Quality of Life Research

, Volume 14, Issue 10, pp 2187–2196 | Cite as

Relationship Among Sociodemographic Factors, Clinical Conditions, and Health-related Quality of Life: Examining the EQ-5D in the U.S. General Population

  • Erica I. LubetkinEmail author
  • Haomiao Jia
  • Peter Franks
  • Marthe R. Gold


Introduction: Health-related quality of life (HRQL) measures are used increasingly in evaluations of clinical and population-based outcomes and in economic analyses. We investigate the influence of demographic, socioeconomic, and chronic disease factors on the HRQL of a representative U.S. sample. Methods: We examined data from 13,646 adults in the 2000 Medical Expenditure Panel Survey, a nationally representative sample of the U.S. general population, who completed a self-administered questionnaire containing the EQ-5D, a preference-based measure. We assessed the relationships between EQ-5D scores and sociodemographic variables, including age, sex, race/ethnicity, income and education, and six common chronic conditions. Results: In fully adjusted models, EQ-5D scores decreased with increasing category of age and were lower for persons with a lower income and educational attainment as well as each of the six conditions. Although the EQ-5D scores were lower for females and Whites compared with Blacks such differences were not of a magnitude considered to be clinically important. Conclusions: In the U.S., sociodemographic factors and clinical conditions are strongly associated with scores on the EQ-5D. Population health studies and risk-adjustment models should account and adjust for these factors when assessing the performance of health programs and clinical care.


