Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, United Kingdom.
PLoS Med. 2023 Apr 11;20(4):e1004146. doi: 10.1371/journal.pmed.1004146. eCollection 2023 Apr.
Most research on the Coronavirus Disease 2019 (COVID-19) health burden has focused on confirmed cases and deaths, rather than consequences for the general population's health-related quality of life (HRQoL). It is also important to consider HRQoL to better understand the potential multifaceted implications of the COVID-19 pandemic in various international contexts. This study aimed to assess the association between the COVID-19 pandemic and changes in HRQoL in 13 diverse countries.
Adults (18+ years) were surveyed online (24 November to 17 December 2020) in 13 countries spanning 6 continents. Our cross-sectional study used descriptive and regression-based analyses (age adjusted and stratified by gender) to assess the association between the pandemic and changes in the general population's HRQoL, measured by the EQ-5D-5L instrument and its domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), and how overall health deterioration was associated with individual-level (socioeconomic, clinical, and experiences of COVID-19) and national-level (pandemic severity, government responsiveness, and effectiveness) factors. We also produced country-level quality-adjusted life years (QALYs) associated to COVID-19 pandemic-related morbidity. We found that overall health deteriorated, on average across countries, for more than one-third of the 15,480 participants, mostly in the anxiety/depression health domain, especially for younger people (<35 years old) and females/other gender. This translated overall into a 0.066 mean "loss" (95% CI: -0.075, -0.057; p-value < 0.001) in the EQ-5D-5L index, representing a reduction of 8% in overall HRQoL. QALYs lost associated with morbidity were 5 to 11 times greater than QALYs lost based on COVID-19 premature mortality. A limitation of the study is that participants were asked to complete the prepandemic health questionnaire retrospectively, meaning responses may be subject to recall bias.
In this study, we observed that the COVID-19 pandemic was associated with a reduction in perceived HRQoL globally, especially with respect to the anxiety/depression health domain and among younger people. The COVID-19 health burden would therefore be substantially underestimated if based only on mortality. HRQoL measures are important to fully capture morbidity from the pandemic in the general population.
大多数关于 2019 年冠状病毒病（COVID-19）健康负担的研究都集中在确诊病例和死亡人数上，而不是一般人群健康相关生活质量（HRQoL）的后果。考虑到 HRQoL 也很重要，以便更好地理解 COVID-19 大流行在各种国际背景下可能产生的多方面影响。本研究旨在评估 COVID-19 大流行与 13 个不同国家人群 HRQoL 变化之间的关联。
2020 年 11 月 24 日至 12 月 17 日，我们在跨越六大洲的 13 个国家对成年人（18 岁以上）进行了在线调查。我们的横断面研究使用描述性和基于回归的分析（年龄调整，并按性别分层），评估了大流行与普通人群 HRQoL 变化之间的关联，使用 EQ-5D-5L 工具及其领域（移动性、自我护理、日常活动、疼痛/不适和焦虑/抑郁）进行衡量，以及整体健康恶化如何与个体层面（社会经济、临床和 COVID-19 经历）和国家层面（大流行严重程度、政府响应能力和有效性）因素相关。我们还制作了与 COVID-19 大流行相关发病率相关的国家层面质量调整生命年（QALYs）。我们发现，在 15480 名参与者中，平均有超过三分之一的人整体健康状况恶化，主要表现在焦虑/抑郁健康领域，尤其是年轻人（<35 岁）和女性/其他性别。这总体上导致 EQ-5D-5L 指数平均“损失”了 0.066（95%CI：-0.075，-0.057；p 值<0.001），代表整体 HRQoL 下降了 8%。与发病率相关的 QALYs 损失是基于 COVID-19 过早死亡的 QALYs 损失的 5 至 11 倍。本研究的一个限制是，参与者被要求回顾性地完成大流行前的健康问卷，这意味着他们的回答可能受到回忆偏倚的影响。
在这项研究中，我们观察到 COVID-19 大流行与全球人群 HRQoL 下降有关，尤其是在焦虑/抑郁健康领域和年轻人中。如果仅基于死亡率，那么 COVID-19 的健康负担将被大大低估。HRQoL 测量对于全面了解大流行对普通人群的发病率非常重要。
