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Original Article

Association between park accessibility and multimorbidity in Korean older adults: a cross-sectional study

Min-Ju Seoorcid, Jin Young Namorcid

Published online: August 26, 2026

Department of Healthcare Management, Eulji University, Seongnam, Republic of Korea

Corresponding author: Jin Young Nam Department of Healthcare Management, Eulji University, 553 Sanseong-daero, Sujeong-gu, Seongnam 13135, Republic of Korea E-mail: jynam@eulji.ac.kr
• Received: March 27, 2026   • Revised: July 3, 2026   • Accepted: July 5, 2026

© 2026 Korea Disease Control and Prevention Agency.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • Objectives
    Adequate physical activity is essential for promoting healthy life expectancy among older adults. Park accessibility is an important environmental determinant of physical activity and may support multimorbidity management in this population. However, evidence on the association between park accessibility and multimorbidity remains limited, particularly in nationally representative Korean samples. This study examined the association between park accessibility and multimorbidity among older Korean adults.
  • Methods
    This cross-sectional study analyzed data from 10,078 individuals aged ≥65 years who participated in the 2023 National Survey of Older Koreans. Multiple logistic regression was used to examine the association between park accessibility and multimorbidity after adjustment for covariates. Stratified analyses assessed this association by physical activity level, and additional logistic regression analyses evaluated associations between park accessibility and common chronic diseases.
  • Results
    The prevalence of multimorbidity among older adults was 64.8%. After adjustment for all covariates, older adults living 30–59 minutes’ walking distance from a park had higher odds of multimorbidity than those living <15 minutes from a park (adjusted odds ratio, 1.33; 95% confidence interval, 1.12–1.59). Among the common chronic diseases examined, hypertension was significantly associated with park accessibility.
  • Conclusion
    Greater park accessibility may support physical activity and green-space exposure and may thereby contribute to multimorbidity management and healthy life expectancy among older adults.
  • Keywords: Aged; Cross-sectional studies; Multimorbidity; Parks, recreational; Republic of Korea; Walking
Background/Rationale
As of December 2024, individuals aged ≥65 years accounted for 20.3% of the total population of the Republic of Korea, indicating that the country had entered a super-aged society [1]. The Republic of Korea’s aging index has increased rapidly since it first exceeded 100 in 2017; according to Statistics Korea, it is projected to reach 222.7 in 2026 and 244.0 in 2027 [1]. Life expectancy in the Republic of Korea is 83.7 years overall—80.8 years for men and 86.6 years for women—the highest level recorded since national statistics were first compiled [2] and higher than the Organisation for Economic Co-operation and Development average of 78.5 years for men and 83.7 years for women [3].
Population aging and longer life expectancy are expected to make multimorbidity management increasingly challenging in the Republic of Korea’s rapidly growing older population [4]. As the population ages, the prevalence of chronic disease continues to increase. The 2023 National Survey of Older Koreans reported that 86.1% of individuals aged ≥65 years had at least one chronic disease and that 63.9% had multimorbidity, defined as the coexistence of 2 or more chronic diseases [5], without any one disease necessarily being more central than another [6]. Multimorbidity is associated with lower quality of life, reduced functional capacity, employment limitations, and disability [6]. Mortality risk also increases as the number of chronic diseases increases [7]. In the Republic of Korea, multimorbidity may further increase the overall healthcare expenditure burden [8], and among older adults, out-of-pocket medical expenditures rise with the number of chronic diseases, even when the total number of conditions is the same [8]. Multimorbidity is therefore closely related to healthy life expectancy in older adults.
Physical activity has been emphasized as a strategy for preventing and managing multimorbidity. Physical activity, defined as any bodily movement produced by skeletal muscles that requires energy expenditure [9], is associated with lower multimorbidity-related mortality risk in older adults [10]. In a longitudinal study of adults with multimorbidity, participants with low physical activity levels had an approximately threefold higher risk of premature mortality than those with high physical activity levels [11]. Physical activity is therefore an important component of health management for older adults with multimorbidity.
