Health-related quality of life inequity and influencing factors among urban and rural elderly hypertensive populations: baseline survey of the Northern China Lifestyle Medicine Cohort

There is a lack of broader, systematic research examining differences in health-related quality of life (HRQoL) among elderly hypertensive populations across urban and rural settings. This study evaluates these disparities and identifies key influencing factors among urban and rural settings. Data were extracted from the Northern China Lifestyle Medicine Cohort (NCLM-Cohort. Registration number: ChiCTR2500096200; Registration date:2025/01/20) study, which covers four Provinces. Tobit regression and logistic regression analyses were used to assess the relationships between variables and Health Utility Value (HUV), Visual Analogue Scale (VAS) scores, and reported EQ-5D-5L (5L) issues reported in urban and rural participants. The Shapley value decomposition method, which is based on logistic regression analysis, was employed to quantify the weights of each influencing factor. Propensity score matching (PSM) was used to minimize potential confounding bias. A total of 7,062 participants (21.24% urban and 58.16% female) were included. The urban HUV (median 1.000) was greater than the rural HUV (median 0.942), and reported fewer health issues. After PSM, there were net differences in urban-rural HUV (0.009) and reported self-care (7.63%), usual activities (3.37%), and pain/discomfort issues (11.57%). Physical activity was the protective factor for HRQoL and contributed most significantly to decline reporting 5L issues. Medication adherence and the duration of hypertension had conflicting effects on urban-rural HRQoL. Urban HRQoL was driven primarily by clinical and health factors and educational factors, whereas rural HRQoL was influenced predominantly by modifiable health behaviors and economic factors. Compared with rural counterparts, urban participants demonstrated superior HRQoL and fewer health issues, indicating a significant urban-rural health disparity. To address this gap, policymakers should implement differentiated intervention strategies: Urban interventions should integrate mental health services into primary care and strengthen hypertension-related health literacy. For rural populations, policies must prioritize infrastructure development and economic subsidies, and healthcare providers should support them in maintaining adequate sleep and good medication adherence.