Trends and Disparities in Quality of Life Among Older Adults From 1998 to 2018 in China: A National Observational Study

Abstract

ObjectiveTo investigate 20-year trends and disparities in quality of life among older adults in China from 1998 to 2018.MethodsOur study was based on eight representative nationwide health surveys among older adults conducted in China from 1998 to 2018. Quality of life data were obtained from 91,993 individuals aged 65 years or above. All surveys included identical indicators of self-reported quality of life, demographic factors, socioeconomic status, lifestyle habits, and health status. The trends in the standardized prevalence of poor quality of life from 1998 to 2018 were examined by locally weighted scatterplot smoothing regression (LOWESS) analysis. We assessed the prevalence of poor quality of life and its related factors by logistic regression models after adjusting for potential confounders.ResultsThe prevalence of poor quality of life was 38.2% (95% CI: 37.9–38.5%). The trends of poor quality of life showed an inverted “U” shape, that the prevalence increased from 27.8% in 1998 to 43.6% in 2008, and then decreased from 39.2% in 2011 to 32.1% in 2018. Disparities in the prevalence of poor quality of life were exacerbating among participants with low or moderate household income per capita and participants with high household income per capita from 1998 to 2018. After controlling potential confounders, living in rural areas, aged below 80 years, unmarried, living alone, low household income, current smoker, poor dietary diversity, never participating in organized social activities, with chronic diseases, functional disability, poor self-reported health, and unhealthy psychological status were risk factors related with poor quality of life in the multivariate model (all p < 0.05).ConclusionDuring the past two decades, poor quality of life in Chinese older adults showed an inverted “U” trend from 1998 to 2018 that the prevalence of poor quality of life peaked in 2008 and declined since China's deepening health system reform in 2009. However, disparities in the poor quality of life were exacerbating among participants with different socioeconomic statuses. Strengthening the health system is of great importance in improving the quality of life. More efforts are needed to reduce the disparities in the quality of life among the population at the different socioeconomic levels.

Differences in Health-Related Quality of Life and Its Associated Factors Among Older Adults in Urban and Rural Areas

“…18 Other localized studies reached similar conclusions with the quality of life in these studies been measured by a single item rather than a validated scale. 19 , 20 Similar rural-urban HRQoL inequalities have also been observed in a longitudinal study tracking US veterans. 21 Although the urban-rural HRQoL difference have been compared, few research have went a closer looking at the differentials in urban-rural HRQoL influencing factors.…”

Health-related quality of life and its association with socioeconomic status and diet diversity in Chinese older adults

“…In older Brazilian community-dwelling adults, participants with 5 or more years of education tended to report better HRQoL (42). Household income was identified as a risk factor exacerbating the disparities in the prevalence of poor quality of life in a Chinese longitude study from 1998 to 2018 (22). The findings from Chen et al show that older adults' previous occupations played a role in affecting their HRQoL in mainland China (43).…”

“…In terms of the association between DD and HRQoL, it has also been confirmed by previous research. According to a 20year longitudinal study of 91,993 Chinese citizens over the age of 65, poor DD was significantly associated with a poor quality of life after being adjusted for potential confounders (22). Other cross-sectional and longitudinal studies have also identified that DD could benefit older adults' physical functional capacity (23) and memory status (24), as well as suppress cognitive impairment (25) and even mortality (26).…”