The World Health Organization (WHO) Guidelines on Physical Activity and Sedentary Behavior state that regular physical activity provides a wide range of health benefits for older adults, including lower all-cause and cardiovascular mortality; prevention of hypertension, certain cancers, and type 2 diabetes; and improvements in mental health, cognitive function, sleep quality, and weight status [9]. The guidelines recommend that all older adults, including those with chronic conditions, engage in at least 150–300 minutes of moderate-intensity aerobic physical activity per week to obtain substantial health benefits [9].
However, many older adults do not achieve recommended physical activity levels. Health-promoting park activities, including walking, have beneficial effects on physical health as well as social and mental well-being [12]. Because parks are among the most accessible and commonly used spaces for routine physical activity among older adults, park environments and accessibility have received attention as factors that may promote physical activity. One previous study suggested that park accessibility does not directly measure actual park use but instead reflects the opportunity or potential availability of parks [13]. Accordingly, park accessibility has been examined as an important environmental factor in studies of health outcomes among older adults.
Previous studies have suggested that park accessibility is associated with health outcomes [14]. Lack of time, distance, and travel time are major reasons for not using parks, whereas accessibility and opportunities for walking or strolling are primary reasons for park use [15]. Shorter distances to parks have also been associated with more frequent park use for physical activity and health promotion [15].
On the basis of this evidence, public health policies aimed at improving community health should include spatial planning strategies that enhance neighborhood environments [14]. Park planning should also consider residential accessibility as a key factor in encouraging park use for physical activity [15].
Although previous studies have demonstrated the importance of park accessibility for physical activity and health, evidence on its association with multimorbidity in older adults remains limited. Most Korean studies have examined park-use behaviors in specific local areas, whereas nationally representative studies of the relationship between park accessibility and multimorbidity are scarce. Few studies have also investigated whether specific chronic disease combinations or common multimorbidity patterns are associated with park accessibility. As the Republic of Korea has entered a super-aged society and multimorbidity among older adults continues to increase, environment-based health promotion strategies are becoming increasingly important.
Objectives
This study examined the association between park accessibility and multimorbidity among older adults using data from the 2023 National Survey of Older Koreans.
Study Design and Setting
This cross-sectional study used data from the 2023 National Survey of Older Koreans, which was conducted under the auspices of the Ministry of Health and Welfare.
Setting
The National Survey of Older Koreans defined its target population as all individuals aged ≥65 years residing in 17 provinces and metropolitan cities nationwide. The survey population, which served as the sampling frame, consisted of individuals aged ≥65 years residing in enumeration districts identified through the Population and Housing Census, excluding those living in dormitories, specialized facilities, and island regions.
Participants
Stratified cluster sampling was used to ensure that the sample reflected the regional demographic composition of older adults. The final analysis included data from 10,078 individuals. Data were collected through tablet-assisted personal interviews, in which trained interviewers conducted face-to-face visits to individual households.
Variables
The outcome variable was multimorbidity, defined as the co-occurrence of 2 or more chronic conditions without any single disease being prioritized or considered more central than the others [6]. This definition is consistent with the WHO definition [16]. The primary independent variables were park accessibility and physical activity. Park accessibility was defined as the walking time required to reach a park suitable for walking or exercise from the respondent’s residence, and physical activity was defined as weekly exercise duration.
Potential confounders included sex, age, education level, residential area, marital status, living-alone status, home ownership, annual household income, basic livelihood security status, current economic activity, obesity, activities of daily living (ADL), and instrumental activities of daily living (IADL). These confounders were selected on the basis of prior evidence of their associations with multimorbidity among older Korean adults. Sociodemographic factors, including sex, age, education level, marital status, living-alone status, home ownership, annual household income, basic livelihood security status, and current economic activity, as well as obesity, have been identified as significant correlates of multimorbidity in previous studies [17,18]. Residential area was included as a covariate because urban–rural differences in the physical environment and living conditions may influence multimorbidity prevalence among older adults. Functional limitations, measured using ADL and IADL, were also adjusted for because functional status is an important health indicator in older adults and has been included in previous studies of aging-related health outcomes [19].
