Background: China has an enormous and growing middle-aged population. Little is known about health-related quality of life (HRQOL) for this group, especially in rural areas. We examined HRQOL and its individual and household predictors among middle-aged people in rural Mid-east China. Methods. HRQOL questionnaires and information about individual and household characteristics were collected from 428 subjects aged 45 to 65 in 12 villages in Mid-east China. We examined the eight dimensions of the SF-36 instrument, along with the Physical Component Summary (PCS) and Mental Component Summary (MCS) using a reference sample in Hong Kong for standardization. Individual and household predictors of PCS and MCS were examined by one-way ANOVA and binary logistic regression analysis. Results: Self-reported HRQOL was similar to that seen in middle-aged populations elsewhere. Based on univariate analyses, PCS differed by age, education, occupation, household per capita income, drinking water supply, and frequency of household members caring about each other; MCS differed by education, household per capita income, drinking water supply, and frequency of caring about each other. Individual and household-level factors accounted for 12.5% and 8.2% of the variance in PCS, respectively, and for 3.1% and 10.7% of the variance in MCS. Conclusions: HRQOL among middle-aged people in rural China appears similar to that observed elsewhere, and varies by income, education, and other factors. Household factors, particularly the extent to which household members care about each other, are significant predictors of physical and mental health. In addition to improving general socioeconomic conditions, efforts to improve HRQOL for middle-aged people in rural China need to focus on the family environment. © 2014 Zhou et al.; licensee BioMed Central Ltd.