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This study across 12 rural\u2010to\u2010urban care facilities in eastern China analysed 320 environmental and 120 faecal samples. Urbanization progressively reduced microbial alpha diversity in air, surfaces, and resident guts. Urban environments showed increased opportunistic pathogens and antibiotic resistance genes (ARGs), alongside decreased beneficial taxa and short\u2010chain fatty acid pathways. Strong environment\u2010host microbiome concordance was observed, with intensified microbial transmission in urban settings. Critically, environmental microbiome features mediated over 50% of urbanization's detrimental effects on resident frailty, inflammation, and cognitive decline. Models combining environmental and gut microbiome data accurately predicted frailty (AUC\u2009=\u20090.89). 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