Data Sources/Measurement
Multimorbidity, the dependent variable, was defined as the co-occurrence of 2 or more chronic conditions without any single disease being prioritized or considered more central than the others [6]. On the basis of the 2023 National Survey of Older Koreans, this study included the following 33 physician-diagnosed chronic diseases that had been present for at least 3 months: hypertension, stroke, hyperlipidemia (dyslipidemia), angina, myocardial infarction, other heart diseases, diabetes, thyroid disease, osteoarthritis/rheumatoid arthritis, osteoporosis, lumbago/sciatica, fractures/dislocations and accident sequelae, chronic lung disease, asthma, tuberculosis/pulmonary tuberculosis, depression, dementia, Parkinson’s disease, insomnia, cataracts, glaucoma, chronic otitis media, age-related hearing loss, skin diseases, cancer, gastric/duodenal ulcers, hepatitis, liver cirrhosis, chronic kidney disease, prostatic hyperplasia, urinary incontinence, anemia, and other chronic diseases. For the analysis, the total number of chronic conditions reported by each respondent was summed and converted into a binary variable. Individuals with 2 or more conditions were classified as having multimorbidity, whereas those with zero or one condition were classified as not having multimorbidity.
Park accessibility, the primary independent variable, was measured as the walking time required to travel from a respondent’s residence to a park suitable for exercise. Although the 2023 National Survey of Older Koreans originally recorded this variable using 5 categories, the categories were restructured into 4 groups to improve analytical efficiency and balance the response distribution. Specifically, the first 2 categories were merged, resulting in the following final classification: (1) <15 minutes, (2) 15–29 minutes, (3) 30–59 minutes, and (4) ≥60 minutes. Because the survey did not include data on actual park use, walking time to the nearest park was used as a proxy measure of park accessibility. This measure reflects older adults’ opportunity to access parks rather than their actual park utilization.
The physical activity variable was constructed by combining responses on exercise participation, frequency, and duration. For respondents who reported not exercising, weekly exercise time was set to 0 minutes. For respondents who exercised, weekly exercise volume was calculated by multiplying weekly frequency in days by duration per session in minutes. To maintain consistency with the survey skip patterns, “not applicable” responses (original code 9) resulting from a “no” response to exercise participation were recoded as 0. Responses exceeding 1,440 minutes/week were treated as outliers and coded as missing for the physical activity variable because they exceeded plausible limits and were considered unreliable. Because only one such observation was identified (n=1), analyses involving physical activity excluded this case. Finally, on the basis of the WHO Guidelines on Physical Activity and Sedentary Behavior [9], physical activity was dichotomized as <150 min/wk or ≥150 min/wk.
Covariates included sex, categorized as male or female, and age, which was reclassified into 3 groups: young-old adults (65–74 years), old-old adults (75–84 years), and oldest-old adults (≥85 years). Education level was recategorized into 5 groups: no formal or preschool education, elementary school, middle school, high school, and college or higher education. Residential area was categorized as urban or rural, marital status as with or without a spouse, living-alone status as living alone or not living alone, and home ownership as non-homeowner or homeowner. Annual household income was categorized into quintiles, from the 1st quintile (lowest) to the 5th quintile (highest). Basic livelihood security status was classified as recipient, defined as receiving any livelihood, medical, housing, or educational benefits, or non-recipient. Current economic activity was recoded into 2 categories: currently working and not working. The not-working category included individuals with previous work experience and those with no work experience. Obesity was classified by body mass index according to the criteria of the Korean Society for the Study of Obesity as normal/pre-obesity (18.5–24.9 kg/m²), underweight (<18.5 kg/m²), or obesity (≥25.0 kg/m²); missing values were retained as a separate category in the descriptive analyses. Finally, functional limitations were defined using criteria from a previous study [20]. Individuals requiring partial or full assistance with any of the 17 items in the Korean Activities of Daily Living scale (7 items) or Korean Instrumental Activities of Daily Living scale (10 items) were classified as having functional limitations, defined as dependent ADL/IADL.
Bias
To reduce potential bias, statistical analyses were adjusted for potential confounders. In addition, values exceeding 1,440 min/wk for the physical activity variable were considered unlikely among older adults, treated as outliers, and excluded from analyses involving physical activity.
