From February 2021 to November 2022, a total of 7,604 respondents were involved, of which 106 interviews were excluded because the respondents did not complete the whole interview (N = 67), or the interviews did not meet the inclusion criteria (N = 5), or answered with logical inconsistencies (N = 17), or the interview took less than 5 min (N = 17). Finally, a total of 7,498 respondents were included.

The sample relative approximate to the general adult Chinese population in terms of age, sex, ethnicity, and district of residence, each geographic distribution ranged from 9.71 to 25.54% (compared with Communiqué of the Seventh National Population Census and China Statistical Yearbook of 2023 in Table 1, and see Table 2 for details). Of the respondents, 45.84% were men and 54.16% were women. About 89.82% of the respondents were Han ethnicity. And 62.34% of respondents were married and 32.24% were unmarried. 52.28% of respondents were rural householding registration. About 20% of the respondents earn less than 1,300 CNY per month. A considerable proportion of the population possesses a higher level of education, with nearly 50% holding a university degree, while approximately 10% have completed only primary-level education. 50.12% of respondents were employed and 8.58% were unemployed. About 40% of respondents reported the presence of chronic conditions. More than 70% of respondents reported participating in physical activities frequently or occasionally. 74.58% of respondents were non-smokers and 53.77% were non-drinkers (Table 2).

The mean CQ-11D index scores were 0.897(SD: 0.142). The mean CQ-11D index scores of presence of chronic disease respondents were 0.843(SD: 0.184): 0.772(SD: 0.227) for cardiovascular disease, 0.825(SD: 0.205) for hypertension, 0.725(SD: 0.265) for stroke or other cerebrovascular diseases, 0.814(SD: 0.197) for diabetes, 0.819(SD: 0.200) for chronic respiratory disease, 0.803(SD: 0.211) for arthritis, 0.750(SD: 0.265) for osteoporosis or primary osteoporosis, and 0.750 (SD: 0.259) cancer or malignant tumor (Table 2). The mean utility score ranged from 0.921 ± 0.107 (age group 16 ∼ 24) to 0.796 ± 0.248 (age group 75+). Female respondents had lower CQ-11D scores (Mean 0.886, SD 0.150) than male respondents (Mean 0.910, SD 0.131) with the p-values < 0.001. The CQ-11D index scores varied with the demographic and socioeconomic characteristics of respondents, except for ethnicity (p > 0.05) and income (p > 0.05). The lower CQ-11D index scores were associated with older age, being female, being married or widowed, unemployment (including being retired), rural household registration, smoking, drinking, not exercising, lower income, and chronic disease conditions. Respondents in the Northeast region had the highest CQ-11D index scores among the seven geographic divisions. Respondents with primary level education or below had lower CQ-11D index scores (0.825) and those with a university degree education had higher CQ-11D index scores (0.915).

In total, according to the responses of the individual CQ-11D dimensions, most health problems were identified in the PL (70.16%) and SM (63.63%) dimensions (Fig. 1). The percentage of “non-problem” were: 90.29% for XD, 53.03% for SY, 44.25% for DB, 36.37% for SM, 42.34% for JS, 50.85% for TY, 59.91% for XH, 52.64% for TT, 29.85% for PL, 40.72% for FZ, and 45.00% for JL. The percentage of reported problems for each level CQ-11D dimension for sex and age groups (Tables 3 and 4, and Fig. 2). The XING dimensions (XD, SM, DB, TY, SY, JS, TT, and XH) were relatively low percentages of any health problem in the younger age group, which increased with increasing age. The percentage of SHEN dimensions (PL, FZ, and JL) that reported any problems remained at a high level of about 45%∼75% across all age groups. The percentage of respondents who reported any problems in the PL dimension was higher in the 15 ∼ 24, 45 ∼ 54, and 75 + age groups. The proportion of participants who indicated difficulties in the FZ dimension and JL dimension was considerable, with a consistently high level of constraints (> 60%), which remained relatively steady across various age cohorts. We found significant differences between male and female respondents in every health dimension, except for the XD dimension (Table 3). For male respondents, there was a sharp increase in the age groups of 65 to 75 + for all health dimensions. This sharp increase was observed among female respondents in the age groups of 55 ∼ 64 to 65 ∼ 74. Once female respondents reached 75 + years old, the percentage of any problem in dimensions of SM, TT, and XH decreased. In general, a higher percentage of female respondents than males reported any problem across all dimensions.

