Leisure-time physical activity mediates the association between subjective social status and health-related quality of life in middle-aged and older women

OBJECTIVES: Subjective social status (SSS), or one's perceived position in the social hierarchy, is an important determinant of health-related quality of life (HRQoL). However, the mechanisms underlying this relationship are not fully understood. Given known social inequalities in health behaviors, this study examined whether the association between SSS and HRQoL among middle-aged and older women is mediated by leisure-time physical activity (LTPA). METHODS: A cross-sectional online survey was conducted using the Qualtrics research panel with 588 women (mean age = 56.79 years). LTPA was assessed using the International Physical Activity Questionnaire, categorizing participants into no-LTPA and insufficient- and sufficient-LTPA groups (≥600 MET-min/week). SSS was measured at the community (SSS-C) and national (SSS-N) levels using the MacArthur Scale. HRQoL (physical and psychological domains) was assessed using the WHO Quality of Life scale. Path analysis, adjusted for demographics, objective social status, and health conditions, tested associations between SSS and HRQoL with the potential mediating effects of LTPA. RESULTS: Higher SSS scores were significantly associated with better HRQoL domains (ps ≤ .05). The associations of SSS-C with physical and psychological HRQoL were fully and partially mediated by LTPA, respectively. However, no significant association was observed between SSS-N and LTPA (p = .437), and thus, LTPA did not mediate the relationship between SSS-N and HRQoL. DISCUSSION: Subjective social status influences HRQoL among middle-aged and older women through distinct pathways depending on the level of comparison. LTPA partially mediated the relationship between SSS-C and HRQoL, suggesting a potential mechanism through which social status impacts health.