Promoting health equity: Role of perceived neighborhood built environment in rural community resilience to pandemics

The coronavirus disease 2019 (COVID-19) pandemic has highlighted how socioeconomic disparities exacerbate rural health inequalities, demanding enhanced rural community resilience in socioeconomic dimensions. While cross-sectional nonpandemic evidence supports the impacts of the perceived neighborhood built environment (NBE) on these dimensions, whether the NBE influences these dimensions in a pandemic context and their potential two-way correlations remain unclear. Herein, we use a cross-lagged analysis of Chinese longitudinal data to investigate the associations between the perceived NBE and these dimensions during the COVID-19 pandemic. Our results indicate that rural communities with better prepandemic NBE perceptions generally exhibit greater socioeconomic resilience during the pandemic. However, in more disadvantaged western rural communities, the perceived NBE and community-level economic resilience are negatively correlated. Prepandemic individual-level socioeconomic resilience positively affects during-pandemic NBE perceptions, suggesting a reciprocal relationship. Our findings underscore the socioeconomic role of the perceived NBE in promoting the pandemic resilience and health equity of rural communities.