Frequencies of having “any problems” (level 2–4) in the CQ-11D dimensions in the whole sample

Frequencies of having “any problems” (level 2–4) in the CQ-11D dimensions presented by sex and age groups

Table 5 shows the results of multivariate analysis on socio-demographic characteristics and health-relative variables. The sex (female), older than 65 age, ethnicity of non-Han, being widowed or divorced, primary education level or below, household registration (rural), students or unemployed, smoking (occasionally, frequent, or former smoker), drinking (occasionally, frequent, or former drinker), physical activity(occasionally, never, or uncertain), changes self-perceived health status compared to the previous year (improved, worsened, or uncertain), and presence of chronic diseases were negative association with health utility scores and both significant. The North, Central, and West-north geographic divisions, rural household registration, retirement, and being married were negative but not significantly associated with HRQoL. Compared with a monthly income of less than 1300 CNY, when the monthly income increased to 1300 ∼ 13,000 CNY, there was a significant positive correlation with the health utility value.

Table 6 shows the results of ordinal logistic regression on socio-demographic characteristics and health-relative variables. The female respondents had significantly higher odds of reported problems in all of the 11 dimensions. Compared with the 15 ∼ 24 age group, older age groups had lower odds of reporting health problems of SHEN dimensions (OR 0.49 ∼ 0.76). The odds of reporting problems with XD dimension increase with age (OR 3.16 ∼ 10.17). After the age of 65 years, the odds of reporting problems in the XING dimensions (SY, DB, TY, XH, and TT) are significantly increased (OR 1.38 ∼ 1.73). Compared with ethnic Han respondents, minority ethic respondents had higher odds of reporting problems were higher in XD and SY dimensions (OR 1.21 ∼ 1.90) and lower in the PL and FZ dimensions (OR 0.79 ∼ 0.80). Respondents who had experienced marriage had higher odds of reporting problems both in the XING and SHEN dimensions, especially those who were divorced and widowed respondents (OR 1.26 ∼ 2.13). The odds of reporting health problems increased with educational attainment in 3 dimensions of SHEN dimensions (PL, FZ, and JL), with those who were High school/Junior college and university educated having an OR 1.25  1.35 compared with those with higher than primary school education. Compared with employed respondents, unemployed respondents had higher odds of reporting health problems in some dimensions of XING dimensions (XD, SY, DB, JS, and TY) and had lower odds of reporting health problems in PL. Retired respondents had higher odds of reporting health problems in some dimensions of XING dimensions (XD, DB, SM, and TT), which may be related to the older age of retired respondents compared with employed respondents.

Among health indicators, occasionally/often smoking (OR 1.5524 ∼ 2.8399), occasionally/often drinking (OR 1.14 ∼ 2.8307), occasionally/never participated in physical activities (OR 1.25 ∼ 2.13), and worsened/uncertain changes in self-perceived health status compared to the previous year (OR 1.47 ∼ 3.49) increase the odds of reporting problems in almost all of the dimensions. Compared to non-smokers, occasional smokers have some negative impact on XD, SY, DB, JS, TY, XH, TT, and PL dimensions, with an OR range of 1.23 to 2.83. Frequent smokers compared to non-smokers have negative impacts on XD, DB, XH, PL, and FZ dimensions, with an OR range of 1.20 to 1.55. Former smokers compared to non-smokers have negative impacts on the XH dimension, with an OR of 1.35. It can be seen that the number of dimensions with negative impacts is former smokers < frequent smokers < occasional smokers. For drinkers, there were similar results. Compared to non-drinkers, occasional drinkers have some negative effect on DB, SM, JS, TY, XH, TT, PL, FZ, and JL dimensions, with an OR range of 1.14 to 1.43; Frequent drinkers have some negative effect on XD, SY, DB, SM, TY, XH, TT, PL, FZ and JL, with OR range of 1.29 to 2.11; former drinkers have some negative effect on DB, SM, JS, TT, PL and JL, with an OR range of 1.33 to 1.68. It can be seen that the number of dimensions with negative impacts is former drinkers < occasional drinkers < frequent drinkers. Respondents with chronic conditions had an OR 1.62 ∼ 4.23 for reporting problems across all dimensions, especially the XD dimension (OR = 4.23).