Objective: Measuring children's health-related quality of life (HRQOL) is of growing importance given increasing chronic diseases. By integrating HRQOL questions into the European GABRIEL study, we assessed differences in HRQOL between rural farm and non-farm children from Germany, Austria, Switzerland and Poland to relate it to common childhood health problems and to compare it to a representative, mostly urban German population sample (KIGGS). Methods: The parents of 10,400 school-aged children answered comprehensive questionnaires including health-related questions and the KINDL-R questions assessing HRQOL. Results: Austrian children reported highest KINDL-R scores (mean: 80.9; 95% CI [80.4, 81.4]) and Polish children the lowest (74.5; [73.9, 75.0]). Farm children reported higher KINDL-R scores than non-farm children (p=0.002). Significantly lower scores were observed in children with allergic diseases (p<0.001), with sleeping difficulties (p<0.001) and in overweight children (p=0.04). The German GABRIEL sample reported higher mean scores (age 7-10years: 80.1, [79.9, 80.4]; age 11-13years: 77.1, [74.9, 79.2]) compared to the urban KIGGS study (age 7-10years: 79.0, [78.7-79.3]; age 11-13years: 75.1 [74.6-75.6]). Socio-demographic or health-related factors could not explain differences in HRQOL between countries. Conclusions: Future increases in chronic diseases may negatively impact children's HRQO
