Subjective well-being and its association with subjective health status, age, sex, region, andsSocio-economic characteristics in a chinese population study

This study analyse how subjective well-being (SWB) in a Chinese population varies with subjective health status, age, sex, region and socio-economic characteristics. In the Household Health Survey 2010, face-to-face interviews were carried out in urban and rural counties in eastern, middle and western areas of China (n = 8,000, aged 15–102 years). To measure subjective health status, a global self-rated health question, the EQ-5D descriptive system, and a visual analogue scale of health status was included. To measure SWB, a validated Chinese version of a question on self-reported happiness, adopted from the World Values Survey, was included. SWB increased with socio-economic status (income and education), and was lower among unemployed individuals and divorced individuals. SWB also increased strongly with subjective health status. When health status was divided into different dimensions using the EQ-5D, the anxiety/depression dimension was the most important dimension for SWB. The reported SWB was also higher in rural counties than in urban counties in the same area, after controlling for socio-economic characteristics and subjective health statusThe Swedish Research Council (Swedish Research Links Programme 348-2009-6538Karolinska Institutet’s Research Foundation Grantsish Research Links Programme 348-2009-6538), Karolinska Institutet’s Research Foundation Grants and the National Natural Science Foundation of China (Project 70873064).Publishe

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

BackgroundGeneric health-related quality of life instruments, such as the EQ-5D, are increasingly used by countries to monitor population health via general population health surveys. Our aim was to demonstrate analytic options to measure socio-demographic differences in self-reported health using the EuroQol Group's archive of EQ-5D-3L population surveys that accumulated over the past two decades.MethodsAnalyses captured self-reported EQ-5D-3L data on over 100,000 individuals from 18 countries with nationally representative population surveys. Socio-demographic indicators employed were age, sex, educational level and income. Logistic regression odds ratios and the health concentration index methodology were used in the socio-demographic analysis of EQ-5D-3L data.ResultsStatistically significant socio-demographic differences existed in all countries (p < 0.01) with the EQ VAS based health concentration index varying from 0.090 to 0.157 across countries. Age had generally the largest contributing share, while educational level also had a consistent role in explaining lower levels of self-reported health. Further analysis in a subset of 7 countries with income data showed that, beyond educational level, income itself had an additional significant impact on self-reported health. Among the 5 dimensions of the EQ-5D-3L descriptive system, problems with usual activities and pain/discomfort had the largest contribution to the concentration of overall self-assessed health measured on the EQ VAS in most countries.ConclusionThe EQ-5D-3L was shown to be a powerful multi-dimensional instrument in the analyses of socio-demographic differences in self-reported health using various analytic methods. It offered a unique insight of inequalities by health dimensions

Is Preoperative Patient-Reported Health Status Associated with Mortality after Total Hip Replacement?

The influence of comorbidities and worse physical status on mortality following total hip replacement (THR) leads to the idea that patient-reported health status may also be a predictor of mortality. The aim of this study was to investigate the relationship between patient-reported health status before THR and the risk of dying up to 5 years post-operatively. For these analyses, we used register data on 42,862 THR patients with primary hip osteoarthritis operated between 2008 and 2012. The relative survival ratio was calculated by dividing the observed survival in the patient group by age- and sex-adjusted expected survival of the general population. Pre-operative responses to the five EQ-5D-3L (EuroQol Group) dimensions along with age, sex, education status, year of surgery, and hospital type were used as independent variables. Results shown that, as a group, THR patients had a better survival than the general population. Broken down by the five EQ-5D-3L dimensions we observed differentiated survival patters. For all dimensions, those reporting extreme problems had higher mortality than those reporting moderate or no problems. In conclusion, worse health status according to the EQ-5-3L before THR is associated with higher mortality up to five years after surgery. EQ-5D-3L responses may be useful in a multifactorial individualized risk assessment before THR.This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site

Experience-based VAS values for EQ-5D-3L health states in a national general population health survey in China

