Unmasking hidden pathways: how household air pollution and lifestyle are associated with quality of life in Yunnan outpatients

Background – Non-communicable diseases (NCDs) are a major health challenge in China. This study examined comorbidity prevalence among outpatients in Yunnan and its association with health-related quality of life (HRQoL). Methods – Using stratified cluster sampling, 5, 978 outpatients (2019–2022) were recruited. Data on comorbidities, HRQoL (EQ-5D-5L), and sociodemographics were analyzed via structural equation modeling. Results – Mean age was 38.1 years; 56.8% female. Nearly half (49.1%) had ≥1 NCD. Mean HRQoL score was 0.89 ± 0.20. HRQoL was positively associated with socioeconomic status (β = 0.170, 95%CI: 0.140–0.199), Han ethnicity (0.052, 0.027–0.077), and preference for heavily seasoned foods (0.028, 0.006–0.051); negatively with age (−0.171, −0.190 to −0.143), addictive behaviors (−0.070, −0.094 to −0.046), divorce/widowhood (−0.082, −0.131 to −0.034), and NCDs (−0.040, −0.060 to −0.020). NCDs were positively associated with household fuel exposure (0.647, 0.615–0.679), age (0.143, 0.123–0.162), and addictive behaviors (0.075, 0.050–0.100); negatively with socioeconomic status (−0.064, −0.097 to −0.030) and Han ethnicity (−0.037, −0.064 to −0.010). Age, ethnicity, fuel exposure, addictive behaviors, and socioeconomic status had indirect associations with HRQoL via NCDs. Conclusion – Socioeconomic status, household fuel exposure, addictive behaviors, and demographics are significantly linked to NCDs and HRQoL. Interventions targeting modifiable factors are needed.