Inequalities in health-related quality of life: repeated cross-sectional study of trends in general practice survey data

Vishalie Shah; Jonathan Stokes; Matt Sutton

doi:10.3399/BJGP.2020.0616

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Figure 1.
EQ-5D-5L score (with 95% confidence intervals) for males and females, England, 2012–2017.
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Figure 2.
EQ-5D-5L score (with 95% confidence intervals) for males and females by age categories, England, 2012–2017.
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Figure 3a.
EQ-5D-5L score (with 95% confidence intervals) for males and females by quintiles of deprivation, England, 2012–2017. 3b. Change in EQ-5D- 5L score across clinical commissioning groups by quintiles, England, 2012–2017.
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Figure 4.
EQ-5D-5L domain score (with 95% confidence intervals) for males and females, England, 2012–2017.

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Although life expectancy at birth has stalled in some high-income countries and inequalities have widened, there has been less focus on other population health indicators, such as health-related quality of life (HRQoL). The authors examine trends and inequalities in HRQoL in England using data on 3.9 million adults from large national surveys from 2012 to when the series ended in 2017. There has been no change in average HRQoL, but there have been increases in inequalities for females, particularly the youngest and those living in the most deprived areas. These deteriorations are driven by increases in anxiety and depression, and should be a future policy priority.

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Table 1.

Sample characteristics of GPPS responders across England for each survey waves

	Jul–Sep 2012		Jan–Mar 2013		Jul–Sep 2013		Jan–Mar 2014		Jul–Sep 2014		Jan–Mar 2015		Jul–Sep 2015 Jan–Mar 2016				Jan–Mar 2017
Demographic characteristics^a
% female	0.51	(0.50)	0.51	(0.50)	0.51	(0.50)	0.50	(0.50)	0.51	(0.50)	0.51	(0.50)	0.51	(0.50)	0.51	(0.50)	0.51	(0.50)
% aged 18–24	0.10	(0.30)	0.10	(0.30)	0.10	(0.30)	0.10	(0.30)	0.10	(0.30)	0.10	(0.29)	0.10	(0.30)	0.10	(0.30)	0.09	(0.29)
% aged 25–34	0.18	(0.38)	0.18	(0.38)	0.18	(0.38)	0.18	(0.38)	0.17	(0.38)	0.17	(0.38)	0.18	(0.38)	0.18	(0.38)	0.17	(0.38)
% aged 35–44	0.18	(0.39)	0.18	(0.38)	0.18	(0.38)	0.18	(0.38)	0.17	(0.38)	0.18	(0.38)	0.17	(0.38)	0.17	(0.38)	0.17	(0.38)
% aged 45–54	0.19	(0.39)	0.19	(0.39)	0.19	(0.39)	0.19	(0.39)	0.19	(0.39)	0.19	(0.39)	0.19	(0.39)	0.19	(0.39)	0.19	(0.39)
% aged 55–64	0.15	(0.36)	0.15	(0.35)	0.15	(0.36)	0.15	(0.36)	0.15	(0.36)	0.15	(0.36)	0.15	(0.36)	0.15	(0.36)	0.15	(0.36)
% aged 65–74	0.11	(0.32)	0.12	(0.32)	0.12	(0.32)	0.12	(0.32)	0.12	(0.33)	0.12	(0.33)	0.12	(0.33)	0.12	(0.33)	0.13	(0.33)
% aged 75–84	0.07	(0.25)	0.07	(0.25)	0.07	(0.25)	0.07	(0.25)	0.07	(0.25)	0.07	(0.25)	0.07	(0.25)	0.07	(0.25)	0.07	(0.25)
% aged ≥85	0.02	(0.16)	0.03	(0.16)	0.03	(0.16)	0.03	(0.16)	0.03	(0.16)	0.03	(0.16)	0.03	(0.16)	0.03	(0.16)	0.03	(0.16)
IMD 2015	22.00	(15.65)	21.58	(15.45)	21.62	(15.53)	21.64	(15.52)	21.64	(15.53)	21.64	(15.49)	21.62	(15.50)	21.69	(15.48)	21.70	(15.51)
EQ-5D-5L^a
Utility score^b	0.821	(0.23)	0.825	(0.22)	0.821	(0.23)	0.822	(0.22)	0.822	(0.22)	0.823	(0.23)	0.823	(0.22)	0.820	(0.23)	0.818	(0.23)
Mobility	4.593	(0.85)	4.612	(0.83)	4.594	(0.85)	4.607	(0.84)	4.597	(0.84)	4.610	(0.83)	4.604	(0.84)	4.612	(0.83)	4.612	(0.83)
Self-care	4.842	(0.57)	4.844	(0.57)	4.843	(0.57)	4.843	(0.57)	4.847	(0.56)	4.843	(0.57)	4.846	(0.57)	4.844	(0.57)	4.840	(0.58)
Usual activities	4.566	(0.87)	4.583	(0.86)	4.568	(0.87)	4.577	(0.86)	4.573	(0.86)	4.581	(0.86)	4.578	(0.86)	4.580	(0.86)	4.580	(0.86)
Pain/discomfort	4.272	(0.93)	4.295	(0.92)	4.274	(0.93)	4.281	(0.92)	4.277	(0.93)	4.285	(0.92)	4.283	(0.93)	4.279	(0.92)	4.274	(0.93)
Anxiety/depression	4.533	(0.82)	4.535	(0.82)	4.532	(0.83)	4.524	(0.82)	4.536	(0.82)	4.520	(0.83)	4.530	(0.83)	4.503	(0.85)	4.482	(0.86)
N	425 734		442 215		400 629		409 923		381 628		390 748		378 241		376 764		732 434

↵a Data presented as weighted mean (SD).
↵b Utility score of 1 indicates perfect health. GPPS = General Practice Patient Survey. IMD = Index of Multiple Deprivation. SD = standard deviation.