Prioritizing health as a core development strategy highlights its importance as a key indicator of modernization and well-being. Improving the health-related quality of life (HRQoL) of rural older adults, especially those with multiple chronic diseases, aligns with a people-centered development approach. However, the specific livelihood capitals influencing their HRQoL remain unclear.

To assess the HRQoL of rural older adults with different chronic disease profiles and analyze the impact of livelihood capitals on their HRQoL.

A multi-stage stratified random sampling method was used to survey 1 900 rural residents aged ≥60 years in Zhejiang, Chongqing, and Gansu provinces from July to August 2023. HRQoL was measured using the EQ-5D-3L scale. Livelihood capitals included social capital (social participation frequency), human capital (education level, employment status), financial capital (annual income, medical insurance type), digital capital (internet usage frequency), and psychological capital (life satisfaction, expectations, and self-confidence). HRQoL utility values were compared among older adults without chronic diseases, those with a single chronic disease, and those with multimorbidity. Multiple linear regression was used to explore the influence of livelihood capitals on HRQoL across groups.

A total of 1 419 valid responses were collected (effective response rate: 74.68%). Among them, 517 (36.43%) had no chronic diseases (utility value: 0.91±0.13), 640 (45.10%) had a single chronic disease (utility value: 0.87±0.16), and 262 (18.46%) had multimorbidity (utility value: 0.80±0.19), with significant differences among the groups (P<0.05). Regression analysis showed that for those without chronic diseases, employment status (human capital), internet use frequency (digital capital), and life expectations (psychological capital) were significant factors (P<0.05). For those with a single chronic disease, social participation (social capital), employment (human capital), internet use (digital capital), life satisfaction, and self-confidence (psychological capital) influenced HRQoL (P<0.05). For those with multimorbidity, social participation, medical insurance type (financial capital), internet use, and self-confidence were key factors (P<0.05).

HRQoL decreases with the increase of the number of chronic diseases.It is necessary to explore and utilize the advantages of livelihood capital to improve the HRQoL of rural elderly.

健康优先发展战略下，健康作为现代化、幸福生活的最重要指标，提升农村老年人，尤其是慢性病共病人群的健康生命质量是践行"以人民为中心"发展思想的关键体现，但影响农村老年人生命质量的具体生计资本尚未明确。

了解不同类别慢性病患病农村老年人的生命质量，并分析生计资本对各类别农村老年人生命质量的影响。

于2023年7—8月，采用多阶段分层随机抽样法在浙江省、重庆市、甘肃省抽取≥60岁老年人1 900名。采用欧洲五维健康量表（EQ-5D-3L）评价老年人的健康生命质量，纳入的生计资本指标包括社会资本（社会参与频率）、人力资本（受教育程度、就业状况）、金融资本（家庭年收入、医疗保险类型）、数字资本（互联网使用频率）、心理资本（生活满意度、生活期望、自信心）。比较非慢性病老年人、单一慢性病老年人、慢性病共病老年人的健康效用值，采用多元线性回归分析不同慢性病患病情况老年人中生计资本对健康生命质量的影响。

共回收有效问卷1 419份，问卷有效回收率为74.68%。其中，非慢性病老年人517名（36.43%），健康效用值为（0.91±0.13）；单一慢性病老年人640名（45.10%），健康效用值为（0.87±0.16）；慢性病共病老年人262名（18.46%），健康效用值为（0.80±0.19）。非慢性病、单一慢性病、慢性病共病老年人的健康效用值比较，差异有统计学意义（P<0.05）。多元线性回归分析结果显示：对于非慢性病老年人，人力资本中的就业状况、数字资本中的数字媒体使用频率、心理资本中的生活期望是健康效用值的影响因素（P<0.05）；对于单一慢性病老年人，社会资本中的社交参与频率、人力资本中的就业情况、数字资本中的互联网使用频率、心理资本中的生活满意度和自信心是健康效用值的影响因素（P<0.05）；对于慢性病共病老年人，社会资本中的社交参与频率、金融资本中的医疗保险类型、数字资本中的互联网使用频率、心理资本中的自信心是健康效用值的影响因素（P<0.05）。

农村老年人的健康效用值得分随慢性病患病数量增加呈现下降趋势。生计资本会对各群体健康生命质量产生一定影响，建议综合考虑多维资本，发掘并利用其优势来改善农村老年生命质量。