Urban-rural difference in the associations between living arrangements and the health-related quality of life (HRQOL) of the elderly in China—Evidence from Shaanxi province

Abstract

BackgroundSo far limited evidence exist comparing the difference between urban and rural elder residents in relation to how living arrangements correlates to health-related quality of life(HRQOL) of the elderly.ObjectiveThis study aims to compare the HRQOL of the elderly with four living arrangements: living with spouse only (LS), living alone (LA), living with a spouse and adult children(LSC) and the single elderly living with adult children (SLC) in urban and rural areas of China.MethodsThe data were drawn from the 2013 wave of Chinese National Health Service Survey in Shaanxi Province, which included 11,729 elderly people. The Chinese version of the EQ-5D-3L questionnaire was used to measure the HRQOL. Tobit regression model and logistic regression models were employed to estimate the associations between living arrangements and the HRQOL of the elderly.ResultsThe EQ-5D utility scores of the urban elderly with four different living arrangements (LS, LA,LSC and SLC) were 0.9141, 0.8392, 0.8176 and 0.9080, which were almost all higher than their rural counterparts. After controlling other confounding variables, tobit regression estimates showed that the EQ-5D utility scores of the single elderly either living alone or living with adult children were lower than the elderly living with a spouse in urban areas. In rural areas only the single elderly living with adult children were more disadvantaged. Additionally the logistic regression results showed living-alone elderly had worse psychological health and the single elderly living with adult children had worse physical health.ConclusionThe findings suggest that the urban elderly have better HRQOL than the rural elderly and the elderly with different living arrangements in urban and rural area have different HRQOL. More attention should be given to the poor mental health of the elderly living alone and the worse physical health of the single elderly living with adult children.

Social-Demographic Correlates of the Mental Health Conditions among the Chinese Elderly

“…Marital status and living arrangement are other important factors influencing the mental health of the elderly. Our study showed that single/divorced/widowed persons and those living alone were more likely to suffer from mental problems, which are consistent with the findings from other studies [30,32,33]. In addition, this may be attributed to the changes of family structure from a multi-child family to a single-child one.…”

Health-related quality of life among elderly individuals living alone in an urban area of Shaanxi Province, China: a cross-sectional study

“…Interestingly, we found significant sex differences in HRQoL, with women reporting better mental health than men. These results are similar to those of previous studies in China and South Korea, 25,26 which found that men are more likely to report poor mental health. In our study, we observed a difference in MCS but not in PCS, which may stem from demographic factors and the distribution of chronic conditions.…”

Factors contributing to the ceiling effect of the EQ-5D-5L: an analysis of patients with prostate cancer judged “no-problems”

“…In addition, Konnopka and Koeing [12] observed significant associations between age and the EQ-5D-5L dimensions of "morbidity" and "self-care." In terms of living alone, one study analyzed the associations between living arrangement and HRQoL, revealing that HRQoL among older adults living alone or with adult children was worse than those living with a spouse in an urban area [37]. In addition to living alone, quality of care and support is also associated with HRQoL [26].…”