban renewal has a positive impact on the social adaptation ability of older adults at the 1% significance level. Model 3 showed that the social adaptability had a positive and significant impact on the self-assessed health at the 1% significance level. This indicated that urban renewal had improved the self-assessed health of older adults by expanding their social adaptability.

Table 8.

Mechanism test results

Variables	Model 1	Model 2	Model 3
	Self-assessed health	Social adaptation ability	Self-assessed health
Urban renewal	0.089***	0.231***	0.075***
	(0.014)	(0.051)	(0.023)
Social adaptation ability			0.132***
			(0.019)
N	21654	21654	21654
Pseudo R2	0.040	0.035	0.062
Fixed Cit−1	yes	yes	yes
Fixed year	yes	yes	yes
Control variable	yes	yes	yes

Note: The values in brackets are robust standard errors; years represent time-fixed effects; *, **, and *** represent significant levels of 10, 5, and 1%, respectively

Further analysis of the impact of urban renewal on health inequality

When urban renewal has improved individual self-assessed health, is it at the cost of exacerbating health inequality within the group, or at the cost of further alleviating health inequality? This study conducted empirical testing on this.

According to the relative deprivation theory, the deeper the degree of relative deprivation of health among older adults at a health disadvantage, the more severe the situation of health inequality. Referring to the study on health inequality by Chen et al.(2024) [59], the relative deprivation index of self-assessed health has been used to measure the degree of health inequality among older adults. The specific measurement method was as follows: represented the older adults with a sample size of , and was arranged in ascending order of health level to obtain the distribution vector of self-assessed health . From this, it can be concluded that when compared to the individual , the relative deprivation index of the individual’s health is:

2

On this basis, the average relative deprivation index of self-assessed health for the individual i can be calculated as:

3

The degree of health inequality was represented by ; indicated the rank mean of the individual’s health across all samples; indicated the average health of all samples in the group ; indicated the percentage of people in the group whose health status exceeded ; Indicated the average health level of samples in the group that exceeded .

Model 1 of Table 9 only included the variable of health inequality, while Model 2 added control variables and fixed effects on the basis of Model 1. The results showed that urban renewal exacerbated the degree of health inequality among older adults at the 1% significance level, regardless of whether a control variable was introduced.

Table 9.

Effects of urban renewal on the health inequality of older adults

Variables	Model 1	Model 2
	health inequality	health inequality
Urban renewal	0.083***	0.098***
	(0.012)	(0.015)
_cons	−0.100***	0.454***
	(0.016)	(0.108)
N	21654	21654
Pseudo R2	0.030	0.040
Control variable	no	yes
Fixed Cit−1	no	yes
Fixed year	no	yes

Note: The values in brackets are robust standard errors; years represent time-fixed effects; *, **, and *** represent significant levels of 10, 5, and 1%, respectively

Discussion

Our research indicated that urban renewal significantly improves the self-assessed health of older adults, which is consistent with previous studies [60]. Urban renewal had a positive impact on the self-assessed health of older adults at the 1% significance level, and the coefficient was 0.089. The robustness test further verified the credibility of the results. This is consistent with current research on the relationship between urban renewal and the self-assessed health of older adults [61, 62].

The heterogeneity test results indicate that urban renewal has a significant improvement effect on the self-assessed health of older adults in the central region. Urban renewal had a positive impact on the average self-assessed health score of older adults in the central region at the 1% significance level, and the coefficient was 0.066. Its mechanism of action is mainly reflected in two key dimensions: firstly, relying on the strategic location advantage of the national transportation hub, the central region has significantly improved the collaborative efficiency of regional medical resources through infrastructure upgrading, effectively alleviating the structural contradiction of uneven distribution of medical resources [63]; Secondly, in response to the specific demographic characteristics of the region, where the permanent population accounts for 25.83% of the national average and the aging rate exceeds the national average by 1.2% points, the urban renewal project implements differentiated strategies, focusing on promoting the renovation of aging friendly facilities and optimizing the supply of community older adults care services [64]. The formation of this region-specific effect may be closely related to the unique urbanization evolution path and population mobility patterns in the central region. The differences in its mechanism of action compared to developed coastal areas in the east and underdeveloped areas in the west are worthy of further research and exploration. Age stratification analysis further reveals that urban renewal has the most significant health promotion effect on middle-aged and younger older adults aged 60–79, which is highly consistent with the World Health Organization’s theory of the golden window period for health intervention.

