Social Inequalities in Health-Related Quality of Life Among Chinese Older Adults Across Multimorbidity Patterns

Background: Although social inequalities in health-related quality of life (HRQOL) have been widely studied, little is known about how they differ across multimorbidity patterns. To address this knowledge gap, this study examined how social inequalities in HRQOL vary by multimorbidity patterns among older Chinese adults.

Methods: This study used nationally representative data from the China Health and Retirement Longitudinal Study, with only the 2020 wave cross-sectional data being used in the analysis. First, latent class analysis was used to identify the predominant patterns of multimorbidity and to classify older adults into different groups. Regression models were then used to examine the associations between multimorbidity patterns (key independent variables) and four dimensions of HRQOL (outcome variables), namely, physical pain, basic self-care ability, independent living ability, and depressive symptoms. Finally, regression models were used to examine specific socioeconomic factors (e.g., gender, education, and income) in relation to HRQOL outcomes across different multimorbidity patterns.

Results: Older adults with chronic conditions were categorized into low multimorbidity, high multimorbidity, respiratory, cardiovascular-metabolic, and gastroarthritis classes. Physical pain, loss of self-care, loss of independent living, and depressive symptoms were all more pronounced in those with typical multimorbidity patterns (p < 0.001). Gender, education, income, social participation, health insurance, health technician, and region were all significant factors associated with different dimensions of HRQOL, and their effects varied across multimorbidity patterns.

Conclusion: There is a significant HRQOL burden of multimorbidity among older adults in China, and the burden varied across multimorbidity patterns. It is important to develop targeted health interventions that address the specific needs of different multimorbidity groups and take into account social inequalities in HRQOL outcomes.