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

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. 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. 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). 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.