Urban and residential environments and osteoarthritis: evidence for disease onset, symptoms, and care

Objective To examine how urban and residential environments relate to osteoarthritis (OA) onset, symptoms, physical function, self-management, and healthcare use, while separating OA-specific findings from evidence that operates indirectly through physical activity, body weight, and other mediators. Data sources PubMed/MEDLINE was searched from inception through August 2026 for studies combining OA or arthritis with neighborhood and built-environment exposures. Citation tracking supplemented the database search. We gave the greatest weight to prospective cohorts, systematic reviews, and studies with clearly defined exposures and outcomes; no OA-specific natural experiment was identified in the PubMed-indexed literature examined. Data synthesis The literature is uneven. A small number of longitudinal cohorts link composite neighborhood improvement, residential natural space, housing conditions, and air pollution with incident OA or arthritis. These studies move the field beyond purely hypothetical pathways, but most use broad exposures or outcomes and remain susceptible to residential selection, detection bias, and residual confounding. Most OA-specific studies address daily activity, perceived accessibility, knee function, self-efficacy, pain, and access to conservative or surgical care, but these associations are largely cross-sectional. Conclusion Urban and residential environments are associated with the conditions under which people remain active, manage symptoms, and obtain care, although much of this evidence is cross-sectional. Evidence for an independent effect on OA onset remains limited. Future studies should measure environmental change over time, distinguish incidence from symptom progression and service use, and make their causal assumptions explicit.