Study Size
The study size was determined by the number of participants included in the 2023 National Survey of Older Koreans. A total of 10,078 individuals aged ≥65 years were included in the final analysis.
Quantitative Variables
Age was used as a continuous variable in the regression analyses, whereas age group (65–74, 75–84, and ≥85 years) was used to describe the general characteristics of the study population. Physical activity was derived from weekly exercise time in the raw data and categorized according to the WHO guideline as inadequate physical activity (<150 min/wk) or adequate physical activity (≥150 min/wk).
Statistical Methods
Descriptive statistical analyses were performed to describe the general characteristics of the study population. Continuous variables were examined for distribution, and categorical variables are presented as frequencies and percentages. Multiple logistic regression was performed to examine the association between park accessibility and multimorbidity after adjustment for confounding variables. Before the stratified analysis, the interaction between park accessibility and physical activity in relation to multimorbidity was assessed. Stratified logistic regression analyses were then conducted by physical activity level (<150 and ≥150 min/wk). Logistic regression was also performed to investigate the associations between park accessibility and the 5 most common chronic diseases—hypertension, hyperlipidemia, diabetes mellitus, osteoarthritis/rheumatoid arthritis, and osteoporosis—and depression. No missing data were observed for the main outcome or independent variables; therefore, no additional missing-data procedures were required. However, values exceeding 1,440 min/wk for the physical activity variable were treated as outliers. Because only one such observation was identified (n=1), it was coded as missing for the physical activity variable only, and analyses including physical activity were conducted after excluding the affected case. Sensitivity analyses were conducted to evaluate changes in the odds ratio for the group living ≥60 minutes from a park. With multimorbidity as the dependent variable and park accessibility as the primary independent variable, additional independent variables were entered individually to assess changes in the odds ratio. All statistical analyses were performed using IBM SPSS Statistics for Windows ver. 29.0 (IBM Corp.), with statistical significance set at p<0.05.
Ethics Statement
This study was exempt from review by the Institutional Review Board (IRB) of Eulji University (IRB No: EUIRB2025-345) because it involved a secondary analysis of data from the 2023 National Survey of Older Koreans. Informed consent was obtained from all participants during the original survey. Because the present study involved a retrospective analysis of anonymized data, additional participant consent was not required.
Participants
A total of 10,078 individuals aged ≥65 years were included in the study. Because one observation for the physical activity variable exceeded 1,440 min/wk and was coded as missing, analyses involving physical activity were based on 10,077 participants.
Descriptive Data
The general characteristics of the study population are summarized in Table 1. Regarding park accessibility, the largest proportion of participants lived <15 minutes from a park (60.9%), whereas the smallest proportion lived ≥60 minutes from a park (2.4%). Overall, 38.6% of participants met the physical activity guideline. One observation for the physical activity variable exceeded 1,440 min/wk and was treated as missing; therefore, the distribution of physical activity was based on 10,077 participants.
Outcome Data
Among the 10,078 individuals included in this study, 6,530 (64.8%) had multimorbidity. By park accessibility category, multimorbidity prevalence was lowest among participants living <15 minutes from a park (63.8%) and highest among those living 30–59 minutes from a park (70.8%). The prevalence of each chronic condition included in the multimorbidity definition is presented in Table 2.
Main Results
Table 3 presents the association between park accessibility and multimorbidity after adjustment for sex, age, education level, residential area, marital status, living-alone status, home ownership, annual household income, basic livelihood security status, current economic activity, obesity, ADL, and IADL. Participants with inadequate physical activity had 1.16-fold higher odds of multimorbidity than those with adequate physical activity (adjusted odds ratio [aOR], 1.16; 95% confidence interval [CI], 1.06–1.27). For park accessibility, participants living 30–59 minutes from a park had significantly higher odds of multimorbidity than those living <15 minutes from a park (aOR, 1.33; 95% CI, 1.12–1.59). In contrast, no significant difference was observed for participants living 15–29 minutes from a park, whereas those living ≥60 minutes from a park had significantly lower odds of multimorbidity (aOR, 0.73; 95% CI, 0.55–0.98).
