The impact of ambient air pollution on health-related quality of life: a nationwide study in China

To explore the impact of ambient air pollution on the health-related quality of life (HRQoL) of Chinese residents.

Air pollutant exposure and HRQoL in 21,909 participants were analyzed using data from the 2022 Psychology and Behavior Investigation of Chinese Residents (PBICR-2022). Air pollutants included fine particulate matter (PM_2.5), PM₁₀, ozone (O₃), nitrogen dioxide (NO₂), and carbon monoxide (CO). HRQoL was measured using the EQ-5D-5L questionnaire, which comprises two sections: the EQ-5D descriptive system (assessing five dimensions: Mobility, Self-care, Usual Activities, Pain/Discomfort, and Anxiety/Depression) and the EQ visual analogue scale (EQ-VAS). The health utility score (HUS) was calculated based on responses to the descriptive system. Multivariate logistic regression and Tobit regression models were used to analyze the association between ambient air pollution exposure and HRQoL.

PM_2.5 (β = − 0.000891 per μg/m³), O₃ (β = − 0.000510 per μg/m³)_, NO₂ (β = − 0.001311 per μg/m³), and CO (β = − 0.050839 per mg/m³) were significantly negatively associated with HUS (all P < 0.05), among NO₂ exhibited the strongest negative association with HUS. All five air pollutants linked to the dimensions of Mobility, Self-care, and Usual Activities (all P < 0.05), whereas no significant associations were observed with Pain/Discomfort and Anxiety/Depression. Subgroup analysis revealed significant inverse associations with HUS among smokers/drinkers (PM_2.5, PM₁₀, NO₂), rural residents/individuals living with others (O₃), and unmarried individuals (CO).

Exposure to ambient air pollutants was significantly associated with impaired HRQoL among Chinese residents, particularly in the dimensions of Mobility, Self-care, and Usual Activities. Notably, PM_2.5, O₃, NO₂, and CO exposure exhibited pronounced negative correlations with HUS. These findings provide significant implications for designing targeted air pollution mitigation strategies, which could effectively enhance population health and quality of life.