Health-related quality of life and its factors among rural middle-aged and older adults with multimorbidity in China: based on the health ecology model
- 1School of Nursing, Dalian University
- 2School of Information Engineering, Dalian University
Abstract
Background Multimorbidity is common among rural middle-aged and older adults and is associated with poorer health-related quality of life (HRQoL). Evidence on HRQoL in this population remains limited in China, particularly from nationally representative data. This study examined factors associated with HRQoL among rural Chinese middle-aged and older adults with multimorbidity. Methods We conducted a secondary analysis of the 2020 China Health and Retirement Longitudinal Study. The analysis included 1,411 rural participants aged 45 years or older with multimorbidity. HRQoL was measured using the EuroQol five-dimensional three-level questionnaire (EQ-5D-3 L). Least absolute shrinkage and selection operator regression was used for variable selection, and Tobit regression was used to estimate associations between selected variables and EQ-5D-3 L utility score. Results In the Tobit regression model, male was positively associated with EQ-5D-3 L utility score (β = 0.089, 95% CI: 0.018 to 0.159). Having three or more chronic conditions (β = − 0.175, 95% CI: − 0.287 to–0.063), poorer self-rated health (β = − 0.148, 95% CI: − 0.184 to–0.112), depressive symptoms (β = − 0.524, 95% CI: − 0.591 to–0.458), and disability (β = − 0.576, 95% CI: − 0.734 to–0.418) were negatively associated with EQ-5D-3 L utility score. Sleep duration of ≥ 9 h (β = 0.138, 95% CI: 0.015 to 0.261) and alcohol drinking (β = 0.109, 95% CI: 0.003 to 0.215) were positively associated with EQ-5D-3 L utility score. Healthcare utilization was also associated with EQ-5D-3 L utility score (β = − 0.069, 95% CI: − 0.132 to–0.005). Conclusion In this secondary analysis of CHARLS data, several individual, behavioural, and policy-related factors were associated with HRQoL among rural Chinese middle-aged and older adults with multimorbidity. These findings may help identify population groups with lower HRQoL and inform future studies and health-management strategies in rural settings.
Related
- Health-related factors among seafarers based on the health ecology model: a cross-sectional study
- Family resilience, dyadic coping, and health-related quality of life among primary caregivers of hospitalized older adults with multimorbidity in Xinjiang, China: a latent profile and mediation analysis
- Multimorbidity and health-related quality of life after tuberculosis treatment in Zimbabwe: A cross-sectional study with household comparators
- Factors associated with health-related quality of life in older cancer survivors: A secondary analysis of data from the 8th Korea National Health and Nutrition Examination Survey (2019-2021).
- Depression and associated factors among women of childbearing age : A cross-sectional study based on the health ecology model
BibTeX
@article{chang2026healthrelated,
title = {{Health-related quality of life and its factors among rural middle-aged and older adults with multimorbidity in China: based on the health ecology model}},
author = {Qihang Chang and Haoning Bu and Jiaxin Yu and Xue Wang and Xingnong Zhao and Libin An and Wentao Li},
journal = {Health and Quality of Life Outcomes},
year = {2026},
month = aug,
doi = {10.1186/s12955-026-02614-9},
url = {https://doi.org/10.1186/s12955-026-02614-9},
note = {CC BY},
}
RIS
TY - JOUR
TI - Health-related quality of life and its factors among rural middle-aged and older adults with multimorbidity in China: based on the health ecology model
AU - Qihang Chang
AU - Haoning Bu
AU - Jiaxin Yu
AU - Xue Wang
AU - Xingnong Zhao
AU - Libin An
AU - Wentao Li
PY - 2026
DA - 2026/08/01
JO - Health and Quality of Life Outcomes
DO - 10.1186/s12955-026-02614-9
UR - https://doi.org/10.1186/s12955-026-02614-9
AB - Background Multimorbidity is common among rural middle-aged and older adults and is associated with poorer health-related quality of life (HRQoL). Evidence on HRQoL in this population remains limited in China, particularly from nationally representative data. This study examined factors associated with HRQoL among rural Chinese middle-aged and older adults with multimorbidity. Methods We conducted a secondary analysis of the 2020 China Health and Retirement Longitudinal Study. The analysis included 1,411 rural participants aged 45 years or older with multimorbidity. HRQoL was measured using the EuroQol five-dimensional three-level questionnaire (EQ-5D-3 L). Least absolute shrinkage and selection operator regression was used for variable selection, and Tobit regression was used to estimate associations between selected variables and EQ-5D-3 L utility score. Results In the Tobit regression model, male was positively associated with EQ-5D-3 L utility score (β = 0.089, 95% CI: 0.018 to 0.159). Having three or more chronic conditions (β = − 0.175, 95% CI: − 0.287 to–0.063), poorer self-rated health (β = − 0.148, 95% CI: − 0.184 to–0.112), depressive symptoms (β = − 0.524, 95% CI: − 0.591 to–0.458), and disability (β = − 0.576, 95% CI: − 0.734 to–0.418) were negatively associated with EQ-5D-3 L utility score. Sleep duration of ≥ 9 h (β = 0.138, 95% CI: 0.015 to 0.261) and alcohol drinking (β = 0.109, 95% CI: 0.003 to 0.215) were positively associated with EQ-5D-3 L utility score. Healthcare utilization was also associated with EQ-5D-3 L utility score (β = − 0.069, 95% CI: − 0.132 to–0.005). Conclusion In this secondary analysis of CHARLS data, several individual, behavioural, and policy-related factors were associated with HRQoL among rural Chinese middle-aged and older adults with multimorbidity. These findings may help identify population groups with lower HRQoL and inform future studies and health-management strategies in rural settings.
SN - 1477-7525
ER -