Collins Brendan
Wirral Borough Council, Birkenhead, UK; Department of Public Health and Policy, University of Liverpool, Liverpool, UK.
Value Health. 2017 Jan;20(1):174-177. doi: 10.1016/j.jval.2016.08.004. Epub 2016 Oct 10.
There is a growing body of evidence that once quality-of-life decrements are factored in, health inequalities become more prominent than using life expectancy alone.
This study aimed to understand what the drivers were in inequalities in quality-adjusted life expectancy (QALE).
This study used EuroQol five-dimensional (EQ-5D) questionnaire data from a large survey from the North West of England (N = 11,500), which were combined with population and mortality data from administrative datasets, to calculate estimated QALE by deprivation quintile.
The gap in QALE between the most and least deprived quintiles was 16.8 years in males and 14.5 years in females. The gap in health-related quality of life between the rich and the poor was most prominent in males and in the age group of 55 to 64 years. People who live in the least deprived areas are less likely to show any level of problems across all five domains of the EQ-5D than those who live in the most deprived areas. People from the least deprived areas are less likely to have severe problems on two domains: pain (odds ratio = 0.45 [95% confidence interval 0.33-0.62]) and anxiety/depression (odds ratio = 0.3 [95% confidence interval 0.19-0.47]).
This study has shown that, in the North West of England, inequalities in QALE are driven by pain and anxiety/depression.
越来越多的证据表明，一旦将生活质量下降因素考虑在内，健康不平等现象比仅使用预期寿命时更为突出。
本研究旨在了解质量调整生命预期（QALE）不平等的驱动因素。
本研究使用了来自英格兰西北部一项大型调查（N = 11,500）的欧洲五维健康量表（EQ - 5D）问卷数据，并将其与行政数据集的人口和死亡率数据相结合，按贫困五分位数计算估计的QALE。
最贫困五分位数与最不贫困五分位数之间的QALE差距，男性为16.8岁，女性为14.5岁。富人与穷人之间与健康相关的生活质量差距在男性以及55至64岁年龄组中最为突出。生活在最不贫困地区的人在EQ - 5D的所有五个领域中出现任何问题水平的可能性都低于生活在最贫困地区的人。来自最不贫困地区的人在两个领域出现严重问题的可能性较小：疼痛（优势比 = 0.45 [95%置信区间0.33 - 0.62]）和焦虑/抑郁（优势比 = 0.3 [95%置信区间0.19 - 0.47]）。
本研究表明，在英格兰西北部，QALE的不平等是由疼痛和焦虑/抑郁驱动的。