Table 4 shows the association between park accessibility and multimorbidity stratified by physical activity level. The model was adjusted for the same covariates as in Table 3, except for physical activity. Among participants with adequate physical activity (≥150 min/wk), those living 15–29 minutes from a park (aOR, 1.219; 95% CI, 1.048–1.419) and those living 30–59 minutes from a park (aOR, 1.337; 95% CI, 1.002–1.785) had significantly higher odds of multimorbidity than the reference group living <15 minutes from a park. In contrast, among participants with inadequate physical activity, those living ≥60 minutes from a park had significantly lower odds of multimorbidity (aOR, 0.659; 95% CI, 0.473–0.918). These findings indicate that the association between park accessibility and multimorbidity differed by physical activity level.
Table 5 shows the associations between park accessibility, the 5 most common chronic diseases, and depression. The models were adjusted for the same covariates as in Table 3. For hypertension, the odds were significantly higher among participants living 15–29 minutes from a park (aOR, 1.20; 95% CI, 1.10–1.32) and those living 30–59 minutes from a park (aOR, 1.36; 95% CI, 1.15–1.61) than among those living <15 minutes from a park. Conversely, the odds of hypertension were significantly lower among participants living ≥60 minutes from a park (aOR, 0.67; 95% CI, 0.51–0.89). No significant associations were observed for hyperlipidemia, osteoporosis, or depression. However, diabetes mellitus and osteoarthritis/rheumatoid arthritis showed statistically significant estimates in some park-accessibility categories.
Key Results
This cross-sectional study examined the association between park accessibility and multimorbidity among adults aged ≥65 years in the Republic of Korea. Park accessibility was significantly associated with multimorbidity after adjustment for sociodemographic factors and health-related behaviors. Specifically, older adults living 30–59 minutes from a park had 1.33-fold higher odds of multimorbidity than those living within 15 minutes of a park.
Limitations
This study has several limitations. First, because of its cross-sectional design, causal relationships between park accessibility and multimorbidity cannot be established; only associations can be examined. Second, the lower odds of multimorbidity observed in the group living ≥60 minutes from a park should be interpreted with caution, and further research is needed to clarify this unexpected finding. Third, the higher prevalence of non-homeownership among individuals with multimorbidity should also be interpreted cautiously. Previous studies have shown that chronic disease is associated with higher healthcare expenditures and greater household financial burden [21], and such economic strain may influence housing circumstances. Because this study used a cross-sectional design, the temporal relationship between home ownership and multimorbidity cannot be established, and reverse causality cannot be excluded. Fourth, this study used walking time to the nearest park as a measure of park accessibility rather than actual park use. Because accessibility does not directly capture individual park-use behavior, the observed association between park accessibility and multimorbidity should be interpreted with caution. Future studies incorporating actual park-use data may help clarify the relationship between park use and multimorbidity among older adults.
Interpretation
These findings are consistent with previous studies demonstrating beneficial associations between green spaces, including parks, and human health and well-being [22]. The WHO reports that green spaces may promote health through multiple pathways, including stress reduction, social interaction, and increased physical activity [23]. Limited park accessibility may therefore reduce older adults’ opportunities to benefit from these mechanisms and may be associated with greater vulnerability to multimorbidity.
Life-space mobility is an important indicator of mortality risk and quality of life among older adults [24]. Accordingly, the physical and environmental characteristics of residential areas may have particularly strong influences on health in later life. Older adults often have a more restricted range of daily activities than younger age groups and may therefore depend more heavily on community facilities. Research on aging infrastructure has indicated that parks serve not only as places for rest but also as motivators for routine outings and facilitators of walking [25]. The present findings therefore suggest that reduced park accessibility may limit opportunities for physical activity and may thereby be associated with higher odds of multimorbidity.
In contrast, the odds of multimorbidity were lower among participants living ≥60 minutes from a park. Because this study was cross-sectional, the mechanisms underlying this finding cannot be determined. However, one possible explanation is that older adults in this group, despite low measured park accessibility, may have been exposed to other beneficial environments, such as natural green spaces. Previous studies have reported that exposure to surrounding green spaces is associated with positive health outcomes independently of proximity to specific park facilities [26].