chronic disease health status population health socioeconomic status 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Cooper, JK, Kohlmann, T, Michael, JA,  et al. 2001Health outcomes. New quality measure for MedicareInt J Qual Health Care13916CrossRefPubMedGoogle Scholar
  2. 2.
    Institute of Medicine. Summarizing Population Health: Directions for the Development and Application of Population Metrics. Field MJ, Gold MR, eds. Washington, D.C.: National Academy Press 1998.Google Scholar
  3. 3.
    Murray CJL, Lopez AD, Mathers CD, et al. (2001) The Global Burden of Disease 2000 project: Aims, methods, and data sources. Global Programme on Evidence for Health Policy Discussion Paper No. 36. World Health Organization. November 2001.Google Scholar
  4. 4.
    Gold, MR, Muennig, P 2002Measure-dependent variation in burden of diseases estimates: Implications for policyMed Care40260266CrossRefPubMedGoogle Scholar
  5. 5.
    Gold, MRSiegel, JERussell, LB eds.  et al. 1996Cost-effectiveness in Health and MedicineOxford University PressNew YorkGoogle Scholar
  6. 6.
    Johnson, JA, Coons, SJ 1998Comparison of the EQ-5D and SF-12 in an adult US sampleQual Life Res7155166CrossRefPubMedGoogle Scholar
  7. 7.
    Borowsky, SJ, Nelson, DB, Fortney, JC,  et al. 2002VA community-based outpatient clinics: performance measures based on patient perceptions of careMed Care40578586CrossRefPubMedGoogle Scholar
  8. 8.
    Zack, MM, Moriarty, DG, Stroup, DF, Ford, ES, Mokdad, AH 2004Worsening trends in adult health-related quality of life and self-rated health – United States, 1993–2001Public Health Rep119493505CrossRefPubMedGoogle Scholar
  9. 9.
    Rabin, R, Charro, F 2001EQ-5D: A measure of health status from the EuroQol GroupAnn Med33337343PubMedGoogle Scholar
  10. 10.
    Kind, P, Dolan, P, Gudex, C,  et al. 1998Variations in population health status: Results from a United Kingdom national questionnaire surveyBr Med J316736741Google Scholar
  11. 11.
    Wu, AW, Jacobson, KL, Frick, KD,  et al. 2002Validity and responsiveness of the euroqol as a measure of health-related quality of life in people enrolled in an AIDS clinical trialQual Life Res11273282CrossRefPubMedGoogle Scholar
  12. 12.
    Weintraub, WS, Foster, J, Culler, SD,  et al. 2004Methods for the economic and quality of life supplement to the cilostazol for RESTenosis (CREST) trialJ Invasive Cardiol16257259PubMedGoogle Scholar
  13. 13.
    Siderowf, A, Ravina, B, Glick, HA 2002Preference-based quality-of-life in patients with Parkinson’s diseaseNeurology59103108PubMedGoogle Scholar
  14. 14.
    Shaw, JW, Johnson, JA, Coons, SJ 2005US valuation of the EQ-5D health states: development and testing of the D1 valuation modelMed Care43203220CrossRefPubMedGoogle Scholar
  15. 15.
    Burstrom, K, Johannesson, M, Diderichsen, F 2001Swedish population health-related quality of life results using the EQ-5DQual Life Res10621635PubMedGoogle Scholar
  16. 16.
    Brazier, J, Jones, N, Kind, P 1993Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaireQual Life Res2169180CrossRefPubMedGoogle Scholar
  17. 17.
    Bélanger A, Berthelot JM, Guimond E, Houle C. A head-to-head comparison of two generic health status measures in the household population: McMaster Health Utilities Index (Mark 3) and the EQ-5D. Statistics Canada. April 2000.Google Scholar
  18. 18.
    Johnson, JA, Pickard, AS 2000Comparison of the EQ-5D and SF-12 health surveys in a general population survey in Alberta, CanadaMed Care38115121CrossRefPubMedGoogle Scholar
  19. 19.
    Jelsma, J, Ferguson, G 2004The determinants of self-reported health-related quality of life in a culturally and socially diverse South African communityBull World Health Organ82206212PubMedGoogle Scholar
  20. 20.
    Devlin, N, Hansen, P, Herbison, P 2000Variations in self-reported health status: Results from a New Zealand surveyNZ Med J113517520Google Scholar
  21. 21.
    Lacey, EA, Walters, SJ 2003Continuing inequality: Gender and social class influences on self perceived health after a heart attackJ Epidemiol Commun Health57622627Google Scholar
  22. 22.
    Fryback, DG, Dasbach, EJ, Klein, R,  et al. 1993The Beaver Dam Health Outcomes Study: Initial catalog of health-state quality factorsMed Decis Making1389102PubMedGoogle Scholar
  23. 23.
    Franks, P, Gold, MR, Fiscella, K 2003Sociodemographics, self-rated health, and mortality in the USSoc Sci Med5625052514CrossRefPubMedGoogle Scholar
  24. 24.
    Franks P, Gold MR. Fiscella K. The sociodemographic determinants of health status in the US. Statistics Canada. in press.Google Scholar
  25. 25.
    Kington, RS, Smith, JP 1997Socioeconomic status and racial and ethnic differences in functional status associated with chronic diseasesAm J Public Health87805810PubMedGoogle Scholar
  26. 26.
    Cohen, SB 2003Design strategies and innovations in the Medical Expenditure Panel SurveyMed Care41III5III12PubMedGoogle Scholar
  27. 27.