Purpose: To investigate the feasibility of deriving experience-based visual analogue scale (VAS) values for EQ-5D-3L health states using national general population health survey data in China. Methods: The EQ-5D-3L was included in the National Health Services Survey (n = 120,709, aged 15–103 years) to measure health-related quality of life. The respondents reported their current health status on a VAS and completed the EQ-5D-3L questionnaire, enabling modelling of the association between the experience-based VAS values and self-reported problems on EQ-5D dimensions and severity levels. Results: VAS values were generally negatively associated with problems reported on the EQ-5D dimensions, and the anxiety/depression dimension had the greatest impact on VAS values. A previously obtained value for dead allowed the values for all 243 EQ-5D-3L health states to be transformed to the 0–1 scale (0 = dead, 1 = full health). Conclusions: This study presents the feasibility of deriving an experience-based VAS values for EQ-5D-3L health states in China. The analysis of these VAS data raises more fundamental issues concerning the universal nature of the classification system and the extent to which Chinese respondents utilise the same concepts of health as defined by this classification system

Cross-national agreement on disability weights: the European Disability Weights Project

BACKGROUND: Disability weights represent the relative severity of disease stages to be incorporated in summary measures of population health. The level of agreement on disability weights in Western European countries was investigated with different valuation methods. METHODS: Disability weights for fifteen disease stages were elicited empirically in panels of health care professionals or non-health care professionals with an academic background following a strictly standardised procedure. Three valuation methods were used: a visual analogue scale (VAS); the time trade-off technique (TTO); and the person trade-off technique (PTO). Agreement among England, France, the Netherlands, Spain, and Sweden on the three disability weight sets was analysed by means of an intraclass correlation coefficient (ICC) in the framework of generalisability theory. Agreement among the two types of panels was similarly assessed. RESULTS: A total of 232 participants were included. Similar rankings of disease stages across countries were found with all valuation methods. The ICC of country agreement on disability weights ranged from 0.56 [95% CI, 0.52–0.62] with PTO to 0.72 [0.70–0.74] with VAS and 0.72 [0.69–0.75] with TTO. The ICC of agreement between health care professionals and non-health care professionals ranged from 0.64 [0.58–0.68] with PTO to 0.73 [0.71–0.75] with VAS and 0.74 [0.72–0.77] with TTO. CONCLUSIONS: Overall, the study supports a reasonably high level of agreement on disability weights in Western European countries with VAS and TTO methods, which focus on individual preferences, but a lower level of agreement with the PTO method, which focuses more on societal values in resource allocation

Feasibility, reliability, and validity of the EQ-5D-Y: results from a multinational study

Ravens-Sieberer U, Wille N, Badia X, et al. Feasibility, reliability, and validity of the EQ-5D-Y: results from a multinational study. QUALITY OF LIFE RESEARCH. 2010;19(6):887-897.To examine the feasibility, reliability, and validity of the newly developed EQ-5D-Y. The EQ-5D-Y was administered in population samples of children and adolescents in Germany, Italy, South Africa, Spain, and Sweden. Percentages of missing values and reported problems were calculated. Test-retest reliability was determined. Spearman's rank correlation coefficients with other generic measures of HRQOL were calculated. Known groups' validity was examined by comparing groups with a priori expected differences in HRQOL. Between 91 and 100% of the respondents provided valid scorings. Sweden had the lowest proportion of reported problems (1-24.9% across EQ-5D-Y dimensions), with the highest proportions in South Africa (2.8-47.3%) and Italy (4.3-39.0%). Percentages of agreement in test-retest reliability ranged between 69.8 and 99.7% in the EQ-5D-Y dimensions; Kappa coefficients were up to 0.67. Correlation coefficients with other measures of self-rated health indicated convergent validity (up to r = -0.56). Differences between groups classified according to presence of chronic conditions, self-rated overall health and psychological problems provided preliminary evidence of known groups' validity. Results provide preliminary evidence of the instrument's feasibility, reliability and validity. Further study is required in clinical samples and for possible future applications in economic analyses

Population health and inequalities in health : Measurement of health-related quality of life and changes in QALYs over time in Sweden