In the analysis stratified by physical activity level, the lower odds of multimorbidity among participants living ≥60 minutes from a park persisted only among those with inadequate physical activity. This finding suggests that walking time to a park may partly reflect broader residential environmental characteristics, such as residential greenness, rather than only opportunities for park-based physical activity. Previous research has shown that access to public green space and residential exposure to natural environments are only weakly correlated [27]. Greater residential greenness has also been associated with favorable health outcomes among middle-aged and older adults [28]. Therefore, the unexpected finding among participants living ≥60 minutes from a park may partly reflect differences in residential greenness rather than the direct effect of park accessibility itself. Nevertheless, because this study was cross-sectional, reverse causality cannot be excluded.
Subgroup analyses excluding groups likely to be influenced by environmental characteristics showed a linear increase in the odds of hypertension as park accessibility decreased. This finding is consistent with previous studies reporting that greater access to open public spaces and green areas is significantly associated with lower odds of hypertension [29,30]. In particular, previous research showing that systolic blood pressure was higher when the distance to green space exceeded 1.5 km [31] aligns with the present finding of higher odds of hypertension among older adults living 30–59 minutes, or approximately 1.5–3 km, from a park. Physical constraints on park access may limit opportunities for physical activity and create less favorable conditions for blood pressure regulation. These findings suggest that expanding park infrastructure and improving physical accessibility may help promote cardiovascular health among older adults.
The findings of this study suggest that urban planning interventions aimed at improving park accessibility may contribute to multimorbidity management among older adults. The higher odds observed in the 30–59-minute group raise the possibility that older adults in these areas may have less access to the potential health benefits of parks. To address poor accessibility, expanding pocket parks in vacant lots or underused spaces near residential areas may be a practical alternative to developing large parks, which requires substantial land acquisition. Pocket parks are characterized by high daily accessibility, low cost, and ease of maintenance and may help fill gaps in access to larger parks while providing nearby spaces for physical activity [32]. In addition, studies evaluating pocket parks in low-income neighborhoods have reported that they promote moderate-to-vigorous physical activity more effectively than existing playgrounds in nearby parks, suggesting that pocket parks may provide opportunities for physical activity among nearby residents [33].
Taken together, these findings suggest that improving physical accessibility to parks near residential areas may be a public health strategy for multimorbidity management among older adults. In particular, expanding pocket parks on vacant or underused land may be a feasible complementary approach in high-risk areas where developing large parks is difficult, such as neighborhoods in the 30–59-minute distance category. Consistent with the 6th National Health Promotion Comprehensive Plan (HP2030, 2026–2030), which emphasizes supportive environments for physical activity and reduced regional disparities, these findings may provide preliminary evidence for prioritizing older adults living in areas with limited park accessibility in health promotion policy planning.
Generalizability
Because this study used data from the 2023 National Survey of Older Koreans, its findings may be generalizable to community-dwelling older adults in the Republic of Korea. However, caution is needed when applying these results to older adults living in dormitories, specialized facilities, or island areas, because these populations were not included in the survey. In addition, because physical environments and social contexts differ across countries, these findings should be generalized to older populations in other countries with caution.
In this study, older adults living 30–59 minutes from a park had higher odds of multimorbidity than those living <15 minutes from a park. Overall, poorer park accessibility was associated with higher odds of multimorbidity among older adults, particularly for hypertension. These findings suggest that physical accessibility to parks and green spaces may support the prevention and management of chronic disease among older adults. Urban planning efforts should therefore prioritize improvements in park accessibility within residential neighborhoods rather than focusing solely on the creation of new large-scale parks.
• Park accessibility may support physical activity and healthy life expectancy among older adults.
• People with poor park accessibility have a higher risk of multimorbidity than those with good park accessibility.
• Hypertension was significantly associated with park accessibility.

