According to the theory of life course, family environmental factors in early life have influence on individual health. The objective is to understand the influence and importance of family environmental factors in early life and other factors in adulthood on self-rated health of the middle-aged and elderly, so as to provide reference for active aging and healthy aging.

The demographic data, social support, and early family environmental factors of people over 45 years old from Chinese General Social Survey (CGSS) data in 2021 were collected. Chi-square test, binary Logistic regression, and random forest model were used to analyze the influencing factors and importance of self-rated health of the middle-aged and elderly.

Among the 4 311 subjects, 2 427 were unhealthy and 1 884 were healthy. The regression results showed that the middle-aged and elderly people aged 79 and over, working in agriculture, not working, never engaging in social and recreational activities, middle-and lower-middle-level socioeconomic status, and fathers with college education or above had a higher rate of self-rated unhealth (P < 0.05). The self-rated unhealthy rate of the middle-aged and elderly with normal and overweight, non-depression, average family economic level and higher than the average level of BMI was lower (P < 0.05). The order of influencing factors was depression (73.717), family economic level (55.361), nature of work (47.074), personal socio-economic status (42.177), BMI (38.952), age (28.842), frequency of social and recreational activities (28.270), and father’s education level (22.319).

There are many factors affecting the self-rated health of the middle-aged and elderly in China. Depression, family economic level, and the nature of work are important factors affecting the self-rated health of the middle-aged and elderly in China. Attention should be paid to special groups such as depression, low income, perennial farming, and out of work.