Impact of exposure to ambient air pollution on health related quality of life of rural elderly in western China

The impact of environmental pollution on health is a hot topic in current research; however, research on the association between ambient air pollution and health-related quality of life (HRQoL) in the rural elderly population is limited. The purpose of this study was to investigate the association between long-term ambient air pollution and HRQoL. A total of 4349 participants were included in this study. Ambient air pollution data were collected from the National Earth System Science Data Center. The European Quality of Life Five Dimension Three Level (EQ-5D-3L) was used to measure the health utility index to reflect the HRQoL of the population. A Tobit regression model was constructed to analyze the association between ambient air pollution and the health utility index, and restricted cubic spline (RCS) and logistic regression were further used to explore the impact pathways of ambient air pollution on health utility. The average health utility index for the entire sample was 0.93, and the pain/discomfort dimension was the most commonly reported problem among respondents, with a ratio of 34.24%. The Tobit regression results revealed that for each 1 µg/m³ increase, the health utility index decreased 0.005 for PM_2.5, 0.001 for PM₁₀, 0.010 for SO₂ and 0.002 for O₃ (P < 0.05 for SO₂). The RCS model revealed a nonlinear dose‒response relationship between air pollutants and the five dimensions of health effects (P < 0.05), and the main air pollutants were SO₂, PM_2.5 and PM₁₀. The logistic regression results revealed that, with the exception of O₃, the loss of health utility due to air pollutants (SO₂) was reflected mainly in the self-care, usual activities and mobility dimensions, and the loss of health utility due to air pollutants (PM_2.5 and PM₁₀) was reflected mainly in the self-care and usual activities. Age, exercise status, and chronic disease were negatively associated with the health utility index and each of its domains, including mobility, self-care, usual activities, pain/discomfort and anxiety/depression. The HRQoL of elderly people in rural areas of western China was poor. Negative correlations were found among air pollutants (SO₂), age, exercise status, and HRQoL in elderly people. PM_2.5 and PM₁₀ reduce the quality of life of elderly people by affecting their self-care and usual activities. It is necessary to formulate effective health intervention policies and reduce the concentration of air pollutants.