Ethics Approval

This study was exempt from review by the Institutional Review Board of Eulji University (IRB No: EUIRB2025-345) because it used publicly available secondary data. Informed consent was obtained from all participants during the original survey. Because the present study involved a retrospective analysis of anonymized data, additional participant consent was not required.

Conflicts of Interest

The authors have no conflicts of interest to declare.

Funding

None.

Availability of Data

All data analyzed during this study are included in this published article. Additional data may be requested from the corresponding author.

Table 1.
General characteristics of the study population
Table 1.
Variable Category Total (n=10,078) Non-multimorbidity (n=3,548) Multimorbidity (n=6,530)
Walking time to park (min) <15 6,142 (60.9) 2,222 (62.6) 3,920 (60.0)
15–29 2,969 (29.5) 1,030 (29.0) 1,939 (29.7)
30–59 730 (7.2) 213 (6.0) 517 (7.9)
≥60 237 (2.4) 83 (2.3) 154 (2.4)
Age (y) 65–74 5,731 (56.9) 2,394 (67.5) 3,337 (51.1)
75–84 3,494 (34.7) 941 (26.5) 2,553 (39.1)
≥85 853 (8.5) 213 (6.0) 640 (9.8)
Sex Male 3,872 (38.4) 1,533 (43.2) 2,339 (35.8)
Female 6,206 (61.6) 2,015 (56.8) 4,191 (64.2)
Education level No formal education 1,488 (14.8) 318 (9.0) 1,170 (17.9)
Elementary school 2,961 (29.4) 867 (24.4) 2,094 (32.1)
Middle school 2,127 (21.1) 700 (19.7) 1,427 (21.9)
High school 2,876 (28.5) 1,335 (37.6) 1,541 (23.6)
College or higher 626 (6.2) 328 (9.2) 298 (4.6)
Home ownership status Non-owner 1,979 (19.6) 513 (14.5) 1,466 (22.5)
Owner 8,099 (80.4) 3,035 (85.5) 5,064 (77.5)
Residential area Urban 7,061 (70.1) 2,606 (73.4) 4,455 (68.2)
Rural 3,017 (29.9) 942 (26.6) 2,075 (31.8)
Annual household income Q1, lowest 2,132 (21.2) 617 (17.4) 1,515 (23.2)
Q2 2,205 (21.9) 627 (17.7) 1,578 (24.2)
Q3 2,057 (20.4) 754 (21.3) 1,303 (20.0)
Q4 1,925 (19.1) 780 (22.0) 1,145 (17.5)
Q5, highest 1,759 (17.5) 770 (21.7) 989 (15.1)
National basic livelihood security status Non-recipient 9,414 (93.4) 3,417 (96.3) 5,997 (91.8)
Recipient 664 (6.6) 131 (3.7) 533 (8.2)
Economic activity No 6,130 (60.8) 1,859 (52.4) 4,271 (65.4)
Yes 3,948 (39.2) 1,689 (47.6) 2,259 (34.6)
Spouse No 4,127 (41.0) 1,233 (34.8) 2,894 (44.3)
Yes 5,951 (59.0) 2,315 (65.2) 3,636 (55.7)
Living-alone status No 6,630 (65.8) 2,524 (71.1) 4,106 (62.9)
Yes 3,448 (34.2) 1,024 (28.9) 2,424 (37.1)
Activities of daily living Independent 9,258 (91.9) 3,434 (96.8) 5,824 (89.2)
Dependent 820 (8.1) 114 (3.2) 706 (10.8)
Instrumental activities of daily living Independent 8,316 (82.5) 3,242 (91.4) 5,074 (77.7)
Dependent 1,762 (17.5) 306 (8.6) 1,456 (22.3)
Physical activity (min/wk) <150 6,191 (61.4) 2,003 (56.5) 4,188 (64.1)
≥150 3,886 (38.6) 1,545 (43.5) 2,341 (35.8)
Obesity Normal/pre-obesity 7,186 (71.3) 2,555 (72.0) 4,631 (70.9)
Underweight 238 (2.4) 75 (2.1) 163 (2.5)
Obesity 2,653 (26.3) 918 (25.9) 1,735 (26.6)
Missing 1 (0) 0 (0) 1 (0)

Data are presented as n (%).

Q, quartile.

Table 2.
Prevalence of 33 chronic diseases among older adults
Table 2.
Chronic disease Value
Hypertension 6,002 (59.6)
Stroke 376 (3.7)
Hyperlipidemia (dyslipidemia) 2,955 (29.3)
Angina 338 (3.4)
Myocardial infarction 313 (3.1)
Other heart diseases 472 (4.7)
Diabetes mellitus 2,744 (27.2)
Thyroid disease 436 (4.3)
Osteoarthritis/rheumatoid arthritis 1,750 (17.4)
Osteoporosis 1,188 (11.8)
Lumbago/sciatica 1,038 (10.3)
Fractures/dislocations and accident sequelae 197 (2.0)
Chronic lung disease 111 (1.1)
Asthma 227 (2.3)
Tuberculosis/pulmonary tuberculosis 40 (0.4)
Depression 167 (1.7)
Dementia 205 (2.0)
Parkinson’s disease 66 (0.7)
Insomnia 369 (3.7)
Cataracts 629 (6.2)
Glaucoma 130 (1.3)
Chronic otitis media 47 (0.5)
Age-related hearing loss 297 (2.9)
Skin diseases 107 (1.1)
Cancer 199 (2.0)
Gastric/duodenal ulcers 453 (4.5)
Hepatitis 66 (0.7)
Liver cirrhosis 29 (0.3)
Chronic kidney disease 100 (1.0)
Prostatic hyperplasia 519 (5.1)
Urinary incontinence 368 (3.7)
Anemia 111 (1.1)
Other chronic diseases 210 (2.1)

Data are presented as n (%). “Other chronic diseases” refers to a single, most representative chronic condition reported by the respondent that is not included in the 32 predefined disease categories, in accordance with the survey guidelines.