    MEPS Fact Sheet. January 2003. Agency for Healthcare Research and Quality, Rockville, MD. http://www.meps.; accessed May 25, 2005.Google Scholar
  28. 28.
    MEPS HC-050 2000 Full Year Consolidated Data File. Center for Financing, Access and Cost Trends. AHRQ. June 2003; available at; accessed May 25, 2005.Google Scholar
  29. 29.
    Sullivan, PW, Lawrence, WF, Ghushchyan, V 2005A national catalogue of preference-based scores for chronic conditions in the U.SMed Care43736749CrossRefPubMedGoogle Scholar
  30. 30.
    Walters, SJ, Brazier, JE 2003What is the relationship between the minimally important difference and health state utility values? The case of the SF-6DHealth Qual Life Outcomes14CrossRefPubMedGoogle Scholar
  31. 31.
    Grootendorst, P, Feeny, D, Furlong, W 2000Health Utilities Index Mark 3: evidence of construct validity for stroke and arthritis in a population health surveyMed Care38290299CrossRefPubMedGoogle Scholar
  32. 32.
    Burdine, JN, Felix, MR, Abel, AL,  et al. 2000The SF-12 as a population health measure: An exploratory examination of potential for applicationHealth Serv Res35885904PubMedGoogle Scholar
  33. 33.
    Ware, J,Jr, Kosinski, M, Keller, SD 1996A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validityMed Care34220233CrossRefPubMedGoogle Scholar
  34. 34.
    Ren, XS, Amick, BC 1996Racial and ethnic disparities in self-assessed health status: evidence from the National Survey of Families and HouseholdsEthn Health1293303PubMedCrossRefGoogle Scholar
  35. 35.
    SAS [computer program]. Version 9. Cary, NC: SAS Institute Inc., 2004.Google Scholar
  36. 36.
    Sorlie, PD, Backlund, E, Keller, JB 1995U.S. mortality by economic, demographic, and social characteristics: The National Longitudinal Mortality StudyAm J Pub Health85949956PubMedGoogle Scholar
  37. 37.
    Cooper, RS 1993Health and the social status of blacks in the United StatesAnn Epidemiol3137144PubMedGoogle Scholar
  38. 38.
    Otten, MW,Jr, Teutsch, SM, Williamson, DF,  et al. 1990The effect of known risk factors on the excess mortality of black adults in the United StatesJAMA263845850CrossRefPubMedGoogle Scholar
  39. 39.
    Howard, G, Anderson, RT, Russell, G,  et al. 2000Race, socioeconomic status, and cause-specific mortalityAnn Epidemiol10214223CrossRefPubMedGoogle Scholar
  40. 40.
    Smith, JP, Kington, R 1997Demographic and economic correlates of health in old ageDemography34159170PubMedGoogle Scholar
  41. 41.
    Sharma, S, Malarcher, AM, Giles, WH,  et al. 2004Racial, ethnic and socioeconomic disparities in the clustering of cardiovascular disease risk factorsEthn Dis144348PubMedGoogle Scholar
  42. 42.
    Osmond, DH, Vranizan, K, Schillinger, D,  et al. 1996Measuring the need for medical care in an ethnically diverse populationHealth Serv Res31551571PubMedGoogle Scholar
  43. 43.
    Shetterly, SM, Baxter, J, Mason, LD,  et al. 1996Self-rated health among Hispanic vs non-Hispanic white adults: The San Luis Valley Health and Aging StudyAm J Public Health8617981801PubMedCrossRefGoogle Scholar
  44. 44.
    Weinick, RM, Jacobs, EA, Stone, LC,  et al. 2004Hispanic healthcare disparities: challenging the myth of a monolithic Hispanic populationMed Care42313320PubMedGoogle Scholar
  45. 45.
    Hui, C, Triandis, HC 1989Effects of culture and response format in extreme response styleJ Cross-Cult Psychol20296309Google Scholar
  46. 46.
    Fuh, JL, Wang, SJ, Lu, SR,  et al. 2000Psychometric evaluation of a Chinese (Taiwanese) version of the SF-36 health survey amongst middle-aged women from a rural communityQual Life Res9675683CrossRefPubMedGoogle Scholar
  47. 47.
    Lam, CL, Gandek, B, Ren, XS,  et al. 1998Tests of scaling assumptions and construct validity of the Chinese (HK) version of the SF-36 Health SurveyJ Clin Epidemiol5111391147CrossRefPubMedGoogle Scholar
  48. 48.
    Wu, SC, Li, CY, Ke, DS 2000The agreement between self-reporting and clinical diagnosis for selected medical conditions among the elderly in TaiwanPublic Health114137142CrossRefPubMedGoogle Scholar
  49. 49.
    Fiscella, K, Franks, P, Gold, MR, Clancy, CM 2000Inequality in quality: Addressing socioeconomic, racial, and ethnic disparities in health careJAMA28325792584PubMedGoogle Scholar
  50. 50.
    Bierman, AS, Lurie, N, Collins, KS, Eisenberg, JM 2002Addressing racial and ethnic barriers to effective health care: The need for better dataHealth Aff (Millwood)2191102CrossRefGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Erica I. Lubetkin
    • 1
    Email author
  • Haomiao Jia
    • 2
  • Peter Franks
    • 3
  • Marthe R. Gold
    • 1
  1. 1.Department of Community Health and Social MedicineSophie Davis School of Biomedical Education/CUNY Medical SchoolNew YorkUSA
  2. 2.Department of Community MedicineMercer University School of MedicineMaconUSA
  3. 3.Department of Family and Community MedicineUniversity of CaliforniaDavis, SacrementoUSA

Personalised recommendations