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.
Highlights
Ensuring healthy lives and promoting well-being for all at all ages by 2030 is a global sustainable development goal (SDG) set by the United Nations
Of the 91,993 participants included in the study, 73.0% were older than 80 years of age, 52.1% lived in a rural region, 55.8% were women, 81.5% lived with family members, 58.7% never went to school, and 49.2% frequently went to bed hungry in childhood
The prevalence of poor quality of life was 38.2%
Summary
Ensuring healthy lives and promoting well-being for all at all ages by 2030 is a global sustainable development goal (SDG) set by the United Nations. Some studies assessed the time trends of poor quality of life [1, 6, 9, 10]. Atlantis et al [6] investigated the 10-year trends in quality of life among 9,059 people aged ≥15 years who participated in representative surveys of the South Australian population in 1998, 2004, and 2008. They found that scores on the physical component of SF-36 were stable and scores on the mental component were significantly decreased from 1998 to 2008 [6]. Rehkopf et al [10] found that general health improved in people aged 65 years and older in the United States from 2003 to 2017 with the percentage of poor health decreasing from 23% in 2003 to 19% in 2017
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