Abstract
ObjectiveTo examine the association between individual-level deprivation and health-related quality of life (HRQL) in the general population.MethodsData from a population-based survey in the Canadian province of Alberta were used. Individual-level deprivation was assessed using the Canadian Deprivation Index (CDI) and the Ontario Deprivation Index (ODI). HRQL was assessed using the EQ-5D-5 L. Differences in problems in the EQ-5D-5 L dimensions, index and visual analogue scale (VAS) scores across levels of deprivation were examined. Multivariate logistic and linear regression models adjusted for socio-demographic and other characteristics were used to examine the independent association between deprivation and HRQL.ResultsOf the 6314 respondents, 39% were aged between 18 and 44 years and 38% between 45 and 64 years; 60% were female. Mean EQ-5D-5 L index and VAS scores were 0.85 (standard deviation [SD] 0.14) and 79.6 (SD 17.7), respectively. Almost one-third (30.6%) of respondents reported no problems on all EQ-5D-5 L dimensions. Few participants reported some problems with mobility (23.8%), self-care (6.2%) and usual activities (25.2%), while 59.3 and 35.5% reported some levels of pain/discomfort and anxiety/depression, respectively. Differences between the most and least deprived in reporting problems in EQ-5D-5 L dimensions, index and VAS scores were statistically significant and clinically important. In adjusted regression models for both deprivation indices, the least well-off, compared to the most well-off, had higher likelihood of reporting problems in all EQ-5D-5 L dimensions. Compared to the most well-off, the least well-off had an EQ-5D-5 L index score decrement of 0.18 (p < 0.01) and 0.17 (p < 0.01) for the CDI and ODI, respectively. Similarly, an inverse association was found between the VAS score and the CDI (β = − 17.3, p < 0.01) as well as the ODI (β = − 13.3, p < 0.01).ConclusionIndividual-level deprivation is associated with worse HRQL. Poverty reduction strategies should consider the effects of not only neighbourhood-level deprivation, but also that of individual-level deprivation to improve overall health.
Highlights
According to World Health Organization’s Commission on Social Determinants of Health-final report, the conditions in which people grow, live and work can directly affect their quality of life [1]
We examined the association between deprivation indices (CDI and Ontario Deprivation Index (ODI)) and the EQ-5D-5 L dimensions, index and visual analogue scale (VAS) score, and found that, people with more deprivation were more likely to report problems in all dimensions of the EQ-5D-5 L
The overall patterns were quite consistent; higher Canadian Deprivation Index (CDI) and ODI scores were associated with lower EQ-5D-5 L index and VAS scores
Summary
According to World Health Organization’s Commission on Social Determinants of Health-final report, the conditions in which people grow, live and work can directly affect their quality of life [1]. A decent income, good-quality housing, food security, a sense of social belonging and a sound physical environment allow people to be healthy in all dimensions of health including physical, mental, social, emotional, and spiritual. Material deprivation is one component of deprivation that includes goods and conveniences necessary for leading a socially acceptable life which meets or rises above the standards of living attained by the majority of the population, such as adequate housing, sports facilities, shops with affordable healthy food and health care facilities [4]. In Canada, Quebec and Ontario are using the deprivation indices to measure and monitor, and to assess the progress in reducing poverty [3]
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