Health-Related Quality of Life and Associated Factors Among Climate-Induced Coastal Migrants in Bangladesh - A Cross-Sectional Study

Climate-induced displacement is driving millions of Bangladeshis to ecologically precarious char lands, yet health-related quality of life (HRQoL) among these migrants remains empirically underexamined. To quantify HRQoL across four WHOQOL-BREF domains and identify its key demographic, migration-related, and socioeconomic determinants among climate-displaced coastal migrants in Subarnachar, Bangladesh. A community-based descriptive cross-sectional study was conducted in Subarnachar upazila, Noakhali district. Using multi-stage cluster sampling across four unions, 146 eligible adult migrants were recruited (100% response rate). Data were collected via interviewer-administered structured questionnaires incorporating the validated Bengali WHOQOL-BREF. Analyses included descriptive statistics, independent t-tests, one-way ANOVA, backward stepwise multiple linear regression, and binary logistic regression. IRB approval was obtained in accordance with the Declaration of Helsinki. Mean participant age was 42.5 years (SD ±11.8); 54.8% were male and 65.1% had no formal education. Overall, 89% reported poor or below-average HRQoL. Domain mean scores (0–100 scale) were: Physical Health 42.1 (±13.8), Psychological Health 34.2 (±12.5), Social Relationships 48.3 (±15.6), and Environmental Health 29.1 (±11.2). Binary logistic regression identified five independent predictors of poor overall HRQoL: female sex (AOR=3.65; 95% CI: 1.92–6.84; p=0.001), no formal education (AOR=2.92; 95% CI: 1.18–5.35; p=0.012), multiple prior displacements (AOR=4.30; 95% CI: 2.15–8.75; p<0.001), reliance on saline-contaminated drinking water (AOR=5.85; 95% CI: 2.85–12.10; p<0.001), and decreased post-migration income (AOR=3.25; 95% CI: 1.52–6.95; p=0.004). Climate migrants in Subarnachar experience profound, multidimensional HRQoL deficits, most critically in the environmental and psychological domains. Saline water contamination was the strongest single predictor of poor well-being, indicating that ecological hazards at resettlement destinations perpetuate rather than resolve pre-existing vulnerability. These findings challenge the framing of internal migration as effective climate adaptation and call for migration-sensitive policies encompassing water desalination infrastructure, secure land tenure, gender-responsive social protection, and community-based psychological support.