Health-related quality of life and associated multimorbidity patterns among adults in rural northern China: a cross-sectional study

Among rural adults aged ≥ 30 years in Shanxi Province, China, 37.05% had multimorbidity. Compared with participants without multimorbidity, they had lower health utility (0.94 vs. 1.00) and more frequent HRQoL impairment (63.69% vs. 32.80%). Age ≥ 60 years was negatively associated with HRQoL, whereas higher education, annual income ≥ 20,000 yuan, high alcohol consumption, and high-intensity physical activity were positively associated with HRQoL. Pain/discomfort was the most frequently affected dimension (56.48%). Dementia had the lowest utility index among individual conditions (0.78), and patterns involving pain or functional impairment, such as arthritis and stroke, showed the greatest HRQoL burden. These results have potential implications for public health strategies aimed at managing the clustering of multiple chronic conditions with high burden—especially those with pain and functional limitations—over single prevalent conditions to maximise health gains in resource-limited rural settings.