AUTHOR=Spronk Inge , Haagsma Juanita A. , Lubetkin Erica I. , Polinder Suzanne , Janssen M. F. , Bonsel G. J. 

TITLE=Health Inequality Analysis in Europe: Exploring the Potential of the EQ-5D as Outcome

JOURNAL=Frontiers in Public Health

VOLUME=Volume 9 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2021.744405

DOI=10.3389/fpubh.2021.744405

ISSN=2296-2565

ABSTRACT=Objective: This study explored the additive value of the multi-item EQ-5D-5L as outcome measure in health inequality analyses, relative to the single-item EQ VAS.
Methods: A general population sample from Italy, the Netherlands and United Kingdom (UK) completed the EQ-5D-5L and the EQ VAS. Level of education was selected as proxy for SES. EQ-5D-5L level sum scores (LSS) were compared against EQ VAS scores. Stratified and multivariable analyses were used to study associations between SES and the LSS/EQ VAS relative to the presence of chronic health conditions. 
Results: A total of 10,172 people participated. In the UK and Netherlands, the LSS was worst for respondents with a low education level and better for respondents with a middle and high educational level. For Italy, the LSS was best for respondents with a middle educational level compared to respondents with a low and high educational level. The same patterns were observed for the EQ VAS, but differences were somewhat smaller. Multivariable analyses showed generally stronger predictive relations in the UK, and with the LSS. The presence of chronic health conditions and being unable to work were independent strong predictors, canceling out educational effects. 
Conclusions: In three different European countries, EQ-5D measures show the presence of education-dependent health inequalities, which are universally explained in regression analysis by, independently, the presence of chronic health conditions and the inability to work. In stratified analysis, the EQ-5D-5L level sum score discriminates somewhat better between participants with different levels of SES compared to the EQ VAS.