Socioeconomic Indicators of Self-Reported Health Based on EQ-5D-5L: Results From General Population Surveys in England and Spain

OBJECTIVES: The aim was to explore socioeconomic determinants of health based on EQ-5D-5L data collected from nationally representative general population surveys.

METHODS: Analyses captured EQ-5D-5L data from two countries with nationally representative population surveys, including the Health Survey for England 2018 (N=7,085) and the Spanish National Health Survey 2011-2012 (N=21,058). Key socioeconomic variables in both surveys included age (3 categories), gender, education (no qualification vs with qualification), social class (NRS social grade equivalent in three levels), income (lowest 2 quintiles vs highest 3 quintiles) and family status (three categories). Odds ratios, polarity ratios, and generalized and Erreygers concentration indices were calculated.

RESULTS: All odds ratios showed robust evidence for the existence of inequalities in self-reported problems along the EQ-5D-5L by key socioeconomic stratifiers after controlling for age in both countries (1.12 – 2.54 along each dimension, 1.06 – 3.74 across stratifiers). The polarity ratio between groups with the highest and lowest education level was largest for self-care (3.74) in England and mobility (3.42) in Spain. Those married/cohabiting consistently reported less problems in all dimensions in both countries compared to those with another family status. The generalized health concentration index based on EQ VAS was 0.124 in England and 0.130 in Spain. The Erreygers concentration index based on any reported EQ-5D problems identified that the most important contributors to income related inequalities were being single (24.6%), middle level social class (19.1%), and age 65+ (15.72%) in England, and lowest social class (47.9%), age 65+ (19.2%), and lowest education level (11.3%) in Spain.

CONCLUSIONS: Our analyses illustrated standardized reporting of sociodemographic indicators based on EQ-5D-5L and showed a different health inequality profile for England and Spain. Results can be useful for both health policy makers and researchers such as those considering population health diversity or evaluating the health economic impact of new treatments.