Among the 2,914 participants, 189 (6.6%) were recent cancer survivors (Table 1). Participants were predominantly non-Hispanic White (78.2%), straight/heterosexual (96.2%), and married/living as married (60.4%). Most participants (71.1%) had lived in the same home for 10 + years, and 63.2% lived in an urban county.

Overall, 1,383 (47.7%) participants were categorized as ‘not actively engaged,’ and 1,518 (52.3%) were categorized as ‘actively engaged’ (Table 1). Compared to participants who were not actively engaged, participants who were actively engaged lived in census tracts with lower percent park land and lower walkability scores (both p < 0.05). Active engagement also varied by participant sex, age group, race/ethnicity, marital status, educational attainment, and annual household income (all p < 0.05).

On average, participants’ physical HRQoL score was 46.45 (SE = 0.22). In bivariate analysis, physical HRQoL was higher for actively engaged participants (mean = 47.10, SE = 0.29) compared to not actively engaged participants (mean = 45.74, SE = 0.33) (est. = 1.36, SE = 0.44, p < 0.01; Table 2, Fig. 1). In addition, physical HRQoL was positively associated with census tract-level walkability and negatively associated with county-level social associations (both p < 0.01; Table 2). Physical HRQoL also varied by recent cancer survivorship, marital status, educational attainment, annual household income, residential stability, and rurality (all p < 0.001).

Physical and mental health-related quality of life (HRQoL) scores by ‘active engagement with life’ among older adults (ages 50 + years) in seven mid-Atlantic states (n = 2,914) (error bars indicate 95% confidence intervals)

In exploratory moderation analysis of differences in these relationships by recent cancer survivorship, we found evidence for one interaction. The relationship between active engagement and physical HRQoL depended on cancer survivorship status (interaction p = 0.05). Specifically, among the general population, physical HRQoL was higher for actively engaged versus not actively engaged participants (mean = 47.40, SE = 0.29, and mean = 46.29, SE = 0.34, respectively; bivariate est. = 1.10, SE = 0.43, p = 0.01), and among cancer survivors, this relationship was even stronger (mean = 44.29, SE = 1.22, and mean = 39.34, SE = 1.40, respectively; bivariate est. = 4.95, SE = 1.84, p < 0.01) (Fig. 2A; for multivariable estimates stratified by cancer survivorship status, see Supplementary Table S1).

Physical (panel A) and mental (panel B) health-related quality of life (HRQoL) scores by ‘active engagement with life’ and recent cancer survivorship status among older adults (ages 50 + years) in seven mid-Atlantic states (n = 2,914) (error bars indicate 95% confidence intervals)

In multivariable analysis, active engagement was associated with higher physical HRQoL, even after adjusting for cancer and sociodemographic characteristics (est. = 0.94, SE = 0.46, p = 0.04) (Table 2). Physical HRQoL was negatively associated with recent cancer survivorship (est. = -4.75, SE = 1.02, p < 0.001). In addition, physical HRQoL was higher for participants with greater educational attainment, household income, and residential stability, and it was lower for widowed participants and rural participants, compared to their reference groups (all p < 0.01).

On average, participants’ mental HRQoL score was 50.22 (SE = 0.22). In bivariate analysis, mental HRQoL was higher for actively engaged participants (mean = 51.33, SE = 0.28) compared to not actively engaged participants (mean = 49.03, SE = 0.33) (est. = 2.30, SE = 0.43, p < 0.001; Table 3, Fig. 1). None of the other social interaction variables was associated with mental HRQoL in bivariate analysis. Mental HRQoL varied by recent cancer survivorship, sex, age group, race/ethnicity, sexual orientation, marital status, annual household income, residential stability, and rurality (all p < 0.05).

In exploratory moderation analysis of differences in these relationships by recent cancer survivorship, we found evidence for one interaction. The relationship between residential stability and mental HRQoL depended on cancer survivorship status (interaction p = 0.10). Specifically, among the general population, mental HRQoL was higher for participants who had been living in the same home for 10 + years compared to < 10 years (mean = 51.11, SE = 0.26, and mean = 49.17, SE = 0.45, respectively; est. = 1.93, SE = 0.48, p < 0.001), and among cancer survivors, this relationship was even stronger (mean = 49.98, SE = 1.08, and mean = 44.56, SE = 1.71, respectively; est. = 5.42, SE = 1.94, p < 0.01). We also probed the interaction for active engagement (interaction p = 0.16), finding that, mental HRQoL was higher for actively engaged versus not actively engaged participants, both among the general population (mean = 51.59, SE = 0.28, and mean = 49.47, SE = 0.35, respectively; est. = 2.11, SE = 0.44, p < 0.001) and among cancer survivors (mean = 50.31, SE = 1.15, and mean = 45.48, SE = 1.48, respectively; est. = 4.83, SE = 1.84, p < 0.01) (Fig. 2B).

In multivariable analysis, active engagement was associated with higher mental HRQoL, even after adjusting for cancer and sociodemographic characteristics (est. = 2.10, SE = 0.46, p < 0.001) (Table 3). None of the other social interaction variables was associated with mental HRQoL in multivariable analysis. Mental HRQoL was negatively associated with recent cancer survivorship (est. = -2.96, SE = 1.03, p < 0.01). In addition, mental HRQoL was higher for participants in the older age group, with non-Hispanic Black or Other race/ethnicity, and with greater household income, and it was lower for participants who were female or with ‘other’ marital status (all p < 0.05; Table 2).