Analysis of Factors Associated with Quality of Life of Older Adults in Four Prefectures of Yunnan Province

Wei CHANG; Kejin LIN; Chuangdie YANG; Chuanzhi XU

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Wei CHANG, Kejin LIN, Chuangdie YANG, Chuanzhi XU. Analysis of Factors Associated with Quality of Life of Older Adults in Four Prefectures of Yunnan Province[J]. Journal of Kunming Medical University.

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Wei CHANG, Kejin LIN, Chuangdie YANG, Chuanzhi XU. Analysis of Factors Associated with Quality of Life of Older Adults in Four Prefectures of Yunnan Province[J]. Journal of Kunming Medical University.

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Analysis of Factors Associated with Quality of Life of Older Adults in Four Prefectures of Yunnan Province

1.
School of Public Health，Kunming Medical University，Kunming Yunnan 650500
2.
Kunming Medical University Haiyuan College，Kunming Yunnan 650101，China

Received Date: 2026-07-17
Available Online: 2026-10-28

Abstract

Abstract

Objective To investigate the current quality of life （QoL） of older adults in four prefectures of Yunnan Province, to identify factors associated with QoL, and to examine the impact of construct overlap between candidate independent variables and WHOQOL-BREF items on effect estimation. Methods From August 2023 to July 2024, older adults were recruited from Kunming, Qujing, Honghe and Xishuangbanna of Yunnan Province using multistage stratified cluster sampling, and 2003 valid questionnaires were obtained. QoL was measured with the WHOQOL-BREF, and activities of daily living （activities of daily living, ADL） were assessed with the Barthel Index. The reliability and validity of the scales in this sample were reported; item-level Spearman correlation diagnostics were performed prior to statistical analysis to identify construct overlap, based on which a corrected outcome constructed from the 24 domain items was derived. Hierarchical multiple linear regression was used; all independent variables were z-standardized, and standardized coefficients （β） with 95%CI, R² and ΔR² were reported with HC3 robust standard errors. Exploratory structural equation modeling （structural equation modeling, SEM） and a path model based on observed composite scores were further conducted to characterize the association network among factors. Results The corrected overall QoL score of the 2003 participants was 67.23±13.04; the scores for the four domains — the physical, psychological, social relationships and environment — were 65.46±16.21, 67.77±15.86, 64.86±15.69 and 69.26±14.57, respectively, with the social relationships domain scoring lowest and the environment domain highest. Cronbach’ s α was 0.906 for the 24-item total scale and 0.723～0.786 for the four domains; confirmatory factor analysis showed satisfactory fit （CFI = 0.951, TLI = 0.945, RMSEA = 0.068）. Item-level diagnostics showed a high correlation between the self-rated health item and the D2 item （r_s = 0.836, P < 0.001）. When D1/D2 served as the outcome, the standardized β of self-rated health was 0.768 （R² = 0.590）. In the final model with the corrected 24-item overall QoL as the outcome （R² = 0.469）, self-rated health （β = 0.318）, residential comfort （β = 0.159）, ADL （β = 0.152）, urban residence （β = 0.138）, educational level （β = 0.135）, community satisfaction （β = 0.114）, medical accessibility （β = 0.105）, being married （β = 0.064） and regular exercise （β = 0.059） were positively associated with QoL, the number of chronic diseases was negatively associated （β = -0.044, P = 0.029）, whereas monthly income showed no statistically significant association （β = -0.010, P = 0.658）. Re-estimation after excluding the four overlapping items （D12, D15, D23, D24） from the outcome did not change the direction or significance of these associations. In the path model based on observed composites, perceived environment （β = 0.216）, self-rated health （β = 0.409）, ADL （β = 0.191） and socioeconomic status （β = 0.190） were positively associated with non-environmental QoL, while the number of chronic diseases was negatively associated （β = -0.068）. Conclusion Older adults in four prefectures of Yunnan Province scored relatively high in the environment domain and relatively low in the social relationships domain. Self-rated health, ADL and residential-environment factors were robustly and positively associated with QoL, with self-rated health being the strongest. Construct overlap between candidate exposures and outcome items inflated effect estimates and warrants item-level diagnostics with outcome- and exposure-side corrections.
- Aged,
- Quality of life,
- Construct overlap,
- Structural equation modeling,
- Yunnan

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