ORIGINAL RESEARCH article
Front. Public Health
Sec. Environmental Health and Exposome
Socioeconomic status influences the relationship between residential green space and the risk of osteoporosis among rural adults: A large-scale population-based study
Provisionally accepted
- 1Department of Orthopaedic Surgery, Yongjia County People's Hospital, Wen Zhou, China
- 2Zhumadian Center for Disease Control and Prevention, Zhumadian, China
- 3Gansu University of Chinese Medicine, Lanzhou, China
- 4Northwest Minzu University, Lanzhou, China
- 5Zhengzhou University, Zhengzhou, China
- 6Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
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Objective: Residential green space has been associated with a range of chronic health outcomes. However, the relationship with osteoporosis remains understudied. This study aimed to investigate the relationship between residential green space exposure and the prevalence of osteoporosis, and further to examine the combined effects of socioeconomic status (SES) on this relationship. Methods: This study involved 6544 participants from the Henan Rural Cohort study. Residential green space was measured via normalized difference vegetation index (NDVI) and enhanced vegetation index (EVI). The SES was assessed by marital status, educational level, and average monthly income scores. Logistic regression and restricted cubic spline models were applied to explore the associations between residential green space exposure and osteoporosis risk. Results: Higher levels of NDVI and EVI were significantly associated with lower odds of osteoporosis. Participants in the middle tertiles (T2) and highest tertiles (T3) of residential green space exposure exhibited lower odds of osteoporosis compared to those in the lowest tertile (T1) [OR (95%CI), EVI: T2, 1.01 (0.86, 1.18) & T3, 0.63 (0.54, 0.74); NDVI: T2, 0.73 (0.63, 0.86) & T3, 0.60 (0.51, 0.70)]. Higher SES was also associated with lower osteoporosis risk [OR (95%CI), T2, 0.89 (0.76, 1.03) & T3, 0.78 (0.64, 0.94)]. Moreover, participants with both high greenness exposure and high SES had a significantly lower risk of osteoporosis. Conclusion: This study indicated that greater exposure to residential green space could be associated with a reduced risk of osteoporosis among rural adults, with SES potentially enhancing this relationship. These findings provided valuable insights for developing public health strategies to prevent and control osteoporosis in rural populations.
Keywords: Health inequity, Osteoporosis, Residential green space, rural adults, Socioeconomic status
Received: 29 Aug 2025; Accepted: 28 Nov 2025.
Copyright: © 2025 Li, Zhao, Wang, Wang and Pan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Chongjian Wang
Jun Pan
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