Does GDP Buy Perceived Urban Health? Evidence from China’s Urban Physical Examination Survey

Rapid economic growth does not necessarily translate into better perceived urban health. Using the 2024 nationwide Urban Physical Examination (UPE) resident survey in China, this study assesses how city economic level relates to perceived urban health, proxied by city-level overall satisfaction. The survey was conducted in April–June 2024 in the main urban districts of 47 cities, yielding 692,800 responses and 499,500 valid questionnaires. We aggregate satisfaction to the city level, match it with GDP and key city characteristics, and estimate the GDP–satisfaction association using restricted cubic splines (RCS) to test for potential non-linearity. Across unadjusted and covariate-adjusted models (accounting for population scale and density, industrial structure, fiscal capacity, and regional effects), results show a robust positive association between economic level and satisfaction, while nested-model tests provide no evidence that spline terms improve fit over a linear specification within the observed GDP range. Substantial dispersion around the fitted curve indicates that GDP is an enabling capacity rather than a sufficient condition, pointing to cross-city differences in how effectively resources are converted into lived urban quality. We propose using GDP-adjusted satisfaction benchmarking within the UPE cycle to identify underperforming cities and prioritize targeted governance and renewal actions.