A population-based study on health-related quality of life among urban community residents in Shenyang, Northeast of China

It has been a tendency in recent studies that health-related quality of life (HRQoL) has attracted more attentions because of the rising standard of living environment and advances in public health and medical care, which is an individuals’ satisfaction or happiness with the dimensions of life insofar as they affect or are affected by health [1]. Certain surveys and population-based studies were conducted in different regions of China [2‐9]. Individuals’ physical, emotional and social functioning has been evaluated in different degree of HRQoL in China [10]. High reliability and validity was confirmed in studies and measured by SF-36 in Chinese HRQoL studies. HRQoL has also been measured for health management and clinical advices of chronic diseases [11‐14]. Elderly adults’ HRQoL were focused on different conditions for the reason that the aging group has expanded tremendously in decades worldwide especially in China, the largest population scale worldwide [15‐19].

Northeast area was an important industrial base in China. It has been making a significant contribution in economic development and social construction since the 1950s. However, great changes have taken place in humanities and natural environment because social structure has been greatly changed since the 1990s. The living environment, income status and lifestyle of residents changed a lot. Thus, the quality of life and health has changed. The prevalence of chronic diseases rate of urban residents in Liaoning province has dramatically increased in recent decades (from 27.49 to 41.86 %), much higher than the country’s results (28.3 %) in China’s fourth national health services survey in 2008 [20, 21]. Investigations of HRQoL in northeast of China could provide specific public health policy in northeast area in order to improve individuals’ health. In addition, factors associated with HRQoL could be applied in clinical practice when health management is occupying. There have been studies used successfully in specific groups such as college teachers, caregivers and poverty individuals in northeast China in recent years [22‐24]. However, study in general urban population has not been specifically conducted yet. Thus, this article is aimed at assessing the health-related quality of life in the population of urban community residents in Shenyang, northeast of China, and evaluating the related factors influenced by HRQoL.

This study investigated a large population-based sample of HRQoL in northeast China. The residents’ physical health was better than their mental health, which was in accordance with the earlier study in other areas of China [2]. According to the above results, age, educational level, marital status, quality of sleep and chronic disease status were the factors related to HRQoL scores. Age was one of the most common and important factor associated with HRQoL in previous researches [2, 3, 10, 22]. In our study, younger community residents had higher scores in physical health, while middle-age group had better mental health. Earlier study found that the rural middle-age residents’ MCS scores were higher than PCS scores [27], which was similar to the results among urban areas in previous studies [2, 28‐30]. Increasing age might lead to deteriorating physical and mental health. Therefore, younger residents had better physical health. Educational level might directly or indirectly associate with health-related quality of life in previous surveys [16]. Education means more opportunities to find a job with a better salary and better living conditions in both urban and rural areas [17]. Furthermore, it is more convenient for highly educated residents to obtain information of health in a more efficient ways so as to adjust their health conditions in time. Consequently, residents with higher education would obtain higher HRQoL might be due to their higher social class and economic status [16]. Marital status was the factor partly associated with the physical and mental health dimensions in HRQoL. Family and social support of unmarried and widowed or divorced patients were less than that of the married patients [31]. Mutual support and help between couples may positively influence the mental health. But relationships between couples needed to be taken care of, such as their children and parents, may affect their physical health. 4-2-1 family mode was extremely increasing in Chinese families, which means a child should support their parents who also need to support their parents together. While current unmarried people have fewer burdens in their families, therefore their physical health seems be better than those married. Sleep quality strongly influenced the residents’ physical and mental health. Residents who had better quality of sleep had higher scores of HRQoL. Sleep problems resulting from ageing were the factors associated with sleep quality [32] since younger adults have longer sleep than middle-aged and older adults. Chronic conditions were a positively factor related to HRQoL. Low quality of sleep may affect immune system, the ability to function and social activities, and may have an impact on physical and mental health in HRQoL [33]. The impact of chronic conditions in general populations was reflected more in PCS than in MCS scores [15]. Compared to the rural areas, adequate health information and knowledge, higher level of basic infrastructure, higher incomes, availability of health services may help urban residents prevent chronic diseases in northeast China [34]. The convenience might also be helpful for patients suffering from chronic diseases to hold an optimistic attitude to cure the disease. Higher consciousness of health and level of medical treatment were available to improve their physical and mental health.