According to the three-dimensional framework of health proposed by the World Health Organization, urban renewal commonly promotes older adults’ “physiological- psychological-social” health by optimizing the built environment. At the same time, it systematically activates the social adaptation ability of older adults by reconstructing intergenerational interaction space and enhancing community network resilience as intervention paths. Existing studies often consider social adaptation as a mediating variable in health-related fields [65]. Based on this theoretical framework, this study finds through empirical research that social adaptation also has a significant mediating effect between urban renewal and the self-assessed health of older adults. The impact of urban renewal on the social adaptation improvement and health improvement of older adults was significant at the 1% significance level. This data indicates that urban renewal has significantly improved the self-assessed health of older adults by enhancing their social adaptability. Specifically, urban renewal builds a comprehensive support network that promotes the social adaptability of older adults through the synergistic effects of aging-friendly design, systematic planning, and participatory governance [66, 67]. This spatial transformation has not only gained widespread recognition among older adults but also achieved health promotion effects through multiple transformation mechanisms.

However, further discussion found that although urban renewal has improved the self-assessed health of older adults, it has further exacerbated health inequality among older adults. This study showed that urban renewal had a positive impact on the exacerbation of health inequalities among older adults at the 1% significance level. The reason for this is that the allocation of spatial resources in urban renewal has long followed the principle of “efficiency first”. On the one hand, this has prompted advantageous communities to form cumulative advantages in health resources through the siphon effect. On the other hand, the population replacement effect caused by community aristocracy has led to a vicious cycle of structural health deprivation for low-income older adults [68].

Conclusions

Maintaining healthy attention to urban renewal, especially for those who live in areas with backward urban renewal, is crucial to achieving health equity. This study was to explore the impact of urban renewal on the self-assessed health of older adults, and the conclusions were as follows: (1) Overall, urban renewal had a positive effect on improving the self-assessed health of older adults, which improved the self-assessed health by significantly enhanced the social adaptability of older adults. The conclusion was still valid after the robustness test. (2)The impact of urban renewal on the self-assessed health of older adults varied significantly across different geographical areas and age groups. (3) However, further analysis revealed that urban renewal exacerbated the health inequality of older adults

Based on the above findings, our study provides the following implications. First, future urban renewal should focus on optimizing public space design, improving aging-friendly facilities, and enhancing accessibility to medical services to directly improve the physical and mental health of older adults. At the same time, by establishing community activity centers, education programs, and social venues, the social participation and adaptability of older adults can be enhanced, indirectly promoting their health level improvement. Second, differentiated measures are needed to address regional health inequality. The central region can further strengthen the inclusiveness of the renewal policy and consolidate the existing achievements; The eastern region should focus on resource integration and precision services to avoid the marginalization of older adults caused by the “excessive commercialization” of updates; The western region needs to increase investment in infrastructure and medical resources to make up for the regional development gap. In addition, the government should establish a dynamic monitoring mechanism, incorporate health equity indicators into the urban renewal evaluation system, and tilt to vulnerable regions through fiscal transfer payments or special funds, to ensure the coordinated promotion of elderly health improvement and inequality reduction, and ultimately achieve the overall goal of “healthy aging”.

This study has three main limitations. Firstly, limited by the data availability, this study can only select the self-assessed health indicator as the core variable, and this indicator selection has certain research limitations. Secondly, although this study refers to the dimensional division ideas of existing literature and constructs a comprehensive urban renewal indicator from three dimensions of households, communities, and cities, covering the core aspects, the connotation and impact dimensions of urban renewal are complex. The existing indicator system may not fully exhaust its key features, so there are certain construction limitations. Thirdly, the sample data only selects three years, 2016, 2018, and 2020. There is a lack of long-term follow-up observations over a longer time span, making it difficult to fully reveal the long-term dynamic impact effects of urban renewal. Future research can be improved and expanded in three aspects: integrating objective health indicators such as medical institution physical examination data and community health records with self-assessed health data for cross-validation to reduce measurement biases caused by subjective indicators; combining the practical characteristics of urban renewal such as policy evolution and spatial transformation, and incorporating emerging dimensions such as policy strength and residents’ participation to enrich the hierarchy and comprehensiveness of the urban renewal indicator system; expanding the time span of the sample, and through tracking panel data or conducting long-term follow-up surveys, deeply analyzing the long-term dynamic mechanism of urban renewal on the health of older adults, so as to provide more solid empirical support for the long-term optimization of relevant policies.

Authors’ contributions

X.W. contributed to the study’s conception and design. H.Y. performed data analysis, interpretation, and drafting of the study. Y.L. reviewed and supervised the study. All authors have read and agreed to the published version of the manuscript.

Funding

This study is supported by National Social Science Foundation of China(25CGL121).

Data availability

CLASS data are available at http://class.ruc.edu.cn/English/Home.htm.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interest

The authors declare no competing interests.