Table 3.
Association between park accessibility and multimorbidity
Table 3.
Variable Category OR (95% CI)
Walking time to park (min) <15 1.00
15–29 1.07 (0.97–1.17)
30–59 1.33 (1.12–1.59)
≥60 0.73 (0.55–0.98)
Age 1.02 (1.02–1.03)
Sex Male 1.00
Female 1.15 (1.04–1.27)
Education level College or higher 1.00
No formal education 2.31 (1.83–2.90)
Elementary school 2.04 (1.68–2.48)
Middle school 1.99 (1.64–2.40)
High school 1.26 (1.05–1.51)
Home ownership status Owner 1.00
Non-owner 1.55 (1.37–1.75)
Residential area Urban 1.00
Rural 1.19 (1.07–1.31)
Annual household income (quartile, Q) Q1, lowest 1.00
Q2 1.23 (1.07–1.42)
Q3 1.12 (0.97–1.30)
Q4 1.18 (1.01–1.38)
Q5, highest 1.26 (1.07–1.49)
National basic livelihood security status Non-recipient 1.00
Recipient 1.30 (1.05–1.62)
Economic activity Yes 1.00
No 1.43 (1.29–1.57)
Spouse No 1.00
Yes 1.13 (0.94–1.36)
Living alone status No 1.00
Yes 1.27 (1.04–1.55)
Activities of daily living Independent 1.00
Dependent 1.30 (1.00–1.69)
Instrumental activities of daily living Independent 1.00
Dependent 1.96 (1.65–2.32)
Physical activity (min/wk) ≥150 1.00
<150 1.16 (1.06–1.27)
Obesity Normal/pre-obesity 1.00
Underweight 1.12 (0.84–1.50)
Obesity 1.01 (0.92–1.11)

ORs and 95% CIs were estimated using logistic regression, adjusted for sex, age (continuous), education level, residential area, spouse status, living alone status, home ownership, annual household income, basic livelihood security status, current economic activity, functional limitations (activities of daily living/instrumental activities of daily living), physical activity, and obesity. OR, odds ratio; CI, confidence interval.

Table 4.
Association between park accessibility and multimorbidity stratified by physical activity level
Table 4.
Variable Category <150 ≥150
OR (95% CI) OR (95% CI)
Walking time to park (min) <15 1.00 1.00
15–29 0.969 (0.856–1.098) 1.219 (1.048–1.419)
30–59 1.302 (1.042–1.628) 1.337 (1.002–1.785)
≥60 0.659 (0.473–0.918) 1.054 (0.560–1.982)

Models were stratified by weekly physical activity (<150, ≥150 minutes). ORs and 95% CIs were estimated using stratified logistic regression, adjusted for sex, age (continuous), education level, residential area, spouse status, living alone status, home ownership, annual household income, basic livelihood security status, current economic activity, functional limitations (activities of daily living/instrumental activities of daily living), and obesity.

OR, odds ratio; CI, confidence interval.

Table 5.
Association between park accessibility and common chronic diseases
Table 5.
Chronic disease Walking time to park (min) OR (95% CI) p
Hypertension <15 1.00 <0.001
15–29 1.20 (1.10–1.32) <0.001
30–59 1.36 (1.15–1.61) <0.001
≥60 0.67 (0.51–0.89) 0.005
Hyperlipidemia <15 1.00 0.454
15–29 1.04 (0.94–1.14) 0.465
30–59 1.10 (0.92–1.30) 0.306
≥60 0.86 (0.63–1.16) 0.323
Diabetes mellitus <15 1.00 0.003
15–29 1.20 (1.09–1.32) <0.001
30–59 1.05 (0.88–1.25) 0.616
≥60 0.97 (0.71–1.31) 0.833
Osteoarthritis/rheumatoid arthritis <15 1.00 <0.001
15–29 0.90 (0.79–1.01) 0.093
30–59 1.41 (1.16–1.71) <0.001
≥60 1.28 (0.93–1.73) 0.119
Osteoporosis <15 1.00 0.045
15–29 1.03 (0.89–1.19) 0.717
30–59 1.33 (1.06–1.68) 0.016
≥60 1.37 (0.95–1.95) 0.088
Depression <15 1.00 0.890
15–29 0.99 (0.70–1.40) 0.942
30–59 1.24 (0.69–2.22) 0.467
≥60 0.92 (0.32–2.59) 0.867

ORs and 95% CIs were estimated using logistic regression, adjusted for sex, age (continuous), education level, residential area, spouse status, living alone status, home ownership, annual household income, basic livelihood security status, current economic activity, functional limitations (activities of daily living/instrumental activities of daily living), physical activity, obesity.

OR, odds ratio; CI, confidence interval.

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