JCNRJournal of Clinical and Nursing Research2208-36852208-3693Bio-Byword Scientific Publishing Pty. Ltd.10.26689/jcnr.v9i10.12369ArticleThe Mediating Effect of Pain on the Relationship between Sleep Quality and Health-Related Quality of Life among Elderly Patients with Chronic Diseases: An Empirical Analysis Based on CHARLS Datahttps://artdesignp.com/journal/JCNR/9/10/10.26689/jcnr.v9i10.12369GuiZiyu,LiuZimeng,ZhengMeijie,LiuWenxiu,HaoRan,ZhangXinping,LiXian20259102025-11-10Abstract:Objective:To explore the mediating effect of pain between sleep quality and health-related quality of life in elderly patients with chronic diseases. Methods: Based on the 2018 China Health and Aging Tracking Survey (CHARLS) data, 3,284 elderly patients with chronic diseases aged 60 or above were selected as the research subjects. The sleep quality, pain status, health-related quality of life, and demographic-related data of these elderly patients were obtained. Pearson correlation analysis was used to explore the correlations among the variables; linear regression models and Bootstrap repeated sampling method were used to analyze the mediating effect of pain between sleep quality and health-related quality of life. Results: Sleep quality was positively correlated with health-related quality of life (r=0.218,P<0.001), and pain was negatively correlated with sleep quality and health-related quality of life (r=-0.496, -0.067, P<0.001). The mediating effect results showed that pain played a partial mediating role between sleep quality and health-related quality of life in elderly patients with chronic diseases (effect value=0.049), and the mediating effect accounted for 23.33%. Conclusion: Pain is a mediating variable between sleep quality and health-related quality of life in elderly patients with chronic diseases. This suggests that clinical practice should incorporate pain assessment into the routine management of elderly patients with sleep disorders and chronic diseases. By alleviating pain, sleep quality can be improved, and subsequently, their health-related quality of life can be enhanced.

Wang R, Huang Y, Geng M, et al., 2025, The Relationship Between Residents’ Health Literacy and Health-Related Quality of Life in Qingdao City: The Mediating Role of Self-Efficacy and the Moderating Role of Chronic Disease Status. Modern Preventive Medicine, 52(05): 887–892.

Yao Q, Zhang Y, Xu L, 2018, Research on the Health-Related Quality of Life of Chinese Residents and Its Influencing Factors: An Empirical Analysis Based on the National Health Service Survey. Population and Development, 24(03): 85–95.

Wang Y, 2010, Research on the Health-Related Quality of Life of Chinese Residents and Its Impact on Utilization of Health Services, thesis, Peking Union Medical College.

The Central Committee of the Communist Party of China and the State Council, 2016, The “Healthy China 2030” Planning Outline. (2016-10-25) [2025/6/5]. https://www.gov.cn/zhengce/2016-10/25/content_5124174.htm

National Bureau of Statistics of China, 2025, Statistical Bulletin of the National Economic and Social Development of the People’s Republic of China for the Year 2024. (2025-02-28) [2025/6/5]. https://www.gov.cn/lianbo/bumen/202502/content_7008605.htm

National Health Commission of China, 2019, Healthy China Initiative (2019–2030). [2025/7/1].https://www.nhc.gov.cn/guihuaxxs/c100133/201907/2a6ed52f1c264203b5351bdbbadd2da8.shtml

Wang M, Chen X, Wang A, et al., 2022, Chronic Disease Management in Primary Healthcare Institutions: Experiences, Issues and Suggestions—Based on Case Analysis. Health Economics Research, 39(03): 46–49.

Wang Z, Zhao M, Chen T, et al., 2022, Meta-Analysis of the Prevalence of Sleep Disorders Among Elderly People in China. Chinese General Practice, 25(16): 2036–2043.

Stubbs B, Vancampfort D, Thompson T, et al., 2018, Pain and Severe Sleep Disturbance in the General Population: Primary Data and Meta-Analysis From 240,820 People Across 45 Low- and Middle-Income Countries. General Hospital Psychiatry, 53: 52–58.

