Inequality and heterogeneity in health-related quality of life: findings based on a large sample of cross-sectional EQ-5D-5L data from the Swedish general population

Abstract

Purpose This study aimed to investigate inequality and heterogeneity in health-related quality of life (HRQoL) and to provide EQ-5D-5L population reference data for Sweden. Methods Based on a large Swedish population-based survey, 25,867 respondents aged 30‒104 years, HRQoL is described by sex, age, education, income, economic activity, health-related behaviours, self-reported diseases and conditions. Results are presented by EQ-5D-5L dimensions, respondents rating of their overall health on the EQ visual analogue scale (EQ VAS), VAS index value and TTO (time trade-off) index value allowing for calculation of quality-adjusted life years (QALYs). Ordinary Least Squares and multivariable logistic regression analyses were used to study inequalities in observed EQ VAS score between socioeconomic groups and the likelihood to report problems on the dimensions, respectively, adjusted for confounders. Results In total, 896 different health states were reported; 24.1% did not report any problems. Most problems were reported with pain/discomfort. Women reported worse HRQoL than men, and health deteriorated with age. The strongest association between diseases and conditions and EQ VAS score was seen for depression and mental health problems. There was a socioeconomic gradient in HRQoL; adjusting for health-related behaviours, diseases and conditions slightly reduced the differences between educational groups and income groups, but socioeconomic inequalities largely remained. Conclusion EQ-5D-5L population reference (norms) data are now available for Sweden, including socioeconomic differentials. Results may be used for comparisons with disease-specific populations and in health economic evaluations. The observed socioeconomic inequality in HRQoL should be of great importance for policy makers concerned with equity aspects.

Socio-demographic indicators of self-reported health based on EQ-5D-3L: A cross-country analysis of population surveys from 18 countries

“…Our results are in line with previous findings using the one-dimension self-rated health question (4) showing variation in inequalities in health associated with socioeconomic status across European countries. The successful application of the EQ-5D (both 3L or 5L) in socio-demographic analyses in selected countries and regions were also confirmed by several other recent studies (36)(37)(38)(39), and in vulnerable groups like homeless persons (40). Specifically, Sronk et al showed that among three European countries the EQ-5D-5L was able to detect education level related inequalities in health, however, differences varied across countries and some of the impact was canceled out when controlling for chronic conditions and ability to work.…”

Evaluating Health Inequality in Five Caribbean Basin Countries Using EQ-5D-5L

“…EQ-5D-5L has been used to evaluate health inequality in other studies. Mean index values, EQ VAS scores, 'domain scores' (the mean level of reported problems from 1 to 5 on the five dimensions), and level sum scores (the mean of sum of the five levels for a population) have been used to compare socioeconomic and demographic groups in various countries in Europe and Asia [6][7][8][9]. Ordinary least squares regression models have been used to estimate coefficients for the effect of demographic and socioeconomic indicators on EQ VAS scores.…”

“…Ordinary least squares regression models have been used to estimate coefficients for the effect of demographic and socioeconomic indicators on EQ VAS scores. Logit and tobit regression models have been used to estimate odds ratios for reporting problems on the five dimensions [8][9][10][11][12].…”

Differences in self-reported health between cardiac arrest survivors with good cerebral performance and survivors with moderate cerebral disability: a nationwide register study

“…Compared with a Swedish population-based study, including 25 867 adults between 30 and 103 years, 29 the CA survivors with good cerebral performance reported equal median scores on the EQ VAS as persons with low education level, the group with poorest health status in the general population. However, survivors with moderate cerebral disability reported in average 15 points lower on Open access the EQ VAS compared with persons with low education level in the general population.…”