Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg D-85758, PO Box 1129, Germany.
Health Qual Life Outcomes. 2014 Apr 25;12:58. doi: 10.1186/1477-7525-12-58.
A number of studies have shown an association between health-related quality of life (HRQL) and socioeconomic status (SES). Indicators of SES usually serve as potential confounders; associations between SES and HRQL are rarely discussed in their own right. Also, few studies assess the association between HRQL and SES among those with a chronic disease. The study focuses on the question of whether people with the same state of health judge their HRQL differently according to their SES, and whether a bias could be introduced by ignoring these differences.
The analyses were based on a representative sample of the adult population in Germany (n = 11,177). HRQL was assessed by the EQ-5D-3 L, i.e. the five domains (e.g. 'moderate or severe problems' concerning mobility) and the Visual Analog Scale (VAS). SES was primarily assessed by educational level; age, sex and family status were included as potential confounders. Six chronic diseases were selected, each having a prevalence of at least 1% (e.g. diabetes mellitus). Multivariate analyses were conducted by logistic and linear regression.
Among adults with a chronic disease, most 'moderate or severe problems' are reported more often in the low (compared with the high) educational group. The same social differences are seen for VAS values, also in subgroups characterized by 'moderate or severe problems'. Gender-specific analyses show that for women the associations with VAS values can just be seen in the total sample. For men, however, they are also present in subgroups defined by 'moderate or severe problems' or by the presence of a chronic disease; some of these differences exceed 10 points on the VAS scale.
Low SES groups seem to be faced with a double burden: first, increased levels of health impairments and, second, lower levels of valuated HRQL once health is impaired. These associations should be analysed and discussed in their own right, based on interdisciplinary co-operation. Social epidemiologists could include measures of HRQL in their studies more often, for example, and health economists could consider assessing whether recommendations based on HRQL scales might include a social bias.
多项研究表明，健康相关生活质量（HRQL）与社会经济地位（SES）之间存在关联。SES 的指标通常作为潜在的混杂因素；SES 与 HRQL 之间的关联很少被单独讨论。此外，很少有研究评估慢性病患者中 HRQL 与 SES 之间的关联。本研究重点关注的问题是，具有相同健康状况的人是否会根据 SES 对其 HRQL 做出不同的判断，以及如果忽略这些差异，是否会引入偏差。
分析基于德国成年人的代表性样本（n=11177）。HRQL 通过 EQ-5D-3L 进行评估，即五个领域（例如，关于行动能力的“中度或严重问题”）和视觉模拟量表（VAS）。SES 主要通过教育程度来评估；年龄、性别和家庭状况被纳入潜在混杂因素。选择了六种慢性疾病，每种疾病的患病率至少为 1%（例如糖尿病）。使用逻辑回归和线性回归进行多变量分析。
在患有慢性病的成年人中，大多数“中度或严重问题”在低（与高）教育组中报告得更频繁。VAS 值也存在同样的社会差异，在以“中度或严重问题”为特征的亚组中也是如此。性别特异性分析表明，对于女性，VAS 值与社会经济地位的关联仅在总样本中可见。然而，对于男性，这种关联在以“中度或严重问题”或存在慢性疾病为特征的亚组中也存在；其中一些差异在 VAS 量表上超过 10 分。
低 SES 群体似乎面临着双重负担：首先，健康受损的程度增加，其次，一旦健康受损，他们的 HRQL 评价水平较低。这些关联应该根据跨学科合作进行单独分析和讨论。社会流行病学家可以更频繁地在他们的研究中纳入 HRQL 测量，例如，健康经济学家可以考虑评估基于 HRQL 量表的建议是否可能包含社会偏见。
