Objective To understand the relationship between proactive health behaviors and quality of life among middle-aged and elderly residents in Laiwu district, Jinan city, Shandong province, and to provide a reference for improving the quality of life of middle-aged and elderly people in the region.

Methods From August to October 2022, a multi-stage random cluster sampling method was used to select 867 middle-aged and elderly residents aged ≥ 45 years old in Laiwu district, Jinan city for a questionnaire survey. The European Five-Dimensional Health Scale (EQ-5D) was used to obtain health utility values based on the Chinese population health utility scoring system to evaluate quality of life. A multivariate Tobit regression model was used to analyze the relationship between proactive health behaviors and quality of life among middle-aged and elderly residents.

Results The health utility values of the 702 middle-aged and elderly residents aged ≥ 45 years old finally included in Laiwu district, Jinan city, Shandong province ranged from – 0.216 to 1.000, with an average health utility value of 0.942 (0.862, 1.000). After adjusting for confounding factors such as gender, age, education level, marital status, average monthly household income, type of medical insurance, smoking status, and presence of chronic diseases, the results of the multivariate Tobit regression model showed that the health utility values of middle-aged and elderly residents who never drank alcohol (β = 0.019, 95%CI: 0.011 – 0.027) and had quit drinking (β = 0.015, 95%CI: 0.003 – 0.028) were higher than those of middle-aged and elderly residents who drank alcohol. The health utility values of the middle-aged and the elderly residents who ate fresh vegetables and fruits ≥ 4 times/week (β = 0.158, 95%CI: 0.017 – 0.299) were higher than those who did not eat fresh vegetables and fruits. The health utility values of middle-aged and elderly residents who engaged in moderate physical activity in the past week (β = 0.057, 95%CI: 0.023 – 0.090) were higher than those who did not exercise. The health utility values of the middle-aged and the elderly residents who went to bed between 20 : 00 – 22 : 00 (β = 0.074, 95%CI: 0.029 – 0.119) were higher than those who went to bed before 20 : 00. The health utility values of the middle-aged and the elderly residents who believed they needed health management very much (β = 0.020, 95%CI: 0.005 – 0.036) and believed they could try health management (β = 0.014, 95%CI: 0.002 – 0.030) were higher than those who held the attitude of not needing it.

Conclusion The proactive health behaviors of the middle-aged and the elderly residents in Laiwu district, Jinan city, Shandong province, such as the frequency of eating fresh vegetables and fruits per week, engaging in moderate physical activity, and the need for their own health management, were positively correlated with their quality of life.