Spatial inequities in urban resource access, neighborhood social capital, and late-life depression : insights from Hong Kong's aging population

Abstract

Spatial disparities in urban resources and health outcomes among older adults are well documented, with growing empirical attention to how absolute levels of accessibility affect health. However, less is known about the implications of intra-area inequality in infrastructure access, which may represent an additional form of environmental disadvantage with mental health consequences. Using data from 5007 older adults aged 50 and above in Hong Kong, we examined how accessibility and within-district inequality of urban facilities are associated with depressive symptoms. Accessibility indicators for four types of urban facilities were calculated for 1746 Large Subunit Groups using an exponential distance-decay model and aggregated to 18 districts. District-level access inequality was measured by Gini coefficient. Principal component analysis was conducted to reduce multicollinearity, yielding two key factors: resource accessibility and resource inequality. Results from population-weighted linear regressions with district fixed effects reveal that higher resource inequality was associated with more depressive symptoms, whereas higher resource accessibility was associated with less symptoms. Importantly, neighborhood social capital buffered the negative impact of resource inequality, yet did not modify the effect of accessibility. Our findings highlight a dual pathway linking the urban built environment to late-life mental health: the absolute level of supportive infrastructure reduces depressive symptoms, whereas inequitable spatial allocation increases them. Strengthening neighborhood social capital can mitigate, but not fully offset the psychological burden of structural resource inequality. Creating age-friendly and mentally healthy cities therefore requires integrating distributional justice into infrastructure planning alongside initiatives that foster neighborhood trust and reciprocity.