Health-related quality of life among urban, rural, and island community elderly in Taiwan

Background Purpose: There are published norms of the 36-item short form of the Medical Outcomes Study Questionnaire (SF-36) for many countries, but few such studies have been conducted in Taiwan. The purpose of this study was to provide the norms for the SF-36 health status measure in urban, rural, and remote island community elderly populations, and to explore the relation between demographic or characteristic factors and the SF-36. Methods: A structed questionnaire was used for door-to-door data collection in this survey of an urban, a rural, and a remote population (Shinpai, Yuli, and Kinmen, respectively, in Taiwan). Interviewers also collected information on subjects' demographics, medical history, use of health services, and health-related quality of life using the SF-36. A total of 6503 subjects who were at least 65 years of age were invited, and 4424 (73.1%) participated in the survey. Results: The urban norms were significantly higher than the rural norms in seven scales of the SF-36 and significantly higher than the island norms in 4 scales, including physical functioning (84.6 vs 77.1), role limitations due to physical problems (77.8 vs 70.2), general health perceptions (70.5 vs 65.5), and role limitaions due to emotional problems (90.6 vs 85.2). Remote island norms were significantly higher than urban and rural norms in vitality and mental health scales. In the multivariate analyses, women had significantly poorer scores in all scales of the SF-36 than men (p<0.05), except for social functioning. Higher education was significantly associated with increased scores in all scales, except for vitality/energy and mental health scales. Scores of all scales were significantly reduced according to the number of chronic diseases a subject had. The need for domestic services and utilization of inpatient and outpatient health services were associated with lower scales (p<0.05). Conclusions: There were significant differences between urban, rural, and remote island elderly populations in most scales of the SF-36. The urban elderly populations had the greatest health-related quality of life on most scales, particularly on the physical health scales. The remote island elderly population had the highest scores on the vitality and mental health scales, whereas the rural population had the poorest health-related quality of life, particularly rural women.