Exploratory analysis of health-related quality of life among the empty-nest elderly in rural China: an empirical study in three economically developed cities in eastern China

Abstract

Background: Along with rapid economic development, the aging process in China is gradually accelerating. The living conditions of empty-nest rural elderly are worrisome. As a more vulnerable group, empty-nest elderly are facing more urgent health problems. This study explores the health-related quality of life (HRQOL) of empty-nest elderly in rural China and aims to arouse more social concern for their HRQOL.

Methods: Research subjects were empty-nest rural elderly from three cities: Nanjing, Suzhou, and Wenzhou (ages ≥ 60, n = 967). This study used the five-dimensional European quality of health scale (EQ-5D) and the 12-item Short Form Health Survey (SF-12) to measure the HRQOL of the respondents. Spearman correlation coefficient, stereotype logistic regression, ordered probit regression and multinomial logistic regression, and Structural equation model (SEM) methods are employed to study the relationship.

Results: (1) The Spearman correlation coefficient shows that the correlations of similar domains between the SF-12 and the EQ-5D scales are relatively strong. (2) Men's scores are higher than that of women's in general health (GH) and anxiety/depression (AD) models. (3) The scores of physical component summary (PCS), physical functioning (PF), mental health (MH), and usual activities (UA) decline with age. (4) Apart from PCS, vitality (VT), and role-emotional (RE) as dependent variables, the education passes all the significance tests. The higher the education is, the higher the scores of physical or psychological health are. (5) The scores of PCS and bodily pain (BP) of empty-nest elderly are divorced or higher in other marital status. (6) In SEM analysis, the effect of basic information of empty-nest elderly on SF-12 scale is more significant.

Conclusions: First, the frequency histograms of EQ-5D show that the scores of empty-nest elderly in rural China are generally low. Second, in all SF-12 items, the HRQOL is low. Third, men's scores are higher than that of women's. The elderly with higher education reported higher scores than those with lower education. Fourth, the effect of socio-demographic variables of the rural Chinese empty-nest elderly on SF-12 scores is more significant, whereas the effect on EQ-5D scores is less significant.

Figure 1

Changes in the population since the P. R. China was founded (Data resources: National Bureau of Statistics of the People’s Republic of China).

Figure 2

Distribution across the severity levels of the EQ-5D domains at baseline.

Figure 3

Utility score curve.

Figure 4

Distribution across severity levels of the SF-12 domains at baseline.

Figure 5

SEM analysis of SF-12 and EQ-5D.