People live longer, but all years are not in full health. A health policy which aims to improve both the average level of health and reduce inequalities in health needs a global measure which can be monitored over time. A summary measure of population health ideally should combine quantity (survival) and quality (health status or health-related quality of life (HRQoL)) into a single measure. Such a measure, qualityadjusted life years (QALYs), has been developed in the field of economic evaluation of health care. Estimation of QALYs requires data on survival and the corresponding health state score reflecting HRQoL on a scale between 0 (dead) and I (full health). The overall aim of this thesis was to estimate HRQoL and QALYs on a population level and by socioeconomic group over time in Sweden, and to contribute to the methodology regarding summary measures of population health. This thesis also addresses the importance of whose preferences to use when valuing health states. The thesis is based on five papers. Two data sources were used to obtain health states scores. Study I and II were based on the 1998 Stockholm County Public Health Survey where the generic HRQoL measure, the EQ-5D self-classifier (where respondents may classify their health into five dimensions within three levels of severity), and a rating scale and a time trade-off (TTO) question were included. Study III-V were based on the Statistics Sweden's Survey of Living Conditions (ULF). Responses to selected survey questions in the ULF were mapped into the EQ-5D, using the UK EQ-5D tariff to derive health state scores. Survival data over time were obtained from the official Swedish mortality statistics. To estimate mortality rates by socio- economic group, data from the ULF survey linked to the National Cause of Death Register were used. The health state scores were combined with the calculated life-table survival probabilities to estimate QALYs. In the Stockholm Public Health Survey, most problems were reported in the dimension pain/discomfort, followed by the dimension anxiety/depression, and the prevalence of problems increased with age (Paper I). However, in the dimension anxiety/depression, next to the oldest age group most problems were reported in the youngest age group. Women had lower health state scores than men. After controlling for age, sex, and disease, the HRQoL was lower in the manual than in the non- manual groups. The Stockholm study also suggests that individual and social TTO values differ systematically and that the difference increases with severity (Paper 11). Study III-V support the feasibility of obtaining mean health state scores by mapping survey data to the EQ-5D in order to obtain health state scores for time periods where no HRQoL data were available (Paper 111). Life expectancy for newborn males (females) increased by 3.68 (2.70) years from 1980/81 to 1996/97 (Paper IV). Expected QALYs increased by 2.64 (0.54). Older persons experienced considerable health gains over time whereas the health gains were small or nonexistent for younger women. For 20-year-old men (women) the difference in life expectancy between the highest and the lowest socio-economic group was 2.11 (1.56) years in 1980 and 3.79 (2.15) years in 1997 (Paper V). Corresponding differences in QALYs were 5.76 (4.14) in 1980 and 7.06 (5.66) in 1997, indicating an increase in inequalities in life expectancy and QALYs over time. However, the widening socio-economic inequalities were more stable for men than for women. This thesis provides an example of methods of obtaining health state scores from existing survey data, and of combining survival and HRQoL into a summary measure of health, QALYs, to explore the population health and inequalities in health over time

Association between social capital and health-related quality of life among left behind and not left behind older people in rural China

Abstract Background The association between social capital and health-related quality of life (HRQoL) has not been thoroughly studied among older persons in rural China, especially among those who were left behind or not. This study investigates the association between social capital and HRQoL and examines possible differences of this association between being left behind or not in rural China. Methods A cross-sectional survey of 825 people aged 60 years and older, residing in three rural counties in Jiangsu Province in China, was conducted in 2013. Factor analysis was performed to measure social capital. EQ-5D was used to measure HRQoL. Tobit regression analysis with upper censoring was conducted to explore the association between social capital and EQ-5D index. Results After controlling for individual characteristics, low social capital and being left behind were significantly associated with low HRQoL. Old people with low social capital had 0.055 lower EQ-5D index compared to those with high social capital. Old people being left behind had 0.040 lower EQ-5D index compared to those who were not left behind. For different dimensions of social capital, the main effects came from the domain of trust and reciprocity. There was a significant interaction between low social capital and being left behind on HRQoL, suggesting that low social capital was associated with low HRQoL among persons left behind. Conclusions Our findings indicate that the left behind old people with low social capital were a potentially vulnerable group in rural China. Formulating and implementing initiatives and strategies which increase social capital may foster better HRQoL, especially for old people who were left behind