Abstract
Given the profound impact of adverse life events on later-life health, this study examined how the occurrence, timing, and number of child losses were associated with trajectories of health-related quality of life (HRQoL) among middle-aged and older adults in China. It further explored potential mediating mechanisms and heterogeneity by gender and residence. Using data from four waves (2011-2018) of the China Health and Retirement Longitudinal Study (CHARLS), this study included 13,161 individuals. HRQoL was assessed using the 36-Item Short Form Health Survey (SF-36). Linear mixed models were used to estimate longitudinal HRQoL trajectories, and the Karlson-Holm-Breen method was applied to examine potential mediating pathways. Bereaved parents exhibited lower HRQoL than non-bereaved parents. The association between child loss and HRQoL varied by the timing of the loss and followed a dose-response pattern. Mediation analyses identified intergenerational support and social engagement as potential pathways. Moreover, mothers experienced a steeper decline in HRQoL over time than fathers following child loss. These findings suggest that child loss has a persistent and graded negative association with HRQoL, with important variation by timing and gender. The results highlight the need for targeted support and interventions to mitigate long-term health consequences among bereaved older adults.