Measuring inequality in quality of life: further evidence that the EQ-5D-5L may underestimate it.

Authors

Admassu N Lamu, Gang Chen, Ling Jie Cheng, Jan Abel Olsen, EQ-DAPHNIE Project Team

Published in

Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. Volume 35. Issue 8. Jun 15, 2026. Epub Jun 15, 2026.

Abstract

A previous study found that individuals with identical EQ-5D-5L profiles reported systematically higher EQ VAS scores with increasing educational attainment, which suggests a 'hidden' socioeconomic gradient not captured by the EQ-5D-5L. This study examines the robustness and generalisability of these findings using multi-country data.
We analysed data from 32,327 respondents aged 25 to 79 years across eight high-income countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, the UK, and the US. The data came from the EQ-DAPHNIE study. Within ten selected EQ-5D-5L health profiles, we used linear regression models to estimate the associations between EQ VAS scores and educational attainment or subjective income status, adjusting for age, sex, and country.
We observed a consistent educational gradient in EQ VAS scores across most EQ-5D-5L profiles. Tertiary education was associated with higher scores in all ten profiles, with effects statistically significant at p < 0.10 in seven, of which four at p < 0.01. Income status showed an even stronger gradient, with significant associations in nine of the ten profiles. These patterns were evident in all eight countries.
These multi-country findings provide robust evidence of a socioeconomic gradient in EQ VAS scores among respondents who report identical EQ-5D-5L health profiles, over and above what is reflected in the five EQ-5D-5L dimensions. This pattern has implications for the use of EQ-5D-5L values in equity-informative health technology assessment and population health monitoring.

PMID:
42295447
Bibliographic data and abstract were imported from PubMed on 15 Jun 2026.

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