Factors independently associated with in-hospital HRQoL in adults treated at a high-complexity institution in a middle-income country.

INTRODUCTION: Health systems are increasingly oriented toward value-based care, emphasizing patient-centered outcomes such as health-related quality of life (HRQoL). During hospitalization, HRQoL reflects the interplay of sociodemographic, geographic, and clinical factors, which may be particularly influential in middle-income settings where structural inequities can affect patient-reported outcomes. OBJECTIVE: To identify factors independently associated with HRQoL measured during hospitalization in adults treated at a high-complexity institution in a middle-income country. METHODS: We conducted a cross-sectional analytical study nested within an institutional prospective cohort (2023-2025). We included hospitalized adults with a complete in-hospital HRQoL assessment using the EQ-5D-3L descriptive system and the EQ visual analogue scale (EQ VAS). The EQ VAS score was analyzed as the primary continuous outcome. Associations were evaluated using bivariate analyses and multivariable linear regression. RESULTS: A total of 46,083 patients were included, with a median EQ-VAS score of 70 (IQR, 60-80). Functional impairment was most commonly reported in usual activities (62.46%). In the multivariable linear regression model, lower EQ-VAS scores were independently associated with increasing age (β = - 0.150 per year) and ICU admission (β = - 1.661), whereas professional education (β = 2.364) and surgical admission (β = 1.672) were associated with higher scores. Across diagnostic groups, mental and behavioural disorders (β = - 2.949) and respiratory diseases (β = - 2.036) showed the strongest negative associations, while pregnancy-related conditions were associated with the highest scores (β = 3.982). CONCLUSION: EQ VAS scores measured during hospitalization were independently associated with sociodemographic and clinical factors, underscoring the multifactorial determinants of self-rated health in acute hospital settings.