The smoking and drinking habits are the major factors causing the decline of physical condition [35, 36]. A review indicated that unhealthy lifestyle behaviors including smoking and drinking were independent predictors of chronic conditions [37]. In this study, chronic disease status was a significant factor of SF-36 scores, whereas smoking and drinking behaviors did not affect HRQoL. In previous studies, smoking was almost hardly associated with the SF-36 scores [38]. The percentage of smokers in our study was 10.4 %, lower than the Chinese smoking rate in 2014 (28.1 %) [39]. It may be considered that most of the smokers did not present subjective symptoms over a threshold [40]. Moderate drinking may have a protective effect on the cardiovascular system [41, 42]; however, alcohol consumption may change because of health conditions [43]. Unlike a study of civil servant in China [44], drinking was not observed as the major association with HRQoL. The reason might be the higher rate of civil servants (62.52 %) than the community residents (13 %).

Interestingly, living environment was not the factor of HRQoL. Residents living in urban had lower physical and mental health than other living regions. The environment might be defined as the sum of all the conditions and elements, which make up the surroundings and influence the development and well-being of the individual [45]. It is emphasized on dwelling conditions in previous studies [18, 46 and 47]. The satisfactory of dwelling conditions reported better health and higher quality of life [18]. The satisfactory dwelling conditions residents considered might be unpolluted environment, which was not concerned until the panic like haze appears. Although a transition of industrial structure has been ongoing in northeast of China, the traditional consciousness of relationship between health and environment might not change. Therefore, transformations of the health concept of community residents would be strengthened to focus on the relationship between environment changes and health issues.

In spite of the characteristics in northeast of China, the reliability in SF was low in this study, which was consistent with the survey of Shanghai. Conceptualization of social function might mislead residents to understand [2]. Furthermore, reliability of VT was lower than SF, which was much lower than other studies [3, 5, 10]. Chinese people have the certain character that they are hardly express their real feelings under most circumstances, even hardly in a direct way to their families [2]. However, characteristic of people in northeast is a contradiction case. Due to multiple history, climate and nature environment factors, the characteristics of cultural personality in northeast of China was different from other areas of China, which were brave, frank, warm and bold. The expression way in northeast of China is more directly than other areas especially in the south area [47]. It makes them easier to participate in social activities more energetically, which might be helpful to their health. Nevertheless, though most factories have moved from the center of the city, decades of heavy industry in Shenyang had a negative impact on residents’ health. In addition, northeast people prefer to drink and smoke in ordinary life for geographical environment and history cultural practice [48], which created bad lifestyle habits influencing health. Laziness psychological feelings dependent on the weather and poor management make northeast people lack the innovation, which might influence their vitality dimension in health-related quality of life.

There are a number of limitations considered in this study. First, the study design was a cross-sectional research, therefore conclusions on the causality of the associations between residents and HRQoL could not be derived. A longitudinal study is needed in future studies. In addition, there are other potential factors which are not taken into account in this study, such as the district-level variations among the residential areas, and the provider-level disparities in the quality of the care provided by different community health centers, as the organizational model of primary care itself may has an impact on primary care quality and health utilization [49, 50]. Although residents were selected almost all from the urban area where community health centers were randomly selected, some underdeveloped regions did not incorporate into the survey area. The representativeness of sample might have potential selection bias. Moreover, the participants who were living in the same household were not taken into account in the survey. It might impact on the results since the similar lifestyle behaviors. Finally, interviewers might mislead the results when the residents received their explanation of the questions. Despite of these limitations above, the sample size was large in this study. Furthermore, the analysis results could provide prospective conclusions relating to HRQoL and its factors in Northeast China.

In conclusions, we assessed the relationships between HRQoL and affected factors in a large-scale population in Shenyang, Northeast China. The results of HRQoL indicated their particular characters through comparing with other areas of China. Furthermore, factors influencing HRQoL were evaluated, including age, educational level, marital status, ethnic group, and chronic disease status and sleep quality. However, smoking and drinking habits were not the factors.

According to these results, policies of public health in order to highlight the long-term supervision and treatment of community residents’ chronic diseases might improve the health-related quality of life on the basis of the community health management. Community residents’ health management includes regular check-ups and special education like eating habits, chronic disease prevention and control etc. Furthermore, a good way of life especially eating habits could be advocated in order to improve residents’ health-related quality of life.