Determinants of Health-Related Quality of Life in Rural Elderly People of the West of Iran: A Population-Based, Cross- Sectional Study

Document Type: Original Article


1 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran/Maternal and Childhood Obesity Research Center, Urmia University of Medical Sciences, Urmia, Iran

2 Department of E-learning in Medical Sciences, Virtual School, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Health Education & Promotion, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran

4 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran


Background and aims: World’s older population is growing, and attention is being directed to the
improvement of their health-related quality of life (HRQoL). This article was conducted to investigate
the HRQoL and associated factors in rural elderly residents in west of Iran.
Methods: By using the multistage sampling method, 346 elders from rural areas of Shahindezh were
enrolled in this population-based, cross-sectional study conducted in 2014. To assess the HRQoL
of the elderly people, the Leiden-Padua (LEIPAD) questionnaire was used. The economic status
was classified into 3 categories (good, moderate, and low) using the principal component analysis.
Descriptive statistics, independent t test, ANOVA, and Spearman correlation coefficient were used to
analyze data. Multivariate linear regression was performed to determine predictive factors.
Results: The mean values and confidence intervals of total core scale and total moderator scale were
38.6 (36.7-40.6) and 31.2 (29.6-32.6), respectively. Univariate analysis showed age, marital status,
economic status, occupation, income source, and ethnicity were associated with HRQoL (P < 0.05).
Multivariate analysis showed the married, the illiterate, widows/widowers and the divorced, people
with low economic status, and the self-employed had low HRQoL with respect to total scale and total
core scale models (P < 0.05).
Conclusion: HRQoL varies according to socioeconomic factors. Its determinants should be addressed
in social and health policies designed to improve the health of older people, especially the most
vulnerable groups.


Main Subjects

1. Bloom DE, Boersch-Supan A, McGee P, Seike A. Population
aging: facts, challenges, and responses. Benefits and
Compensation International. 2011;41(1):22.
2. UN. World population ageing 2009. United Nations
Publications; 2010.
3. Mujahid G. Population ageing in East and South-East Asia:
current situation and emerging challenges. Bangkok: UNFPA
Country Technical Services Team for East and South-East Asia;
4. Statistical Center of Iran, The President’s Office Deputy of
Strategic Planning and Control. National population and
housing Census 2011: Selected Findings. Tehran: Statistical
Center of Iran; 2011.
5. UN. United Nations World Population Ageing: 1950–2050,
Countries of area: Iran.
6. Halvorsrud L, Kalfoss M, Diseth A, Kirkevold M. Quality
of life in older Norwegian adults living at home: a crosssectional
survey. J Res Nurs. 2012;17(1):12-29. doi:
7. Sheykhi MT. Aging and Exposition to Social Problems in Asia
with a Focus on Iran: A Sociological Appraisal. Middle East
Journal of Age & Ageing. 2018;15(1):8-15.
8. Mahdi A, Hosein Mahdi M, Shafiei M. Factors influencing ruralurban
migration from mountainous areas in Iran: A case study
in West Esfahan. Eur Online J Nat Soc Sci. 2014;3(3):723-8.
9. Barbieri M, editor Doi Moi and the elderly: Intergenerational
support under the strain of reforms 2006. Presented at: the
Population Association of America 2006 Annual Meeting; Los
Angeles California March 30-April 1 2006.
10. Rowland DT. Aging in Asia. In: Population Aging. Springer;
2012. p. 209-25.
11. Moeeni M, Pourreza A, Torabi F, Heydari H, Mahmoudi
M. Analysis of economic determinants of fertility in Iran: a
multilevel approach. Int J Health Policy Manag. 2014;3(3):135-
44. doi: 10.15171/ijhpm.2014.78.
12. Zanganeh Baygi M, Seyedin H, Salehi M, Jafari Sirizi M.
Structural and contextual dimensions of Iranian primary
health care system at local level. Iran Red Crescent Med J.
2015;17(1):e17222. doi: 10.5812/ircmj.17222.
13. Jafari M, Rashidian A, Abolhasani F, Mohammad K, Yazdani
S, Parkerton P, et al. Space or no space for managing public
hospitals; a qualitative study of hospital autonomy in Iran. Int
J Health Plann Manage. 2011;26(3):e121-37. doi: 10.1002/
14. World Health Organization (WHO). WHOQOL-BREF:
introduction, administration, scoring and generic version of
the assessment. Geneva: WHO; 1996.
15. Krageloh CU, Billington DR, Henning MA, Chai PP. Spiritual
quality of life and spiritual coping: evidence for a twofactor
structure of the WHOQOL spirituality, religiousness,
and personal beliefs module. Health Qual Life Outcomes.
2015;13:26. doi: 10.1186/s12955-015-0212-x.
16. Michalos AC. Social indicators research and health-related
quality of life research. Connecting the Quality of Life Theory
to Health, Well-being and Education. Springer; 2017:25-58.
17. Kaeberlein M, Rabinovitch PS, Martin GM. Healthy
aging: The ultimate preventative medicine. Science.
2015;350(6265):1191-3. doi: 10.1126/science.aad3267.
18. Barile JP, Edwards VJ, Dhingra SS, Thompson WW. Associations
among county-level social determinants of health, child
maltreatment, and emotional support on health-related quality
of life in adulthood. Psychol Violence. 2015;5(2):183-91. doi:
19. Cheraghi P, Cheraghi Z, Doosti-Irani A, Nedjat S, Nedjat S.
Quality of Life in Elderly Iranian Population Using Leiden-
Padua Questionnaire: A Systematic Review and Meta-
Analysis. Int J Prev Med. 2017;8:55. doi: 10.4103/ijpvm.
20. Cochran WG. Sampling techniques. Hoboken: John Wiley &
Sons; 2007.
21. Ghasemi H, Harirchi M, Masnavi A, Rahgozar M, Akbarian
M. Comparing quality of life between seniors living in families
and institutionalized in nursing homes. Social Welfare
Quarterly. 2011;10(39):177-200.
22. Mohaqeqi Kamal SH, Sajjadi H, Zare H, Beiglarian A.
[Elderly quality of life: A comparison between pensioners 

