Health State Values of Deaf British Sign Language (BSL) Users in the UK: An Application of the BSL Version of the EQ-5D-5L

Abstract

BackgroundDeaf people experience health inequalities compared to hearing populations. The EQ-5D, a widely used, standardised, generic measure of health status which is available in over 100 languages, was recently translated into British Sign Language (BSL) and initial validation conducted. Using data from this previous study of the EQ-5D-5L BSL we aimed to assess (i) whether responses to the EQ-5D differed between a sample of Deaf BSL users and the general population (ii) whether socio-demographic characteristics and clinical measures were associated with EQ-5D index scores in Deaf BSL users and (iii) the impact of psychological distress and depression on health status in Deaf BSL users. MethodsPublished population tariffs were applied to the EQ-5D-5L BSL, using the crosswalk methodology, to estimate health state values. Descriptive statistics (mean, SD, 95% CIs) compared Deaf BSL signer participants' (n=92) responses to data from the general population. Descriptive statistics and linear regression analyses were used to identify associations between Deaf participants' EQ-5D index scores, socio-demographic characteristics, physical health and depression. Descriptive statistics compared the BSL index scores for people with psychological distress/depression to those from two cross-sectional, population-based surveys. ResultsUsing the EQ-5D, Deaf participants had lower mean health-state values (0.78; 95% CI 0.72 -0.83; n=89) than people participating in the 2017 Health Survey for England (0.84; 95% CI 0.83 -0.84; n=7,169). Unlike larger studies, such as the Health Survey for England sample, there was insufficient evidence to assess whether Deaf participants' EQ-5D health state values were associated with their demographic characteristics. Nevertheless, analysis of the BSL study data indicated long-standing physical illness was associated with lower health-state values (OLS coefficient = -0.354; 95% CI -0.484, -0.224; p< 0.01; n=82). Forty-three percent of our Deaf participants had depression. Participants with depression had reduced health status (0.67; 95% CI 0.58 -0.77; n=36) compared to those with no psychological distress or depression (0.87; 95% CI 0.61 -0.67; n=36). ConclusionsThe study highlights reduced health in the Deaf signing population, compared to the general population. Public health initiatives focused on BSL users, aiming to increase physical and mental health, are needed to address this gap. Key points for decision makers This is the first study to investigate health state values in the Deaf population. Deaf BSL users more commonly report health difficulties on the EQ-5D dimensions and typically have lower EQ-5D index values, when compared to the general population.  Depression is prevalent within the Deaf population which has a key impact on health status as measured by the EQ-5D.  The current evidence base for the Deaf population is minimal and further research is needed to identify priority areas, to improve health, and to ensure cost-utility analysis using population specific values are feas...

Health outcomes in Deaf signing populations: a systematic review

“…Health status was found to be poorer in the Deaf population compared with the general population in the self-report studies by Rogers et al [29] (EQ-5D mean index values 0.78 vs 0.84), and Shields et al [10] (43% vs 17% for depression symptoms). However, Kushalnagar et al [20], found that hearing people had worse overall health status compared with Deaf people, suggesting that age may be a contributing factor, as the mean age of the hearing sample was significantly older than that of the Deaf adults.…”

Health outcomes in Deaf signing populations: A systematic review

“…Using validated assessments in sign language, health status was found to be poorer in the Deaf population compared with the general population in the self-report studies by Rogers et al [ 29 ] (EQ-5D mean index values 0.78 vs 0.84), and Shields et al [ 10 ] (43% vs 17% for depression symptoms). However, Kushalnagar et al [ 20 ], found that hearing people had worse overall health status compared with Deaf people, suggesting that age may be a contributing factor, as the mean age of the hearing sample was significantly older than that of the Deaf adults.…”

“…Using the sign language version of the assessment and when the validation has been examined, Munro et al [ 41 ] reported that a clinical sample had a significantly lower mean score for wellbeing (18.57; SD = 9.6) compared with a non-clinical sample (27.04, SD = 8.68) on the ORS-Auslan. Overall health status was found to be poorer for Deaf people with depression compared to those with no psychological distress or depression [ 10 ]. Rogers et al [ 42 ] and Belk et al [ 43 ] found that severity of depression and anxiety was worse for those who self-reported as having mental health difficulties compared to those who did not.…”

“…Suboptimal management of physical health conditions is also common, posing not just immediate health risk but increasing the risk of long-term complications. A UK study using the EQ-5D-5L recorded a mean health-state value of 0.78 for Deaf people compared to the mean health-state value for the general population of a similar age of 0.84 [ 10 ]. Common mental health problems have been found to be more prevalent amongst Deaf people in comparison with the hearing population [ 6 ].…”