Abstract
BackgroundsThe EuroQol Group Five-Dimensional (EQ-5D) instruments have been validated in China for measuring health-related quality of life (HRQoL) and are increasingly being used in health economic studies. However, there is paucity in the literature documenting long-term changes in the EQ-5D results in the Chinese populations. This study aims to identify such changes and their determinants using the EQ-5D-3 L instrument.MethodsData were obtained from the National Health Services Surveys in China, which included the EQ-5D-3 L since 2008. We compared the differences between the 2008 and 2013 surveys in the percentage of reported problems, visual analogue scale (VAS) scores, and the EQ-5D-3 L utility index derived from the national value sets. Factors associated with population changes in these EQ-5D results were identified using logistic, linear and Tobit regression models, respectively.ResultsCompared with 2008, reported problems in self-care (3.3% vs 3.1%), usual activities (4.8% vs 4.6%) and anxiety/depression (6.4% vs 5.3%) decreased, whereas reported problems in mobility (5.1% vs 5.9%) and pain/discomfort (9.3% vs 12.6%) increased significantly (p < 0.05) in 2013. The regression models revealed a rise (β = 1.61, p < 0.001) in VAS scores, but a slight drop (β = − 0.01, p < 0.001) in utility index in 2013 compared with 2008 after controlling for variations in demographic, behavioral, socioeconomic and residential variables. But the effect sizes of the changes over time (estimated by “average change divided by baseline standard deviation”) did not reach the threshold of clinical importance after adjustment for variations in other factors. Higher socioeconomic status (in terms of education, income and residential location) was associated with better EQ-5D-3 L results.ConclusionThe changing trend (decrease) of the utility index is contradictory to that (increase) of the VAS scores, although neither is deemed clinically important. It is evident that socioeconomic and regional disparities in HRQoL exist in China.
Highlights
Health-related quality of life (HRQoL) is a multi-dimensional concept that measures self-reported well-being in physical, mental, and social functioning
The European Quality of Life Five Dimensions (EQ-5D) has been recommended by the National Institute for Health and Care Excellence in the UK [8] and the 2011 Guidelines for Pharmacoeconomic Evaluations in China [15]
The importance of changes in the utility index and visual analogue scale (VAS) scores were estimated using the indicator of effect size: average change divided by baseline standard deviation (SD), which was proposed by Cohen [66]
Summary
Health-related quality of life (HRQoL) is a multi-dimensional concept that measures self-reported well-being in physical, mental, and social functioning. It captures the impacts of health problems and diseases on quality of life [1,2,3,4]. HRQoL has been widely used for assessing outcomes of medical interventions as well as serving as a population health indicator, guiding health policy development and resources allocation [5, 6] It puts a quality perspective into the measurement of years of life [7, 8].
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