Liu Y, Luo L, Fu G, et al., 2025, Research on the Relationship Between Pain and Sleep in Elderly Patients With Chronic Diseases in China and the Mediating Role of Daily Activity Ability and Life Satisfaction. Modern Preventive Medicine, 52(04): 703–708.

Zhao Y, Hu Y, Smith J, et al., 2014, Cohort Profile: The China Health and Retirement Longitudinal Study (CHARLS). International Journal of Epidemiology, 43(1): 61–68.

Zhuo L, Xu L, Ye J, et al., 2018, Time Trade-Off Value Set for EQ-5D-3L Based on a Nationally Representative Chinese Population Survey. Value in Health, 21(11): 1330–1337.

Zhuang L, 2018, Research on the Comprehensive Index Model of Utility Values for the Chinese Population in the European Five-Dimension Three-Level Quality of Life Scale (EQ-5D-3L), thesis Nanjing Medical University.

Zeng J, Yu J, Wang X, et al., 2025, The Longitudinal Impact of Depression in the Elderly on Daily Living Activities Under the Joint Effect of Mediating and Moderating Effects. Modern Preventive Medicine, 52(07): 1290–1295.

Liu Y, Luo L, Fu G, et al., 2025, Research on the Relationship Between Pain and Sleep in Elderly Patients with Chronic Diseases in China and the Mediating Role of Daily Activity Ability and Life Satisfaction. Modern Preventive Medicine, 52(04): 703–708.

Hayes A, Scharkow M, 2013, The Relative Trustworthiness of Inferential Tests of the Indirect Effect in Statistical Mediation Analysis: Does Method Really Matter? Psychological Science, 24(10): 1918–1927.

Gu X, Dai S, Xu A, et al., 2020, Influencing Factors of Health-Related Quality of Life Among the Elderly in Jiangsu Province. Chinese Journal of Public Health, 36(10): 1409–1412.

Narada T, Zhou J, Li G, et al., 2024, Analysis of Health-Related Quality of Life and Its Influencing Factors of Elderly Patients with Multiple Chronic Diseases in the Community. Journal of Zhengzhou University (Medical Edition), 59(05): 621–625.

Huang Y, Li M, Li H, et al., 2021, Correlation Study on Nutritional Status, Pain Degree and Quality of Life of Cancer Patients. Journal of Metabolic Oncology and Nutrition Electronic Edition, 8(05): 530–533.

Cohen S, Vase L, Hooten W, 2021, Chronic Pain: An Update on Burden, Best Practices, and New Advances. Lancet, 397(10289): 2082–2097.

Sun X, Mei J, Xu J, et al., 2024, The Mediating Role of Depression in the Relationship Between Sleep Disorders and Physical and Mental Health-Related Quality of Life in the Elderly. Modern Preventive Medicine, 51(03): 500–506.

Cai Y, 2021, Research on the Relationship Between Sleep Typing of the Elderly and Health-Related Quality of Life Based on Latent Profile Analysis, thesis, Shanxi Medical University.

Zhao Q, Zhang L, Yu L, et al., 2025, Investigation on the Sleep Quality of Elderly in Longning District in Elderly Care Institutions. Preventive Medicine, 37(04): 408–412.

Li N, Xu G, Chen G, et al., 2020, Sleep Quality Among Chinese Elderly People: A Population-Based Study. Archives of Gerontology and Geriatrics, 87: 103968.

Shi Y, Wu D, Yilipa Y, et al., 2024, The Role of Pain and Sleep Quality in the Relationship Between Chronic Diseases and Grip Strength: An Analysis Based on CHARLS Data. Modern Preventive Medicine, 51(08): 1524–1529.

Pu J, Guo C, Yi Y, et al., 2024, Research Progress on Sleep Disorders and Chronic Pain. Medical Research and Trauma Treatment, 37(01): 104–107.

Sun Y, Laksono I, Selvanathan J, et al., 2021, Prevalence of Sleep Disturbances in Patients with Chronic Non-Cancer Pain: A Systematic Review and Meta-Analysis. Sleep Medicine Reviews, 57: 101467.