Abstract
BACKGROUND: Health-related quality of life (HRQoL) is a vital measure of overall well-being and is influenced by chronic conditions and unhealthy lifestyle behaviors. This study aimed to investigate the impact of chronic conditions and unhealthy behaviors on HRQoL among Iranian women aged 18 years and older. METHODS: A national cross-sectional study was conducted in 2024-2025 among 1,803 women from nine provinces in Iran using a convenience sampling method. Data were collected through face-to-face interviews using a structured questionnaire that included sociodemographic characteristics, lifestyle behaviors, chronic disease status, and the validated Iranian versions of the EQ-5D-5 L (hereafter referred to as EQ-5D) and EQ-VAS instruments to assess HRQoL. Given that the dependent variables (EQ-5D utility values and EQ-VAS scores) were not normally distributed and heteroscedasticity was detected, multivariable regression analyses were performed using a generalized linear model (GLM) with robust standard errors, adjusted age, marital status, level of education, place of birth, province, and self-assessed household economic status. RESULTS: Approximately 23.8% of participants reported at least one chronic condition. Women with chronic diseases had significantly lower EQ-5D index (mean = 0.62) and EQ-VAS scores (mean = 64.5) compared to those without (EQ-5D = 0.81, EQ-VAS = 76.1). Unhealthy behaviors, including poor physical activity, poor sleep quality, alcohol consumption, and smoking were all significantly associated with lower HRQoL scores (p-value < 0.05 in univariate analysis). Among these, poor sleep quality demonstrated the strongest negative association with both EQ-5D index and EQ-VAS scores. The GLM analyses indicated that chronic conditions and unhealthy behaviors, poor physical activity, poor sleep quality, and alcohol consumption were independently associated with significantly lower HRQoL after controlling for confounding factors. CONCLUSION: Chronic diseases and unhealthy lifestyle behaviors significantly diminish HRQoL among Iranian women. Public health interventions targeting these modifiable factors, especially improving sleep quality and promoting physical activity, are essential to enhance women's well-being in Iran and similar settings.