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Objective:There have been few population-based studies evaluating health related quality of life (HRQOL) in rural populations in China,and this study aimed to assess the current status of and risk factors for HRQOL in a general rural population in high risk region of esophageal cancer in China.Methods:From November 2015 to September 2016,12,085 permanent residents aged 45-69 years from 257 villages in the Endoscopic Screening for Esophageal Cancer in China (ESECC) trial (ClinicalTrials.gov:NCT01688908) randomly selected from Hua County,Henan Province,China were interviewed.The EQ-5D-3L,a generic measure of HRQOL,and a questionnaire were used to assess their HRQOL and potential risk factors.Results:Among all the participants,30.62％ of the participants reported problems in at least one EQ-5D dimension.Pain/discomfort (25.52％) was the most frequently reported problem followed by anxiety/depression (7.97％),mobility (5.82％),usual activities (2.61％) and self-care (1％).These rural residents had a mean EQ-5D index score of 0.948,and lower EQ-5D index scores were associated with older age,female gender,lower levels of household annual per capita income,living alone,using shallow wells as main source of drinking water,exposure to family members smoking,testiness,unhealthy dietary habits,overweight or obesity,upper gastrointestinal cancer related symptoms and chronic diseases.Conclusions:Rural residents in China have a relatively low quality of life.Health promotion programs in this population should focus on the elderly,especially elderly women and the elderly living alone.Improving basic living circumstances and primary medical care services should be priorities.Results of this study will also serve as the basis for the cost-utility evaluation in our ESECC screening trial.