Assessing Health-Related Quality of life and socioeconomic impacts in low-endemic schistosomiasis: A study from Rural China

To describe and compare health-related quality of life (HRQL) across disease stages (advanced schistosomiasis [AS], schistosomiasis-induced liver fibrosis [SLF], and healthy controls [HP]) in a low-endemic setting, and to explore associations between HRQL and socioeconomic/geographic factors. The findings aim to inform targeted interventions and policies at specific disease stages. A cross-sectional study was conducted in a schistosomiasis-endemic county in Jiangxi Province, China. A total of 2,652 participants, including 884 each in the AS, SLF, and healthy population (HP) groups, were enrolled. HRQL was assessed using the validated Chinese version of the SF-36 questionnaire. Socioeconomic variables (per-capita disposable income of rural households [P-DIRH], per-capita gross domestic product [P-GDP]) and geographic variables (type of schistosomiasis endemic area, endemic status) were analyzed. Non-parametric tests and multivariate linear regression (SPSS 27.0) were employed for statistical analyses. It was observed that the HRQL scores showed a gradually increasing trend (AS <SLF < HP) for the physical component summary (PCS). The median PCS and mental component summary (MCS) scores were lowest in the AS group (71.30 and 71.95), significantly lower than those in the SLF group (78.80 and 77.20) and the HP group (83.80 and 80.80). Patients with AS exhibited the most severe impairments in physical functioning (PF), vitality (VT), social function (SF), and general health (GH). Age ≥ 60 years was most strongly associated with lower HRQL scores (PCS: β = -0.217 to -0.266; MCS: β = -0.153 to -0.168). Areas meeting elimination criteria were positively associated with HRQL (β = 0.114 to 0.109), while low P-GDP regions were strongly associated with poorer HRQL (P < 0.05). HRQL is significantly impaired among schistosomiasis patients in low-endemic areas, driven by age, economic status, and regional disease control efforts. This study underscores the need for integrated interventions combining biomedical care, mental health support, and economic policies to alleviate the long-term burden of schistosomiasis and advance health equity, aligning with the World Health Organization's 2030 elimination goals.