城镇化的快速发展使得居民面临一系列的健康威胁，社区作为居民生活的载体，其建成环境与居民健康之间存在密切联系。厘清建成环境对居民健康的影响及路径是通过优化建成环境提升居民健康的前提。目前，已有研究多集中于西方国家，我国在该领域的研究起步较晚，且研究区域多为大城市，缺乏不同地域、不同人群之间的比较。

本文基于2013年河北省家庭卫生服务调查数据，利用多层线性模型等定量方法分析建成环境对居民自评健康的影响，并在此基础上进一步以居民的锻炼频率和焦虑状况作为中介变量，探究建成环境对居民健康的影响路径。此外，研究中加入对不同地区和不同属性居民之间差异的考虑，以明确建成环境在不同背景下、不同人群之间对居民健康影响的异质性，主要研究结论包括：

（1）建成环境对居民健康有显著影响且存在城乡差异，在城市地区人口密度的增加会导致居民健康水平下降，而农村地区居民健康主要受公园广场和休闲设施可达性的影响。

（2）建成环境会通过健康行为和心理状态影响居民健康，并且在不同城市之间存在差异。对于健康行为路径，所有研究城市中建筑密度的提升均会降低居民锻炼频率，进而降低居民健康水平。在石家庄和唐山，路网密度和绿视率的提升会促进居民进行体育锻炼，公交站点密度的提升则使居民锻炼频率下降。与之相反，在秦皇岛、张家口和衡水，公交站点密度的提升会增加居民锻炼频率。对于心理状态路径而言，在石家庄和唐山，绿视率的提升会缓解居民焦虑从而促进居民健康，而在秦皇岛、张家口和衡水，则是路网密度的提升对居民焦虑起到缓解作用。

（3）建成环境对居民健康的影响存在年龄异质性和收入异质性,老年群体和中低收入居民受到的影响更大。影响路径分析中，老年群体和低收入群体主要受健康行为路径的影响，而中年群体和中高收入群体主要受心理状态路径的影响。

本文研究为理解我国建成环境与居民健康之间的关系提供了科学依据，并为健康城市建设提供相关政策建议。在优化建成环境的过程中，应注重路网密度和街道绿视率的提升，创造友好的出行环境。在城市地区需合理控制建筑密度，农村地区则应加强公共服务设施的建设。同时应结合社区居民特征，重点关注老年人和中低收入群体，尽可能满足不同年龄和收入群体对建成环境的需求。

The rapid development of urbanization has made residents face a series of health threats. As the carrier of residents' lives, the built environment of a community is closely related to residents' health. Clarifying the impact and path of the built environment on residents' health is a prerequisite for improving residents' health by optimizing the built environment. At present, most of the existing investigations are concentrated in western countries. The studies in this field in my country started relatively late, and most of the studies focus on communities in large cities. There is a lack of comparative studies between different regions and different groups of people.

Based on the 2013 household health survey data in Hebei Province, this paper uses quantitative methods such as multi-level linear models to analyze the impact of the built environment on residents’ self-rated health. On this basis, the frequency of exercise and anxiety of residents are used as intermediary variables to explore the impact of the built environment on residents' health. In addition, the study also considered the differences between different levels of cities and residents of different attributes to clarify the heterogeneity of the impact of the built environment on the health of residents in different backgrounds and between different groups of people. The main conclusions include:

(1) The built environment has a significant impact on the health of residents and there are differences between urban and rural areas. The increase in population density in urban areas will lead to a decline in the health of residents, while the health of residents in rural areas is mainly affected by the accessibility of parks, squares and leisure facilities.

(2) The built environment will affect the health of residents through physical exercise and psychological state, and there are differences among different cities. For the health behavior path, the increase of building density in all studied cities will reduce the frequency of residents' exercise. However, in Shijiazhuang and Tangshan, the increase in road network density and green looking ratio will promote residents' physical exercise, and the increase in bus station density will reduce the frequency of residents' exercise. In contrast, in Qinhuangdao, Zhangjiakou, and Hengshui, the increase in the density of bus stops will increase the frequency of residents' exercise. As for the psychological path, in Shijiazhuang and Tangshan, the increase in green looking ratio will relieve residents' anxiety and improve residents' health, while in Qinhuangdao, Zhangjiakou and Hengshui, the increase in road network density will relieve residents' anxiety.

(3) There is age heterogeneity and income heterogeneity in the impact of the built environment on residents' health, and the elderly and low-income residents are more affected. In the impact path analysis, the elderly group and low-income group are mainly affected by the health behavior path, while the middle-aged group and middle-high-income group are mainly affected by the psychological state path.

This paper provides scientific basis for understanding the relationship between the built environment and residents' health, and provides relevant policy suggestions for healthy city construction. In the process of optimizing the built environment, attention should be paid to the improvement of road network density and street green sight rate to create a friendly travel environment. In urban areas, the building density should be controlled reasonably, while in rural areas, the construction of public service facilities should be strengthened. At the same time, we should combine the characteristics of community residents, focus on the elderly and middle and low income groups, and try our best to meet the needs of different age and income groups for the built environment.