Elsevier

Public Health

Volume 146, May 2017, Pages 140-147
Public Health

Original Research
Factors affecting the quality of life among Chinese rural general residents: a cross-sectional study

https://doi.org/10.1016/j.puhe.2017.01.023Get rights and content

Highlights

  • Socio-economic status, including marital status and the levels of education and income, was highly related to quality of life (QOL).

  • In chronic diseases, stroke was a remarkable factor of QOL.

  • Depression symptoms had a strong negative relationship with the QOL.

Abstract

Objectives

The brief version of the World Health Organization's Quality of Life Instrument (WHOQOL-BREF) is widely used for evaluating the personal subjective quality of life (QOL) of patients and particular populations. However, in the absence of sufficient studies among the general population, normative data for WHOQOL-BREF remain scarce. To fill this gap, the present study explored more sociodemographic and health-related factors affecting the QOL.

Study design

In total, 11,351 participants aged ≥35 years in rural areas of Liaoning Province were screened with a stratified cluster multistage sampling scheme in 2012–2013. Anthropometric measurements, laboratory examinations, and self-reported information on disease history were collected by trained personnel. Depression symptoms were assessed using the Patient Health Questionnaire-9.

Methods

Stepwise multiple linear regression was used to explore the association between multiple factors and QOL.

Results

Females and single/widowed subjects had lower QOL scores than males and married/cohabiting subjects, respectively. Total QOL scores and scores for each domain decreased as age increased, but a positive correlation was found between age and the environmental domain score. Participants with higher annual incomes, education levels, and activity levels had higher QOL scores. In the regression model, the coefficient for stroke was −2.17 (95% confidence interval [CI] −2.64, −1.71) for the total QOL score. For a one-level increase in depression level, the total QOL score decreased by 5.62 (95% CI −5.83 to −5.42), physical domain score decreased by 1.63 (95% CI −1.69 to −1.58), and psychological domain score decreased by 1.81 (95% CI −1.87 to −1.75).

Conclusions

Socio-economic status including marital status is highly related to QOL. Regarding chronic diseases, stroke is an important factor of QOL and depressive symptoms have a strong negative relationship with QOL.

Introduction

The World Health Organization (WHO) defines health as ‘a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity’.1 A really healthy person has a high quality of life (QOL) level. The QOL is affected by comprehensive factors in many aspects including physical health, psychological state, ability to be independent, social interpersonal relationships, and environmental adaptability, which reflects the individual's evaluation of themselves in the context of the culture and value systems, and in relation to personal goals, attitude to life, and values.2 A QOL measure is needed for the appropriate evaluation of population health or healthcare interventions. The World Health Organization Quality of Life (WHOQOL) Group designed an instrument to measure QOL (WHOQOL-100) and an abbreviated version (WHOQOL-BREF), but the specific questions have developed over the past three decades to be suitable for respondents with diverse cultural contexts; therefore, it has been promoted to all over the world.3, 4 There are 26 items in the WHOQOL-BREF, which is more convenient to use and valid across cultures.3 Thus, many large-scale epidemiological investigations use the WHOQOL-BREF instrument to evaluate QOL.

Since 2000, Chinese researchers have used the Chinese version of WHOQOL-100 and WHOQOL-BREF.5 Although many studies on QOL have been conducted around the world, few studies have evaluated QOL among large Chinese populations using WHOQOL-BREF, especially among the general population in mainland China. Previous Chinese studies have evaluated QOL in more vulnerable groups, patients and particular minority populations.5, 6, 7, 8, 9, 10, 11 No uniform cut-off value to define a high level of QOL has been set to date. To compare different populations around the world, there is a need for reference values from general populations.12 However, in the absence of sufficient studies among general populations, normative data for WHOQOL-BREF remain scarce. There is a need to study the QOL of the general population using WHOQOL-BREF to provide useful reference values to compare the results of diverse groups.12 Another Chinese study focused on an urban population, but the sample only included 1052 subjects.5 To fill this gap, the present study investigated a large sample of the general rural population in mainland China to provide more results regarding the sociodemographic and health-related factors affecting QOL. In addition to the QOL of patients and particular populations, there is a need to study QOL among the general population to help the national public health departments with the formulation and implementation of culture-specific policies and support.

Section snippets

Study population

Between July 2012 and August 2013, a representative general sample aged ≥35 years was selected from the rural areas of Liaoning Province in Northeast China. The study adopted a multistage, stratified random cluster sampling scheme. In the first stage, three counties (Dawa, Zhangwu, and Liaoyang) were selected from the eastern, southern, and northern regions of Liaoning Province, which has 44 counties in total. Dawa, Zhangwu, and Liaoyang have 15, eight, and 14 towns, respectively. In the second

Results

The main characteristics of the participants are presented in Table 1. Mean age was 53.7 (SD 10.5) years, 53.6% were women, 94.7% were of Han ethnicity, 9.5% had a high school education or above, 33.2% had an annual income exceeding 20,000 CNY, and 35.3% were current smokers. The prevalence of depression among the general population was 5.9%. Chronic diseases included hypertension (50.8%), diabetes (10.2%), CKD (2.1%), and stroke (8.8%).

Table 2 shows the mean scores for the QOL domains based on

Discussion

This study used the standard WHOQOL-BREF instrument to evaluate QOL including four domains. The mean scores for each domain were close to previous data for Chinese populations, but lower than the scores for Western countries.21 As studies of the general population can provide normative values, the data from this study may be used as a reference to compare populations in terms of different diseases or living conditions.12 Using the two cut-off criteria, the difference in the prevalence of low

Ethical approval

This research project was approved by the Ethics Committee of the First Hospital of China Medical University. All participants signed informed consent forms.

Funding

This study was supported by grants from the ‘Twelfth Five-Year’ project funds (National Science and Technology Support Program of China, Grant #2012BAJ18B02) and Liaoning Research Center for Translational Medicine of Cardiovascular Disease (2014225017).

Competing interests

None declared.

References (38)

  • H. Wang et al.

    Effects of nurse-delivered home visits combined with telephone calls on medication adherence and quality of life in HIV-infected heroin users in Hunan of China

    J Clin Nurs

    (2010)
  • O.B. Mkangara et al.

    The univariate and bivariate impact of HIV/AIDS on the quality of life: a cross sectional study in the Hubei Province-Central China

    J Huazhong Univ Sci Technol Med Sci

    (2009)
  • H.M. Yu et al.

    Quality of life of coal dust workers without pneumoconiosis in mainland China

    J Occup Health

    (2008)
  • X. Wang et al.

    Post-earthquake quality of life and psychological well-being: longitudinal evaluation in a rural community sample in northern China

    Psychiat Clin Neurosci

    (2000)
  • J. Zhang et al.

    Discrimination experience and quality of life among rural-to-urban migrants in China: the mediation effect of expectation-reality discrepancy

    Qual Life Res

    (2009)
  • L.N. Cruz et al.

    Quality of life in Brazil: normative values for the WHOQOL-bref in a southern general population sample

    Qual Life Res

    (2011)
  • G. Hu et al.

    Joint effects of physical activity, body mass index, waist circumference and waist-to-hip ratio with the risk of cardiovascular disease among middle-aged Finnish men and women

    Eur Heart J

    (2004)
  • E. O'Brien et al.

    An outline of the revised British Hypertension Society protocol for the evaluation of blood pressure measuring devices

    J Hypertens

    (1993)
  • M.P. Pignone et al.

    Screening for depression in adults: a summary of the evidence for the U.S. Preventive Services Task Force

    Ann Intern Med

    (2002)
  • View full text