Moderating effect of education level on health-related quality of life and health service utilization among middle-aged and elderly hypertensive patients in rural areas
SI Miaomiao
MA Ziyuan
ZHANG Xiaolin
KANG Pan
YI Jikun
MA Yichen
LI Jingyi
ZHANG Yujia
MA Jiani
YAO Xuan
HAN Xuemei
Abstract：Objective:To understand the relationship between health-related quality of life and health service utilization among middle-aged and elderly hypertensive patients in rural areas,and to explore the moderating effect of education level.Methods:A total of 1 391 middle-aged and elderly hypertensive patients in rural areas were selected as the research subjects from the 2018 China Health and Retirement Longitudinal Study(CHARLS)database.Basic information,health status and functional information of middle-aged and elderly hypertensive patients in rural areas from the database were extracted,the utilization status of health service was investigated,and health-related quality of life was evaluated based on the database information and the score of EuroQol Five-dimensional Questionnaire(EQ-5D).The impact of health-related quality of life on health service utilization was analyzed,the moderating effect of education level between health-related quality of life and health service utilization was explored,and visualized the moderating effect using marginal effects diagram.Results:Among 1 391 middle-aged and elderly hypertensive patients in rural areas,457 patients utilized health services,with health service utilization rate of 32.85%.The proportion of middle-aged and elderly hypertensive patients in rural areas who had difficulties in the five dimensions of EQ-5D,in which mobility was 46.59%,self-care ability was 12.94%,daily activity ability was 19.34%,pain or discomfort was 68.51%,anxiety or depression was 38.82%.The health utility value of patients was(0.952±0.085).The results of multiple factor analysis showed that health utility value was an influencing factor of the utilization of outpatient services and inpatient services for middle-aged and elderly hypertensive patients in rural areas.The results after adjusting for confounding factors indicate that higher education level had stronger moderating effect on the relationship between health-related quality of life and health service utilization.The marginal effects diagram showed that the slope of health service utilization for middle-aged and elderly hypertensive patients in rural areas with higher education levels was smaller than that for middle-aged and elderly hypertensive patients in rural areas with lower education levels.Conclusions:Health related quality of life is an important influencing factor of health service utilization among middle-aged and elderly hypertensive patients in rural areas,and education level plays moderating role in the relationship between health-related quality of life and health service utilization.
Keywords：rural areasmiddle-aged and elderlyhypertensionhealth-related quality of lifehealth service utilizationeducational levelmoderating effect
Publication Date：2025-01-24
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 237-243 )