Abstract
Objective: This study explored the additive value of the multi-item EuroQol 5-Dimension 5-Level (EQ-5D-5L) as an outcome measure in health inequality analyses, relative to the single-item EuroQol visual analog scale (EQ VAS).Methods: A sample comprising the general population from Italy, the Netherlands, and United Kingdom (UK) completed the EQ-5D-5L and the EQ VAS. The level of education was selected as a proxy for socio-economic status (SES). EQ-5D-5L level sum scores (LSS) were compared against EQ VAS scores. Stratified and multivariable analyses were used to study the associations between SES and the LSS/EQ VAS relative to the presence of chronic health conditions.Results: A total of 10,172 people participated in this study. In the UK and Netherlands, the LSS was worst for respondents with a low educational level and better for respondents with middle and high educational levels. For Italy, the LSS was best for respondents with a middle educational level compared to respondents with low and high educational levels. The same patterns were observed for the EQ VAS, but differences were slightly smaller. Multivariable analyses showed generally stronger predictive relations in the UK, and with the LSS. The presence of chronic health conditions and being unable to work were independent strong predictors, canceling out the effects of education.Conclusions: In three different European countries, the EQ-5D measures show the presence of education-dependent health inequalities, which are universally explained in regression analysis by independently the presence of chronic health conditions and the inability to work. In stratified analysis, the EQ-5D-5L LSS discriminates slightly better between participants with different levels of SES compared to the EQ VAS.
Highlights
Health inequalities among population groups of various socioeconomic statuses (SES) are an important challenge for public health and social policy, both at the national and international levels [1]
This study explored the potential of the EuroQol 5Dimension (EQ-5D)-5L level sum score (LSS) as an outcome measure in the health inequality analyses relative to the EQ-5D also includes a visual analog scale (EQ VAS)
Our study showed that the EQ-5D5L LSS tended to better discriminate between participants with a different level of education compared to the EQ VAS, both in the general sample as well as in subgroups of participants with a specific chronic health condition
Summary
Health inequalities among population groups of various socioeconomic statuses (SES) are an important challenge for public health and social policy, both at the national and international levels [1]. Existing health inequalities among countries largely have a socio-economic rather than a medical background [2, 3]. Health inequalities are a societal concern; apart from the unfairness. Health Inequality Analysis in Europe of the unequal share in good health per se, it is known that such inequalities impact economic and societal development [4]. Regardless of the general level of development or prosperity, groups with a lower SES (measured by income, education, and/or occupation) have worse health outcomes, i.e., higher mortality rates and higher disease prevalence rates [7]
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