Associations of living environmental risk factors and pain with successful aging among older adults in China: longitudinal evidence from the CHARLS cohort

Living environmental risk factors (LEFs) and pain are both potential modifiable determinants of health status in older adults. However, their independent and combined associations with successful aging (SA) remain unclear. This prospective cohort study included 3,756 adults aged ≥ 60 years from the 2011 wave of CHARLS, with follow-up through 2018. A composite LEFs score was constructed by integrating six domains: outdoor PM₂.₅, household energy sources, water sources, housing type, indoor temperature, and relative humidity. Pain status was assessed via self-reported questionnaires. SA was defined according to Rowe and Kahn’s theoretical framework. The impact of LEFs, pain, and their joint categories on SA was analyzed through Cox regression, whereas restricted cubic splines (RCS) served to characterize dose–response associations. Higher LEFs scores were significantly associated with lower probability of SA (HR = 0.80, 95% CI: 0.72–0.89). RCS analysis revealed a linear inverse association between LEFs and SA ( P for non-linearity = 0.968). Compared to those without pain, participants reporting pain exhibited a significantly lower probability of SA (HR = 0.44, 95% CI: 0.31–0.64). A joint effect of LEFs and pain was observed. Compared to the reference group (“Lower LEFs with pain absent”), the group with “Higher LEFs with pain present” demonstrated the lowest probability of SA (HR = 0.26, 95% CI: 0.15–0.44). Subgroup analyses revealed that the effects were more pronounced in females, individuals with kidney disease, and those with lower educational levels. Sensitivity analyses confirmed the robustness and reliability of these findings. LEFs and pain constitute dual barriers to SA and exert a significant joint adverse effect when coexisting. It is recommended to provide multifaceted environmental and pain interventions for older adults.