The relationship between the number of chronic diseases and health-related quality of life among middle-aged and older adults in rural areas of Yunnan province, China: moderating effect of health lifestyle

Abstract

Background Individuals residing in underdeveloped rural settings may have a higher prevalence of chronic non-communicable diseases (NCDs), lower level of health-related quality of life (HRQoL), and distinct lifestyles. However, this triadic association remains inadequately studied and understood, particularly regarding the role played by health lifestyle. Yunnan province, as a typical underdeveloped region in China, is also witnessing population aging, with NCDs emerging as primary factors influencing both health status and HRQoL among middle-aged and older adults. This study aims to examine the relationship between the number of NCDs and HRQoL while exploring the potential moderating effect of health lifestyle among middle-aged and older adults residing in resource-limited areas. Methods This cross-sectional study was conducted in Yunnan province from July to December 2022. Spearman’s correlation test and Pearson’s correlation test were employed to examine the pairwise correlations among the number of NCDs, HRQoL, and health lifestyle. Hierarchical linear regression analysis was performed to explore the relationship between the number of NCDs and HRQoL, as well as investigate the potential moderating effect of health lifestyle on this relationship. Results Out of the total 2,704 participants, 57.91% presented with at least one NCD. The mean score for health lifestyle and health utility value were calculated as 11.109 and 0.944 respectively. A significant negative association was observed between the number of NCDs and health utility value, while a positive correlation was found between the number of NCDs and health lifestyle score. Health lifestyle exerted a moderating effect on the relationship between the number of NCDs and HRQoL (β = 0.006, P < 0.001), which was also observed for specific health-related behaviors such as sleep duration (β = 0.013, P < 0.001), physical examination attendance (β = 0.006, P < 0.05) and physical activity (β = 0.013, P < 0.001). Conclusions The study highlights that a healthy lifestyle exerts a crucial role in moderating the association between the number of NCDs and HRQoL. Considering the high prevalence of NCDs and substantial decline in HRQoL among middle-aged and older adults, recognizing the potential influence of a healthy lifestyle as a moderator in this relationship could be pivotal for developing effective interventions for this population, even within resource-constrained rural settings.