We analyzed data from a nationally representative sample of 15,973 elderly residents from 866 coun-ties and cities in 2002 and followed up in 2005 with multilevel logistic regression models to investigate how social, eco-nomical environmental factors are associated with health outcomes and mortality risk. After control individual-level fac-tors, we found that air pollution increased the odds of disability in activities of daily living ( ADLs) , cognitive impair-ment, and health deficits index. More rainfall was protective, reducing the odds of ADL disability and cognitive impair-ment. Extremely low seasonal temperatures increased the odds of ADL disability and mortality. Extremely high seasonal temperatures increased the odds of cognitive impairment and health deficit index. Living in a mountain area decreased the odds of ADL disability and health deficits. The conclusion is that efforts to reduce pollution and improve socioeco-nomic conditions could significantly improve the health and survival of the elderly.