Quality of life and influencing factors between local and itinerant populations during the COVID-19 pandemic

Han-Lu Cao,Yi-Yang Cao,Xie Wei,Wen-Shu Zhao,Yi Zhang,Wen-Fei Kong,Xiang-Ning Yang,Wan-Xuan Li,Ze-Han Yu,Zhui Zhang,Jing-Ning Zhao,Xuan Han,Cao Chen,Ning Ding

1Nanjing Medical University,Nanjing,Jiangsu Province 211166,China.2Jiangsu Province Hospital,Nanjing,Jiangsu Province 210029,China.#These authors contributed equally to this work.

Abstract Objective:To determine the difference in quality of life and its influencing factors between local and itinerant populations in Nanjing during COVID-19.Methods:The quality of life questionnaire,which was based on the Brief Scale of WHO Quality of Life and redesigned by the research group,was used to randomly investigate 1150 people in 5 districts of Nanjing.Results:A total of 1112 valid questionnaires were collected(local population,n=558;itinerant population,n=554).The quality of life of the itinerant population was significantly lower than the local population.The itinerant population scores in physiology,psychology,social relationships,and environment were lower than the local population(all P values<0.05).COVID-19 had a greater impact on the itinerant population than on the local population,especially in medical assistance,enjoyment of life,and interpersonal relationships(all P values<0.05).Conclusion:The itinerant population had a lower quality of life than that of the local population during the prevention and control pandemic of COVID-19,thus more social support and help is warranted.

Keywords:Quality of life,Covid-19,Local population,Itinerant population

Introduction

Quality of life is a comprehensive assessment of physiological,psychological,and social functions based on living standards,but the connotation is more complex and extensive,and quality of life focuses more on the degree of satisfaction with the spiritual and cultural high-level needs of people and the evaluation of environmental conditions[1].With the continuous progress and development of society,quality of life has been widely used in the fields of medicine and sociology.

An itinerant population is a special group that has arisen with the rapid development of the economy and urbanization in China,and mainly refers to people who leave their domicile for the purpose of making a living[2].According to recent statistics,the number of people in the itinerant populations in China has reached 247 million[3].People in the itinerant population who shift from a familiar environment to an unfamiliar city faced uncertainty of employment,significant life stressors[4],low socio-economic status,lack of medical conditions and other problems[5],and there is a difference between the quality of life compared to the local population.

The prevention and control of Coronavirus disease 2019(COVID-19)refers to precise prevention and control of imported cases,outbreaks of community spread,and dynamic clearance policy.COVID-19 pandemic has significant implications for clinical,public healthcare,and economic trends.Meanwhile,the application of classic forms of disease control through quarantine has reduced individuals’mobility.Combined with imposed isolation,these measures can have a dramatic effect on quality of life[6].However,few studies have been done on local and itinerant populations in the face of COVID-19.The current study analyzed the quality of life between local population(domicile in Nanjing city)and itinerant population(live in Nanjing but domicile not in Nanjing city)in Nanjing under the COVID-19 pandemic and explored the potential influencing factors.

Objects and methods

Research object

In this study,a stratified random cluster sampling investigation was conducted to select 2 streets in each of 5 districts(Jiangning district,Qixia district,Liuhe district,Gaochun district,and Jianye district)of Nanjing city from 1 May to 20 July 2021.Local and itinerant populations>18 years of age were surveyed on the quality of life during COVID-19 prevention and control.This study was approved by Clinical Study Ethics Committee of the First Affiliated Hospital of Nanjing Medical University(No.20212801)and all participants provided oral informed consent.

Research tool

A redesigned quality of life questionnaire which was based on the Brief Scale of WHO Quality of Life was used[7].The scale had 26 items,among which 24 covered 4 dimensions of quality of life to score the quality of life,as follows:physiology;psychology;social relationships;and environment.In addition,to determine the influence of COVID-19 on the quality of life in itinerant and local populations,we added the impact of COVID-19 and normal prevention and control on the above 26 items of quality of life,as follows:"1,no impact;2,slight impact;3,general impact;4,great impact;and 5,severely impact."All investigators are clinical medicine students and receive uniform training before questionnaire survey.

Statistical and analytical methods

SPSS 22.0 software(IBM? SPSS Inc.,Chicago,IL,USA)was used for statistical analysis of the data.Quantitative data were described by means and standard deviations,and qualitative data were described by percentages.T-tests were used to compare the two groups(local and flouting populations)for quantitative data if normally distributed,and the Kruskal-Wallis H test was used for non-normally distributed data.Qualitative data were compared by theχ2test.A two-tailedP<0.05 was considered statistically significant.

Result

Basic information

A total of 1150 people received the questionnaire survey and 1112(96.7%)valid questionnaires were collected.The local population consisted of 558 people(50.2%)and the itinerant population consisted of 554 people(49.8%).The respondents were between 18 and 80 years of age,including 494 males(44.4%)and 618 females(55.6%).There were 419 unmarried people(33.7%),649 married people(58.4%),and 43 people who identified as“other”(3.9%).A comparison of living habits(exercise,smoking,alcohol consumption,and staying up late)and complicated underlying diseases is shown in Table 1.

