Jie Chen,1,* Yan Xiao,2,* Chaofang Yan,1 Xiaoju Li,1 Yafang Zhang,1 Ying Chen,1 Yuan Huang,1 Rui Deng1 

1School of Public Health, Kunming Medical University, Kunming, Yunnan, People’s Republic of China; 2Foreign Languages Department, Kunming Medical University, Kunming, Yunnan, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Rui Deng; Yuan Huang, Email dengruirita@126.com; huangyuan@kmmu.edu.cn

Purpose: With population aging, individuals in underdeveloped areas may experience a higher prevalence of chronic non-communicable diseases (NCDs), a lower level of health-related quality of life (HRQoL), and distinct lifestyles. However, this triadic association remains inadequately studied, particularly regarding the role of health lifestyle. This study aims to examine the relationship between the number of NCDs and HRQoL, while considering the moderating effect of health lifestyle among middle-aged and older adults residing in resource-limited areas.
Methods: This cross-sectional study was conducted in Yunnan Province from July to December 2022. Participants completed a self-report questionnaire related to socio-demographic information, NCDs conditions, health lifestyle status, and HRQoL, which was assessed using the EuroQol five-dimension five-level (EQ-5D-5L) scale. Hierarchical regression and simple slope tests were used to examine the moderating effect of health lifestyle.
Results: Out of the total 2704 participants, 57.91% presented at least one NCD. The mean scores for health lifestyle and health utility value were 11.109 and 0.944 respectively. The number of NCDs was negatively associated with health utility value, while positively correlated with the health lifestyle score (P< 0.001). The results of hierarchical regression indicated that health lifestyle exerted a negative moderating effect on the relationship between the number of NCDs and HRQoL (β=0.006, P< 0.001), which was also observed for specific health-related behaviors such as sleep duration (β=0.013, P< 0.001), physical examination attendance (β=0.006, P< 0.05) and physical activity (β=0.013, P< 0.001).
Conclusion: These findings highlight the crucial role of a healthy lifestyle in attenuating the association between the number of NCDs and HRQoL. Recognizing the potential modulating influence of a healthy lifestyle in this relationship could be pivotal for developing effective interventions for this population, even within resource-constrained rural settings.

Keywords: chronic non-communicable diseases, health-related quality of life, health lifestyle, health-related behavior, rural, moderating effect