of social security organization and national retirement fund
(Qom County, 2006)]. Journal of Health Administration.
2007;10(27):49-56. [Persian].
23. Kirchengast S, Haslinger B. Gender differences in healthrelated
quality of life among healthy aged and old-aged
Austrians: cross-sectional analysis. Gend Med. 2008;5(3):270-
8. doi: 10.1016/j.genm.2008.07.001.
24. Zaninotto P, Falaschetti E, Sacker A. Age trajectories of quality
of life among older adults: results from the English Longitudinal
Study of Ageing. Qual Life Res. 2009;18(10):1301-9. doi:
25. Blane D, Netuveli G. Quality of life in older ages. Br Med Bull.
2008;85(1):113-26. doi: 10.1093/bmb/ldn003.
26. Fernandez-Ballesteros R, Santacreu I. Aging and quality of life.
International encyclopedia of rehabilitation. Boston: Institute
for Community Inclusion; 2011.
27. Szwarcwald CL, Souza-Junior PR, Esteves MA, Damacena
GN, Viacava F. Socio-demographic determinants of self-rated
health in Brazil. Cad Saude Publica. 2005;21 Suppl:54-64.
doi: /S0102-311x2005000700007.
28. Cherepanov D, Palta M, Fryback DG, Robert SA. Gender
differences in health-related quality-of-life are partly
explained by sociodemographic and socioeconomic variation
between adult men and women in the US: evidence from
four US nationally representative data sets. Qual Life Res.
2010;19(8):1115-24. doi: 10.1007/s11136-010-9673-x.
29. Chen R, Wei L, Hu Z, Qin X, Copeland JR, Hemingway H.
Depression in older people in rural China. Arch Intern Med.
2005;165(17):2019-25. doi: 10.1001/archinte.165.17.2019.
30. Abedzadeh Kalahroudi M. Strategies for improvement quality
of life in menopause. Nurs Midwifery Stud. 2013;2(2):240-1.
31. Abedzadeh Kalahroudi M, Taebi M, Sadat Z, Saberi F,
Karimian Z. Prevalence and severity of menopausal symptoms
and related factors among women 40-60 years in Kashan,
Iran. Nurs Midwifery Stud. 2012;1(2):88-93.
32. Hakansson K, Rovio S, Helkala EL, Vilska AR, Winblad B,
Soininen H, et al. Association between mid-life marital status
and cognitive function in later life: population based cohort
study. BMJ. 2009;339:b2462. doi: 10.1136/bmj.b2462.
33. Abbasimoghadam MA, Dabiran S, Safdari R, Djafarian K.
Quality of life and its relation to sociodemographic factors
among elderly people living in Tehran. Geriatr Gerontol Int.
2009;9(3):270-5. doi: 10.1111/j.1447-0594.2009.00532.x.
34. Kalpakjian CZ, Houlihan B, Meade MA, Karana-Zebari D,
Heinemann AW, Dijkers MP, et al. Marital status, marital
transitions, well-being, and spinal cord injury: an examination
of the effects of sex and time. Arch Phys Med Rehabil.
2011;92(3):433-40. doi: 10.1016/j.apmr.2010.07.239.
35. Song L, Li S, Zhang W, Feldman MW. Intergenerational
support and self-rated health of the elderly in rural China:
An investigation in Chaohu, Anhui province. In: Zeng Y,
Poston DL Jr, Vlosky DA, Gu D, eds. Healthy Longevity in
China: Demographic, Socioeconomic, and Psychological
Dimensions. Dordrecht: Springer; 2008:235-49.
36. Hagedoorn M, Van Yperen NW, Coyne JC, van Jaarsveld CH,
Ranchor AV, van Sonderen E, et al. Does marriage protect
older people from distress? The role of equity and recency
of bereavement. Psychol Aging. 2006;21(3):611-20. doi:
37. Tajvar M, Arab M, Montazeri A. Determinants of health-related
quality of life in elderly in Tehran, Iran. BMC Public Health.
2008;8:323. doi: 10.1186/1471-2458-8-323.
38. Park BW, Lee S, Lee AR, Lee KH, Hwang SY. Quality of Life
Differences between Younger and Older Breast Cancer
Patients. J Breast Cancer. 2011;14(2):112-8. doi: 10.4048/
39. Netuveli G, Wiggins RD, Hildon Z, Montgomery SM, Blane
D. Quality of life at older ages: evidence from the English
longitudinal study of aging (wave 1). J Epidemiol Community
Health. 2006;60(4):357-63. doi: 10.1136/jech.2005.040071.
40. Breeze E, Jones DA, Wilkinson P, Bulpitt CJ, Grundy C, Latif
AM, et al. Area deprivation, social class, and quality of
life among people aged 75 years and over in Britain. Int J
Epidemiol. 2005;34(2):276-83. doi: 10.1093/ije/dyh328.
41. Huguet N, Kaplan MS, Feeny D. Socioeconomic status and
health-related quality of life among elderly people: results from
the Joint Canada/United States Survey of Health. Soc Sci Med.
2008;66(4):803-10. doi: 10.1016/j.socscimed.2007.11.011.