Health-related quality of life in rural, post-industrial regions: Deprivation and structural change

Background

Health-related quality of life (HRQoL) is associated with socioeconomic deprivation at the individual level and the area level. Evidence is limited for post-industrial, rural regions undergoing structural transitions. These transitions entail infrastructural changes, including in healthcare, and are accompanied by substantial uncertainties in living and working situations. This study explores whether living in lignite mining regions in Germany undergoing phase-out is associated with lower HRQoL and whether it has an additional impact on HRQoL beyond the effects of individual and area-level deprivation.

Methods

Data from the 2022 cross-sectional wave of the German Socio-Economic Panel (n = 25.270) were linked to the German Index of Socioeconomic Deprivation (GISD) by district identifiers (n = 400). Mental and physical HRQoL were measured using Sf-12 v2 and compared between lignite mining regions (n = 2.636) and other regions using independent samples t-test. Linear multilevel models [beta, 95%CI] with robust standard errors included GISD, lignite mining region [yes|no] and net equivalised household income [low|middle|high] as predictors, adjusted for sex, age, and migration background.

Results

Mental and physical HRQoL were lower in lignite mining regions in unadjusted comparisons. Lower physical HRQoL was associated with lower household income (βmedium=-2.34, -2.62 to -2.07, βlow=-4.29, -4.57 to -4.01; compared to high income), and higher area-level deprivation (β=-0.54, -0.70 to -0.39). No independent association with living in lignite mining regions was observed (β = 0.12, -0.39 to 0.64). Lower mental HRQoL was associated with lower household income.

Conclusions

Lower HRQoL in lignite regions was attributable to individual- and area-level socioeconomic deprivation, but no additional regional effect was identified. Addressing social inequalities at the individual and area level may promote health equity in regions undergoing structural transitions.

Key messages

• Health related quality of life is lower in post-industrial, rural regions undergoing structural transitions.

• This lower health-related quality of life is driven by area-level and individual deprivation, rather than by an independent regional effect.