OBJECTIVES: To assess and compare the impact of the COVID-19 pandemic on health-related quality-of-life (HRQoL) in the United States, Sweden and Norway.

METHODS: Two waves of web-based survey were conducted in April 2020 and January 2021 to collect demographic data, COVID-19 status, behavior and employment changes related to COVID-19 in each country (EuroQol Grant: 246-2020RA). EQ-5D-5L was used to assess health status of respondents. Results were compared between the two waves to measure changes in HRQoL. One-way ANOVA was used to detect significant differences between countries, and t-tests for differences between waves.

RESULTS: We collected 2,734, 1,003 and 1,020 responses in Wave 1, and 2,252, 1,013 and 1,011 responses in Wave 2 for the US, Sweden, and Norway respectively. Corresponding mean (SD) EQ-VAS scores were 74.6 (±19.2), 68.7 (±21.4), and 69.2 (±20.8) in Wave 1 (p<0.001), and 76.4 (±18.6), 68.2 (±20.3), and 67.8 (±21.7) in Wave 2 (p<0.001). Between waves, only the VAS scores in the US were significantly different (p<0.001). Mean (SD) utility scores were 0.822 (±0.222), 0.768 (±0.260), and 0.808 (±0.248) in wave 1 (p<0.001), and 0.823 (±0.221), 0.783 (±0.237), and 0.777 (±0.271) in wave 2 (p<0.001); there were no significant differences between waves for all three countries. Anxiety/depression was consistently the most problematic EQ-5D-5L subdomain among Swedish and Americans (>50%), followed by pain/discomfort. >45% Norwegians also reported problems in anxiety/depression subdomain in both waves. The proportions reporting problems in anxiety/depression increased in wave 2 for Sweden and Norway, but decreased for the US.

CONCLUSIONS: Population HRQoL in Sweden and Norway has been similar throughout the pandemic, while a rebound in population mean VAS was observed in the US. However, the large proportions reporting problems in anxiety/depression across waves in all 3 countries indicates that mental health issues resulting from the pandemic are a major concern.