OBJECTIVES: To measure the impact of the catastrophic 2008 earthquake in the Sichuan province of China on HRQOL among survivors. METHODS: The study employed a two-wave longitudinal study of survivors 8 months and three years after the earthquake, using a probability cluster sample design stratified according to three levels of earthquake impact. Twelve shelters out of nine townships were selected during the first-wave sampling, which included three shelters out of three severely affected townships, six shelters out of three moderately affected townships, and three shelters out of three mildly affected townships. The study was restricted to individuals between 16 and 89 years of age. A total of 1617 survivors returned the study survey. The SF-36 instrument was used to measure HRQOL and compared with the provincial norm. The second wave was a random sample of 323 respondents from the initial 1617 first-wave respondents, who were interviewed with an identical instrument 3 years after the earthquake. ANOVA and t-tests were used to compare SF-36 scores among residents by earthquake impact levels; against a provincial norm; and between 8 months and 3 years. RESULTS: The SF-36 subscale scores differed by the impact level of earthquake except for RP. Compared with the Sichuan provincial norm, all subscale SF-36 scores of the first-wave respondents were lower at month 8 (all p-values<0.001).  Seven subscale scores of RP, BP, GH, VT, SF, RE, and MH at 3 years were statistically lower than the provincial norm (all p-values<0.05).  Among the second-wave respondents, all the 3-year SF-36 subscale scores improved in comparison to those taken 8 months after the earthquake except for RP and SF. CONCLUSIONS: The HRQOL declined compared with the norm, especially the psychological aspects. Furthermore, the HRQOL 3 years after the earthquake were persistently lower than the norm level, despite its recovery from 8-month level.