Table 1 Comparison between local and itinerant populations

Comparison of dimensions of life quality between local and itinerant populations

The 5 fields,including physical,psychological,social,and environmental fields,ranged from 4-20 points.The self-evaluation of total quality of life score ranged from 0-5 points.The self-score items were subjectively scored by the respondents,and the range was from 0-100 points.The higher the score,the better the condition of the corresponding field.The results showed that there were significant differences in physiology,psychology,social relationships,environment,total quality of life,and self-score between local and itinerant populations in Nanjing(allP values<0.05;Table 2).

Table 2 Comparison of dimensions of quality of life between local and itinerant populations(ˉ±s)

Table 2 Comparison of dimensions of quality of life between local and itinerant populations(ˉ±s)

Source of personal Physical domain Psychological domain Social domain Environment domain Quality of score Self score Local population 14.65±1.88 14.27±2.09 14.20±2.29 14.10±2.06 3.59±0.67 85.11±9.35 Itinerant population 14.28±2.07 13.83±2.20 13.75±2.33 13.55±2.04 3.42±0.70 81.35±11.71 t 3.096 3.348 3.387 4.416 4.141 5.910 P 0.002 0.001 0.001 <0.001 <0.001 <0.001

Detailed comparison of life quality between local population and itinerant populations

The itinerant population had a significantly lower physiology scores with respect to medical help and sleep conditions as compared with the local population.The itinerant population had lower psychology scores with respect to the following five areas:joy and meaning of life;attention;appearance;and negative feelings.The itinerant population had lower social relationship scores with respect to interpersonal interactions and friends.The itinerant population had lower environmental scores in the following seven areas:sense of security;living environment;access to information;leisure activities;living conditions;health conditions;and transportation convenience(allPvalues<0.05;Table 3).

Table 3 Detailed comparison of factors influencing quality of life between local and itinerant populations(ˉ±s)

Table 3 Detailed comparison of factors influencing quality of life between local and itinerant populations(ˉ±s)

Note:The results are presented as the mean±standard deviation.The Kruskal-Wallis test was used for statistical comparison because the data that did not conform to a normal distribution.

Influencing factors Local population Itinerant population Z P Physical domain Pain and discomfort 2.53±1.10 2.56±1.07 -0.609 0.613 Medical help 1.69±0.88 1.86±0.94 -3.091 0.002 Energy 3.51±0.78 3.45±0.83 -2.028 0.193 Mobility 3.76±0.85 3.70±0.90 -0.903 0.268 Sleep conditions 3.39±0.79 3.20±0.88 -4.113 <0.001 Viability 3.62±0.68 3.55±0.67 -1.472 0.114 Work capacity 3.57±0.71 3.52±0.71 -1.464 0.122 Psychological domain Joy of living 3.54±0.73 3.42±0.77 -2.479 0.010 Meaning of living 3.54±0.80 3.44±0.74 -3.273 0.029 Thinking,learning,memory and concentration 3.58±0.69 3.47±0.77 -2.513 0.017 Appearance 3.44±0.88 3.31±0.86 -2.804 0.015 Self-esteem 3.63±0.69 3.58±0.86) -1.035 0.223 Negative feelings 2.33±0.87 2.47±0.90 -2.942 0.007 Social domain Personal relationship 3.60±0.68 3.46±0.73 -3.548 0.001 Sexual activities 3.45±0.77 3.39±0.68 -2.114 0.187 Activities as supporters 3.64±0.68 3.46±0.73 -4.109 <0.001 Environment domain Safety 3.75±0.72 3.57±0.78 -4.419 <0.001 Physical environment 3.52±0.70 3.34±0.76 -4.477 <0.001 Financial resources 3.08±1.01 3.09±1.00 -0.587 0.896 Opportunities for acquiring new information 3.57±0.68 3.43±0.73 -3.548 0.001 Leisure activities 3.34±0.86 3.12±0.90 -3.711 <0.001 Home environment 3.61±0.70 3.52±0.69 -2.241 0.036 Health and social care 3.62±0.66 3.48±0.70 -3.110 <0.001 Transport 3.70±0.72 3.56±0.72 -3.138 0.001

Comparison of the impact of COVID-19 on local and itinerant populations

To determine the impact of COVID-19 and related prevention and control measures on the above 26 quality of life items,we set a scale of 1-5 points.The higher the score,the greater the impact of COVID-19 and related prevention and control measures on the quality of life.The itinerant population had a significantly greater impact than the local population in the following eight areas:pain;medical help;enjoyment of life;meaning of life;security;work ability;support;and living conditions(allP values<0.05;Table 4).

Table 4 Comparison of the impact of COVID-19 on local and itinerant populations(ˉx±s)

Discussion

The results of our survey showed that there are substantial differences in basic conditions between local and itinerant populations.The overall local population tends to be young,while the proportion of the elderly in the itinerant population was significantly greater than the local population,which may be related to the young labor force and the elderly living together temporarily in the city[8].Cities have good educational resources,thus the local population is more educated than the itinerant population.The local population exercises more frequently and has a stronger sense of exercise,which is probably due to the better living conditions and living environment.The alcohol consumption frequency of the local population also differs from the itinerant population.The living conditions of the itinerant population are not ideal,with high work pressure and poor psychological status,which makes them more prone to alcoholism[9].Note:The results are presented as the mean±standard deviation.The Kruskal-Wallis test was used for statistical comparison because the data that did not conform to a normal distribution.

