| Objective:Health-related quality of life (HRQoL) is a multidimensional concept for the comprehensively assessment of physical and mental health, it has many influencing factors. Multiple liner regression analysis was performed to explore the influencing factors of HRQoL or the interaction of a few influencing factors in most of relative studies. However, the influencing factors are not independent, one has direct and indirect effect on HRQoL, and multiple liner regression analysis will has limits when taking into account the complex interactions between them. The purpose of this study is to exploring the influencing factors of HRQoL and the interactions between them by using Path Analysis, an expanded method of multiple liner regression analysis which is adapted to analyze the relationship of multivariate when there are indirect effects between them.Methods:Participants who are over 18 years old were recruited from Zhuhai Hospital of Guangdong Hospital of Traditional Chinese Medicine and the first affiliated hospital of Anhui university of Chinese medicine. HRQoL was measured through 36-item short-form health survey (SF-36). Association between demographic factors (sex, age, marital status and education level), behavioral and lifestyle factors (smoking, drinking, exercise and sleep), health-related factors (disease and BMI) and HRQoL were determined by means of Path Analysis. Three path graph were explored with separated categories of total score of SF-36, physical component summary (PCS) and mental component summary (MCS). Evaluation index of these models were x2, x 2/ df, normed fit index (NFI), relative fit index (RFI), incremental fit index (IFI), Tacker-Lewis index (TLI), comparative fit index(CFI) and root mean square error of approximation (RMSEA).Results:1. The relation among variables and HRQoL. (1) Demographic factors: Male has higher scores of HRQoL (significantly, except PF, RP and SF). The scores of different age groups are significantly different (except SF). The people who are married have higher scores in total SF-36 score, RP, MCS and its 4 domains (p<0.05). Higher educational level is associated with higher HRQoL in PCS, PF, BP and GH. The score of secondary school level was significantly lower than that of bachelor degree or above in VT and that of the other two groups in SF. (2) Behavioral and lifestyle factors:People who preferred smoking has higher HRQoL in PCS and GH than that who don’t (p<0.05). People who preferred drinking has significantly higher scores of HRQoL (except PF, SF and RE). The scores of different sleeping hours groups are significantly different. Less than 6 hours of sleep is associated with lower scores in total score of SF-36, PCS and its 4 domains. Participants with 7-9 hours of sleep have higher scores in MCS and its 4 domains than that with less than 6 or 6-7 hours of sleep. People who do exercise occasionally have loewer total scores (p<0.05). Doing exercise sometimes is associated with higher scores in PCS, doing exercise regularly with lower scores in BP, and doing exercise occasionally with lower scores in GH. Doing exercise occasionally is associated with lower scores in MCS, VT, SF and MH, doing exercise regularly with higher scores in VT and MH. (3) Health related factors:Overweight is associated with higher score than underweight in total score of SF-36, with higher score than underweight and normal weight in GH, MCS and its 4 domains (p<0.05). Obesity is associated with higher than normal weight in MCS, RE and MH (p<0.05). People whith two or more diseases have significantly lower scores in PCS, PF, RP and BP. People with no disease have significantly lower scores in MCS, VT and MH.2. Results of path analysis. (1) The interactions among influencing factors. From perspective of total effects, male is related with higher educational level, preferred smoking, preferred drinking, higher BMI and more diseases. Aging is associated with in marital status, lower educational level, preferred smoking, preferred drinking, less hours of sleep, higher level of exercise, higher BMI and more diseases. In marital status is associated with lower level of exercise, and higher BMI, higher level of education with preferred smoking, preferred drinking, higher level of exercise, lower BMI and less diseases. Preferred drinking is associated with preferred smoking. More hours of sleep are associated with lower BMI and less diseases. Higher BMI is associated with more diseases. (2) Influencing factors of PCS. The influencing factors of positive direct effects of PCS are more hours of sleep (0.118), male (0.114), higher BMI (0.112), higher level of education (0.112) and higher level of exercise (0.076), the negative ones are more diseases (-0.176), aging (-0.148) and other marital status (-0.104). Aging (-0.062) and higher BMI (-0.039) have negative indirect effects to the scores of PCS. (3) Influencing factors of MCS. The influencing factors of positive direct effects of MCS are higher BMI (0.147), higher level of exercise (0.130), more hours of sleep (0.113), higher level of education (0.100) and aging (0.070), the negative ones are other marital status (-0.130) and more diseases (-0.078). Male (0.042) has positive indirect effects and higher BMI (-0.017) has negative indirect effects to the scores of MCS. (4) Influencing factors of total score of SF-36. The influencing factors of positive direct effects of total score of SF-36 are higher BMI (0.141), more hours of sleep (0.125), higher level of education (0.115), higher level of exercise (0.113) and male (0.098), the negative ones are more diseases (-0.135) and other marital status (-0.128). Higher BMI (-0.030) has negative indirect effect to the total scores of SF-36.Conclusion:There are differences among the influence of different variables to the PCS and MCS. And there exist complex interactions among the variables. The important results of this study are included as (1) Male has significantly-higher HRQoL scores, and it has significant indirect effects in MCS which support that the HRQoL of male and female can be developed through improve the indirect influencing factors. (2) Aging has negative direct and indirect effects on the HRQoL in PCS, and little positive effects on the HRQoL in MCS. (3) People in marital status have higher HRQoL, especlly in MCS. (4) The positive of educational level is lower compared to the other factors. (5) Preferred smoking and drinking are not found to be associated with lower HRQoL. (6) People with less than 7 hours of sleep have lower HRQoL in PCS and MCS. (7) Higher level of exercise has positive effect on the HRQoL in PCS and MCS, and it is much higher in MCS than PCS. (8)To some extent, higher BMI has positive effect on the HRQoL in PCS and MCS, and it is much higher in MCS than PCS. (9) More diseases have negative effect on the HRQoL, and the effect is larger in MCS than PCS.
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