Modifiable Factors Associated with Trajectories of Health-Related Quality of Life in Women from Midlife to Older Adulthood: The Study of Women’s Health Across the Nation (SWAN)

BACKGROUND: Midlife health and psychosocial status impact health-related quality of life (HRQL), but few studies have examined these associations from midlife to older adulthood. The current analyses aimed to (1) identify HRQL trajectories in women from midlife to older adulthood, (2) determine factors associated with HRQL trajectories, and (3) examine whether these associations change over time. MATERIALS AND METHODS: We analyzed the 36-Item Short Form Health Survey Physical (PCS) and Mental Component Summaries (MCS) from 2002 to 2023 (ages 48-79 years) in 2,636 women from The Study of Women's Health Across the Nation (SWAN). We used locally weighted scatterplot smoothing to estimate PCS and MCS mean trajectories as a function of age and group-based trajectory models to identify trajectory subgroups. Associations between trajectory group membership and sociodemographic, health-related, menopausal, lifestyle and anthropometric, and psychosocial variables were estimated through mixed-effects models. RESULTS: Mean PCS declined 6.6 points (51.6-45), and MCS increased 3.0 points (50-53) with age. We identified four PCS groups (one stable and three decreasing) and three MCS groups (two stable and one increasing). Compared to the high-stable groups, other PCS and MCS groups were associated with worse health factors. Most associations were stable over time, but financial strain worsened faster in more adverse trajectories. Positive affect and social support increased in the high-stable PCS and MCS groups, while negative affect improved faster in the low, late-increasing MCS group. CONCLUSIONS: These results extend previous research by characterizing heterogeneous HRQL trajectories and identifying potentially modifiable behavioral and health targets for physical and mental HRQL in women from midlife to older adulthood.