Spatial uncertainty and environment-health association: An empirical study of osteoporosis among “old residents” in public housing estates across a hilly environment

Hung Chak Ho*, Wei Cheng, Yimeng Song, Yuqi Liu, Yingqi Guo, Shiyu Lu, Terry Yat Sang Lum, Rebecca Chiu, Chris Webster*

*Corresponding author for this work

Research output: Contribution to journalJournal articlepeer-review

5 Citations (Scopus)



Built environment can influence physical conditions of older adults (e.g. osteoporosis). However, traditional methods using 2-dimensional circular buffer as a spatial structure to measure neighbourhood effect may create bias in health estimation, especially for the hilly and compact environment across low-income neighbourhoods (e.g. public housing estates).

We evaluated the environmental influences on self-reported osteoporosis among “old residents” (age≥65) in Hong Kong (n = 2077). Twelve public housing estates across hilly neighbourhoods in Hong Kong were selected as study sites. A cross-validated approach was developed to evaluate four spatial structures (2D circular, 2D service area, 3D circular, 3D service area). To determine problems of spatial uncertainty, we compared odds ratios (OR) and differences in effect sizes from models using different spatial structures. When all adjusted models achieve significant results based on 95% confidence intervals (CI) and with all positive/negative ORs, this study reported to have reached “a result with consistency”. Results from the 3D service area were then used to explain the environment-health relationship.

Different spatial structures can yield different results. Particularly, circular buffers overestimated environmental effects on self-reported osteoporosis. Overestimated measures were related to walkability and accessibility but not greenery. Specifically, results from the 3D service area showed that more public space and health facilities within a walkable distance (500 m) from a location of subject's residence were negatively associated with self-reported osteoporosis (adjusted ORs: 0.44 [0.29, 0.66]; 0.94 [0.90, 0.99]). However, more major transport facilities at the immediate distance from residence (200 m) was positively associated with self-reported osteoporosis (adjusted OR: 1.11 [1.01, 1.23]).

Physical conditions (e.g. osteoporosis) of older adults living in a hilly neighbourhood could be driven by walking behaviours. It is necessary to include local terrain and road network to define a walkable neighbourhood for environment-health estimations to minimize spatial bias.
Original languageEnglish
Article number115155
Number of pages11
JournalSocial Science and Medicine
Early online date17 Jun 2022
Publication statusPublished - Aug 2022

Scopus Subject Areas

  • Health(social science)
  • History and Philosophy of Science

User-Defined Keywords

  • Spatial uncertainty
  • Built environment
  • Community health
  • Social deprivation
  • Osteoporosis
  • Local accessibility


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