Objective  To examine the status quo and associated factors of death attitude among rural residents in Ningxia Hui Autonomous Region (Ningxia) and to provide evidences for developing relevant interventions in the population.

  Methods  We selected 386 adult residents (≥18 years old) in two rural communities in Ningxia using random cluster sampling for a questionnaire survey conducted in March, 2015. Death Attitude Profile-Revised (DAP-R), General Health Questionnaire-20 (GHQ-20) and Meaning in Life Questionnaire (MLQ) were adopted in the study.

  Results  Of the participants, 10.4%, 9.3%, and 10.1% reported fear of death, death avoidance, and escape acceptance of death, respectively. The participants' death attitude differed significantly by gender, age, education, physical health, mental health, and meaning in life (all P < 0.05). The results of multivariate linear stepwise regression analysis revealed that the participants with better physical and mental health and higher level of meaning in life were more likely to have less fear of death (P < 0.05), death avoidance (P < 0.001) and escape acceptance of death (P < 0.001) and those at elder age, with better physical and mental health, and higher level of meaning in life were more likely to report natural acceptance and approach acceptance of death (both P < 0.05).

  Conclusion  Physical health, mental health and meaning of life are significant impact factors for fear of death, death avoidance, and escaped acceptance of death and are promoting factors of natural acceptance and approach acceptance of death among adult residents in rural areas of Ningxia.