The Social Distribution of Quality Adjusted Life Expectancy (QALE) Among Deprivation Subgroups in China
Author(s)
Peisong Dong, MA1, Xiaoning He, PhD1, Yuhang Xin, PhD1, Jing Wu, PhD1, Jinlei Qi, Phd2, Lijun Wang, MA2, Richard Cookson, PhD3;
1Tianjin University, School of Pharmaceutical Science and Technology, Tianjin, China, 2National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, China, 3University of York, Centre for Health Economics, York, United Kingdom
1Tianjin University, School of Pharmaceutical Science and Technology, Tianjin, China, 2National Center for Chronic and Noncommunicable Disease Control and Prevention, Beijing, China, 3University of York, Centre for Health Economics, York, United Kingdom
Presentation Documents
OBJECTIVES: The social distribution of Quality-Adjusted Life Expectancy (QALE) provides useful information both for monitoring health inequality and for evaluating trade-offs between reducing health inequality and improving total health. The aim of this study is to estimate by QALE by social deprivation subgroups in China, leveraging the most recent County-level Social Deprivation Index 2020 (CSDI 2020).
METHODS: We integrated the 2021 Chinese Death Surveillance System database with the pre-developed CSDI 2020 to establish lifetables spanning five social deprivation subgroups in China. Mortality gaps were adjusted for missing data using external data and a model life table. The Psychology and Behavior Investigation of Chinese Residents 2021 data set (PBICR 2021, n=9961) was utilized to model health-related quality of life as a function of sex, age, and social deprivation from CSDI 2020. Sullivan method was used to convert Life Expectancy (LE) estimates for each subgroup into QALE using the quality of life data. Monte-Carlo simulation was used to estimate standard errors. Sensitivity analysis was carried out to explore alternative prediction models.
RESULTS: In China, both LE and QALE at birth exhibit a descending trend from the least deprived subgroup to the most deprived subgroup. For the least deprived subgroup, LE is 82.2 years and QALE 77.4 years; whereas among the most deprived, the corresponding values decline to 75.2 years and 69.6 years respectively. Individuals in the least deprived quintile in China can anticipate experiencing 7.73 more QALYs (7.98 years longer for men and 7.31 for women) than those in the most deprived quintile. Sensitivity analysis validated the robustness of the results.
CONCLUSIONS: Our results have pinpointed the presence of lifetime health inequality across different social deprivation subgroups in China. The findings can provide support for the assessment of equity effects in healthcare decision-making in China, including equity-informative cost-effectiveness analysis.
METHODS: We integrated the 2021 Chinese Death Surveillance System database with the pre-developed CSDI 2020 to establish lifetables spanning five social deprivation subgroups in China. Mortality gaps were adjusted for missing data using external data and a model life table. The Psychology and Behavior Investigation of Chinese Residents 2021 data set (PBICR 2021, n=9961) was utilized to model health-related quality of life as a function of sex, age, and social deprivation from CSDI 2020. Sullivan method was used to convert Life Expectancy (LE) estimates for each subgroup into QALE using the quality of life data. Monte-Carlo simulation was used to estimate standard errors. Sensitivity analysis was carried out to explore alternative prediction models.
RESULTS: In China, both LE and QALE at birth exhibit a descending trend from the least deprived subgroup to the most deprived subgroup. For the least deprived subgroup, LE is 82.2 years and QALE 77.4 years; whereas among the most deprived, the corresponding values decline to 75.2 years and 69.6 years respectively. Individuals in the least deprived quintile in China can anticipate experiencing 7.73 more QALYs (7.98 years longer for men and 7.31 for women) than those in the most deprived quintile. Sensitivity analysis validated the robustness of the results.
CONCLUSIONS: Our results have pinpointed the presence of lifetime health inequality across different social deprivation subgroups in China. The findings can provide support for the assessment of equity effects in healthcare decision-making in China, including equity-informative cost-effectiveness analysis.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR97
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity
Disease
No Additional Disease & Conditions/Specialized Treatment Areas