Perception of the Residential Living Environment: The Relationship Between Objective and Subjective Indicators of the Residential Living Environment and Health

Multiple studies have found an association between ambient air quality, noise pollution, green spaces and health. The underlying mechanisms of this association remain partly unknown. In this study, we focus on subjective perception as a potential underlying factor. We assess (I) the association between objective and subjective indicators of the living environment and all-cause mortality, as well as (II) the potential modification of the relationship between objective exposures and all-cause mortality by subjective perception: The data consisted of a linkage between the 2001 census, mortality register data from 1 October 2001 to 31 December 2016 and objective indicators of the residential living environment (air and noise pollution and green spaces). We used Cox regression to investigate the impact of objective and subjective indicators of the living environment and their potential interaction effect on all-cause mortality in the Brussels Capital Region: A negative subjective perception of the residential living environment is associated with an increased risk of mortality, even when controlling for socio-demographic parameters. Similarly, objective indicators of air pollutants and green spaces are also related to mortality. When studying the interaction effect, the beneficial effect of a neutral subjective perception stands out. Subjectively satisfied individuals living in the worst objective conditions showed the highest level of mortality hazard. Noise pollution was the only exception, characterized by the lack of an interaction effect: This study showed that besides objective indicators, the subjective perception of the residential environment also matters, and both interact to influence life chances. Subjective indicators not only have a genuine independent impact but also act as an underlying factor in the relationship between the objective residential environment and health.