During the COVID-19 pandemic,there were significant differences between the local and itinerant populations with respect to physiology,psychology,social relationships,and living environment(allPvalues<0.05).The overall quality of life of the local population was better than the itinerant population[10].

The main physiologic factors affecting the differences in life quality between local and itinerant populations were medical help and sleep quality.Due to the social background,family environment,and other factors,the itinerant population is often faced with greater competitive pressure in large cities.Occupations are often more tiring and associated with worse health,so the people in the itinerant population need more medical help[11].In addition,local people pay more attention to their health in daily life,and their medical insurance coverage rate and medical insurance reimbursement amount are higher than itinerant population[12].Local people’s health scores are higher than the itinerant population,which is consistent with the results of similar studies[13].Moreover,the low cultural level of the itinerant population and the lack of social health education lead to insufficient medical knowledge[14].When some simple basic diseases occur,the people in the itinerant population need more professional medical intervention than the local population[15].Basic disease and related drug use can also contribute to differences in sleep,which reduce sleep quality in itinerant populations.

The itinerant population was more likely to have negative emotions,covering almost all psychological aspects[16].Migrants are less satisfied with their appearance and less confident in their ability to concentrate.The feeling of inferiority may be caused by a mismatch between their expectations and reality,as well as a substantial gap in living standards with the surrounding local population.People in itinerant populations who live in the city have the need to integrate into city life;however,the people in itinerant populations need to adapt quickly to the high-consumption and fast-paced life model,thus their life stressors are even greater[17].At the same time,the people in itinerant populations are separated from their relatives and struggle in unfamiliar cities.It is difficult to have a sense of belonging and easy to produce negative emotions of loneliness and depression.These feelings and pressures are difficult to release,which may make it harder for people in itinerant populations to feel the joy and meaning of life than people in local populations.

Interpersonal relationships and support of friends in the local population had higher social relationship scores than the itinerant population.As local residents,most of their relatives and friends are permanent residents of the city,so they can provide timely help.Moreover,the local population is more positive and confident in communicating with others,and it is easy to acquire good interpersonal relationships.For the itinerant population,their social network is mainly based on blood relationship and geography,and the narrow social network limits their interaction and communication with residents[18].In addition,the itinerant population is under great survival pressure and lack time and energy to maintain interpersonal communications with relatives and friends.These factors make interpersonal relationships and support of friends in the itinerant population less than the local population[19].

The itinerant population had a low sense of security,probably because they are not familiar with the surrounding environment.Furthermore,in the case of a low quality of information acquisition and limited economic conditions,the living conditions and environment of the itinerant population are worse.Thus,they often have poor transportation and a lack of health services support[20].Comparatively speaking,urban population has more sense of security in their living environment,which is conducive to neighborhood interaction among residents,thus alleviating their living pressure and discomfort,and improving their self-health cognition level[21].

In general,the impact of COVID-19 on the itinerant population was significantly greater than the local population in nine aspects,including pain,medical help,meaning of life,pleasure of life,sense of security,working ability,economic income,support,and living conditions(allPvalues<0.05).Compared with the urban population,the physiologic situation of the itinerant population was poor.Under the impact of COVID-19,many township hospitals have suspended admissions.The acceptance threshold of large hospitals is too high to accept patients with non-febrile diseases,which makes the medical channels faced by the itinerant population narrower and results in aggravated pain and a more severe lack of medical help.Moreover,as the itinerant population often flows between different regions,it is a high-risk group for the outbreak of infectious diseases[22].The impact of COVID-19 on the economy is considerable.With the shutdown of many companies and enterprises it has had enormous effect on the income of people in Nanjing.The work of the itinerant population is more dependent on the market and service industry,which is more heavily affected.The COVID-19 outbreak led to a lockdown in Nanjing,with many residents unable to egress.As compared with the local population,the itinerant population has been hit harder by unemployment during the pandemic.The local population was more adapted to home life,and convenient access to information enabled them to find fun in home more quickly,like using cloud exercises,video wine table,and other forms of entertainment.

To summarize,there was a significant difference in the quality of life between the local and itinerant populations in Nanjing,and the quality of life in the itinerant population was lower than the local population in many aspects.The impact of COVID-19 on the itinerant population was greater than the local population.The author suggests that more measures can be taken to improve the quality of life of the itinerant population under prevention and control measures during COVID-19.Improve the medical level of primary hospitals and perfect the medical security system for the itinerant population and provide convenient medical services.Building health systems that integrate migrant populations will benefit entire communities,leading to better access to health care for all and positive gains for local populations[23].The employment channels should be broadened and labor skills training should be strengthened for the itinerant population to enhance their professional and technical abilities,and thus increase their economic income.

Conclusion

The itinerant population had a lower quality of life than that of the local population during the prevention and control of COVID-19,thus more social support and help is warranted.