Abstract
PurposeWe assessed the validity of the EQ-5D instrument; explored correlations between area of residence’s conflict intensity and individual health-related quality of life (HRQoL); and identified factors associated with HRQoL in a conflict-affected population in Colombia.MethodsWe conducted a household survey among residents of the Meta province, collecting longitudinal information about HRQoL (EQ-5D-3L instrument), health, demographic and socio-economic indicators, for years 2014 (pre-2016 peace accord), 2018 (post-peace accord) and 2019 (follow-up). After examining EQ-5D’s validity, we analysed panel data using multivariate random effects models to explore associations between area conflict levels (and other factors) and HRQoL. We scrutinised these results further through multivariate linear regressions using cross-sectional data, and provided preliminary estimates of quality-adjusted life years (QALYs) gained since the Colombian peace accord.ResultsIn total, 1309 individuals provided information for years 2014 and 2018; 1106 individuals were followed-up in 2019. Mean EQ-5D scores in 2014, 2018 and 2019 were 0.898, 0.846 and 0.902, respectively. The tests confirmed the validity of EQ-5D. Our estimations indicated a dose–response relationship between conflict levels and HRQoL: people in lightly and heavily affected areas had 0.019 and 0.037 lower EQ-5D scores (respectively) than people in non-affected areas. Other relevant factors included age, marital status, education, assets and health status. We estimated QALY gain of 0.0343 per individual and 20,752 for all Meta adults since the peace accord.ConclusionWe found EQ-5D to be a valid instrument for HRQoL measurement in a conflict-affected population. Area conflict intensity was negatively associated with individual HRQoL.
Highlights
Armed conflicts have profound adverse effects on people’s health [1]
The random effects approach with panel data is more appropriate for our study aims than cross-sectional analysis because: (i) it provides information about the dynamics of people’s health-related quality of life (HRQoL) during and after conflict; (ii) it allows exploration of the associations over time between HRQoL and time-invariant characteristics; and (iii) it mitigates the influence of confounders of the associations of interest, by accounting for changes over time on several individual characteristics and for correlation over time in these characteristics
The results demonstrate that EQ-5D(-3L) is a feasible and valid instrument for the evaluation of HRQoL for this conflict-affected population in Colombia
Summary
Armed conflicts have profound adverse effects on people’s health [1] These effects usually last for long periods in the aftermath of armed conflicts, due to the destruction of health-supporting infrastructure [2]. Policymakers need a good understanding of the consequences of conflicts for people’s health and wellbeing, in order to HRQoL is a multi-dimensional concept that captures information related to physical, mental, emotional, and social well-being [8]. It has been used by clinicians, researchers and public health officials to measure the effects of diseases and treatments [9, 10]. In the literature about conflict-affected populations, HRQoL has been assessed most frequently through the Short-Form Health Survey 36-item (SF-36) [11,12,13] and the World Health Organisation
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