DECLINING POPULATION HEALTH AND WIDENING HEALTH INEQUALITIES: A PRE-POST PANDEMIC ANALYSIS IN A MULTI-ETHNIC ASIAN POPULATION
Author(s)
Ling Jie Cheng, PhD, MPH, BSN (Hons), RN1, Xun Li, MSc2, Yiyun Shou, PhD3, Mythily SUBRAMANIAM, PhD4, Nick Bansback, PhD5, Nan Luo, PhD3.
1National Perinatal Epidemiology Unit, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom, 2School of Engineering, Computing, and Mathematics, Oxford Brookes University, Oxford, United Kingdom, 3Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, 4Research Division, Institute of Mental Health, Singapore, Singapore, 5School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
1National Perinatal Epidemiology Unit, Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom, 2School of Engineering, Computing, and Mathematics, Oxford Brookes University, Oxford, United Kingdom, 3Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, 4Research Division, Institute of Mental Health, Singapore, Singapore, 5School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
OBJECTIVES: The long-term health consequences of the COVID-19 pandemic remain unclear, particularly regarding health-related quality of life (HRQoL) and equity. Singapore, a high-income, multi-ethnic Asian city-state, provides a critical case study to assess sustained pandemic impacts and identify vulnerable subgroups.
METHODS: We conducted a pre-post comparative analysis using two independent, nationally representative, probability-sampled cross-sectional surveys of Singapore residents aged ≥21 years, conducted pre-pandemic (2019, n=600) and post-pandemic (2024, n=1,769). HRQoL was measured using the EQ-5D-5L. We compared mean index scores and dimension-specific problem prevalence, adjusting for sociodemographic factors via multivariable regression. Differential impacts were assessed through interaction analyses. Health equity changes were quantified using inequality of opportunity analysis and Erreygers concentration indices.
RESULTS: Mean EQ-5D-5L index scores declined from 0·95 (SD 0·12) in 2019 to 0.93 (SD 0.13) in 2024 (p=0.0002), persisting after adjustment (β=−0.014, 95% CI −0.024 to −0.004). Anxiety/depression prevalence increased from 17.2% to 24.3% (adjusted OR 1.65, 95% CI 1.25-2.18), driven by younger adults aged 21-44 years (age × survey period interaction, Pinteraction=0.025). Problems in usual activities increased from 3.5% to 6.9% (adjusted OR 2.14, 95% CI 1.14-4.03), concentrated among the lowest income group (<S$2,000; income × survey period interaction, Pinteraction=0.038). From 2019 to 2024, relative inequality of opportunity more than doubled (5.5% to 12.2%), and income-related health inequality increased 5.1-fold (Erreygers CI: +0.005 to +0.028, p=0.004).
CONCLUSIONS: COVID-19's effects on Singaporeans' health appear to have persisted beyond the acute outbreak, particularly amongst younger and lower-income residents, leading to population HRQoL declines and widening inequalities. Two distinct mechanisms appear to drive these changes: long COVID-related functional impairments predominantly affecting usual activities in lower socioeconomic groups, and pandemic-induced mental health deterioration primarily affecting younger adults. Widening socioeconomic health gradients highlight the need for targeted mental health interventions, post-COVID rehabilitation services, and policies addressing social determinants of health.
METHODS: We conducted a pre-post comparative analysis using two independent, nationally representative, probability-sampled cross-sectional surveys of Singapore residents aged ≥21 years, conducted pre-pandemic (2019, n=600) and post-pandemic (2024, n=1,769). HRQoL was measured using the EQ-5D-5L. We compared mean index scores and dimension-specific problem prevalence, adjusting for sociodemographic factors via multivariable regression. Differential impacts were assessed through interaction analyses. Health equity changes were quantified using inequality of opportunity analysis and Erreygers concentration indices.
RESULTS: Mean EQ-5D-5L index scores declined from 0·95 (SD 0·12) in 2019 to 0.93 (SD 0.13) in 2024 (p=0.0002), persisting after adjustment (β=−0.014, 95% CI −0.024 to −0.004). Anxiety/depression prevalence increased from 17.2% to 24.3% (adjusted OR 1.65, 95% CI 1.25-2.18), driven by younger adults aged 21-44 years (age × survey period interaction, Pinteraction=0.025). Problems in usual activities increased from 3.5% to 6.9% (adjusted OR 2.14, 95% CI 1.14-4.03), concentrated among the lowest income group (<S$2,000; income × survey period interaction, Pinteraction=0.038). From 2019 to 2024, relative inequality of opportunity more than doubled (5.5% to 12.2%), and income-related health inequality increased 5.1-fold (Erreygers CI: +0.005 to +0.028, p=0.004).
CONCLUSIONS: COVID-19's effects on Singaporeans' health appear to have persisted beyond the acute outbreak, particularly amongst younger and lower-income residents, leading to population HRQoL declines and widening inequalities. Two distinct mechanisms appear to drive these changes: long COVID-related functional impairments predominantly affecting usual activities in lower socioeconomic groups, and pandemic-induced mental health deterioration primarily affecting younger adults. Widening socioeconomic health gradients highlight the need for targeted mental health interventions, post-COVID rehabilitation services, and policies addressing social determinants of health.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH179
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
No Additional Disease & Conditions/Specialized Treatment Areas