Quality of Life Research

, Volume 21, Issue 1, pp 155–160 | Cite as

Validation of the EQ-5D in a general population sample in urban China

  • Hong-Mei Wang
  • Donald L. Patrick
  • Todd C. Edwards
  • Anne M. Skalicky
  • Hai-Yan Zeng
  • Wen-Wen Gu



To evaluate the reliability and validity of the EQ-5D in a general population sample in urban China.


Thousand and eight hundred respondents in 18 communities of Hangzhou, China were recruited by multi-stage stratified random sampling. Respondents self-administered a questionnaire including the EQ-5D, the SF-36, and demographic questions. Test–retest reliability at 2-week intervals was evaluated using Kappa coefficient, the intraclass correlation coefficient. The standard error of measurement (SEM) was used to indicate the absolute measurement error. Construct validity was established using convergent, discriminant, and known groups analyses.


Complete data for all EQ-5D dimensions were available for 1,747 respondents (97%). Kappa values were from 0.35 to 1.0. The ICCs of test–retest reliability were 0.53 for the EQ-5D index score and 0.87 for the EQ VAS score. The SEM values were 0.13 (9.22% range) and 4.20 (4.20% range) for the EQ-5D index and EQ VAS scores, respectively. The Pearson’s correlation coefficients between the EQ-5D and the SF-36 were stronger between comparable dimensions than those between less comparable dimensions, demonstrating convergent and discriminant evidence of construct validity. The Chinese EQ-5D distinguished well between known groups: respondents who reported poor general health and chronic diseases had worse HRQoL than those without. Older people, females, people widowed or divorced, and those with a lower socioeconomic status reported poorer HRQoL. Respondents reporting no problems on any EQ-5D dimension had better scores on the SF-36 summary scores than those reporting problems.


The Chinese version of the EQ-5D demonstrated acceptable construct validity and fair to moderate levels of test–retest reliability in an urban general population in China.


EQ-5D General population HRQoL China 



Health-related quality of life


Visual analogue scale


  1. 1.
    Rabin, R., & de Charro, F. (2001). EQ-5D: A measure of health status from the EuroQol Group. Annals of Medicine, 33(5), 337–343.PubMedCrossRefGoogle Scholar
  2. 2.
    Wang, H., Kindig, D. A., & Mullahy, J. (2005). Variation in Chinese population health related quality of life: results from a EuroQol study in Beijing, China. Quality of Life Research, 14(1), 119–132.PubMedCrossRefGoogle Scholar
  3. 3.
    Sun, S., Chen, J., Johannesson, M., Kind, P., Xu, L., Zhang, Y., et al. (2011). Population health status in China: EQ-5D results, by age, sex and socio-economic status, from the national health services survey 2008. Quality of Life Research, 20(3), 309–320.PubMedCrossRefGoogle Scholar
  4. 4.
    Zhao, F. L., Yue, M., Yang, H., Wang, T., Wu, J. H., & Li, S. C. (2010). Validation and comparison of EuroQol and short form 6D in chronic prostatitis patients. Value Health, 13(5), 649–656.PubMedCrossRefGoogle Scholar
  5. 5.
    Lubetkin, E. I., Jia, H., & Gold, M. R. (2004). Construct validity of the EQ-5D in low-income Chinese American primary care patients. Quality of Life Research, 13(8), 1459–1468.PubMedCrossRefGoogle Scholar
  6. 6.
    Leung, B., Luo, N., So, L., & Quan, H. (2007). Comparing three measures of health status (perceived health with Likert-type scale, EQ-5D, and number of chronic conditions) in Chinese and white Canadians. Medical Care, 45(7), 610–617.PubMedCrossRefGoogle Scholar
  7. 7.
    Luo, N., Chew, L. H., Fong, K. Y., Koh, D. R., Ng, S. C., Yoon, K. H., et al. (2003). Validity and reliability of the EQ-5D self-report questionnaire in Chinese-speaking patients with rheumatic diseases in Singapore. Ann Acad Med Singap, 32(5), 685–690.PubMedGoogle Scholar
  8. 8.
    Brooks, R. (1996). EuroQol: The current state of play. Health Policy, 37(1), 53–72.PubMedCrossRefGoogle Scholar
  9. 9.
    Dolan, P. (1997). Modeling valuations for EuroQol health states. Medical Care, 35(11), 1095–1108.PubMedCrossRefGoogle Scholar
  10. 10.
    Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 Health survey manual and interpretation guide. Boston, MA: The Health Institute, New England Medical Center.Google Scholar
  11. 11.
    Li, L., Wang, H. M., & Shen, Y. (2003). Chinese SF-36 health Survey: Translation, cultural adaptation, validation, and normalisation. Journal of Epidemiology and Community Health, 57(4), 259–263.PubMedCrossRefGoogle Scholar
  12. 12.
    Scientific Advisory Committee of the Medical Outcomes Trust. (2002). Assessing health status and quality-of-life instruments: attributes and review criteria. Quality of Life Research, 11(3), 193–205.CrossRefGoogle Scholar
  13. 13.
    Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33(1), 159–174.PubMedCrossRefGoogle Scholar
  14. 14.
    Shrout, P. E., & Fleiss, J. L. (1979). Intraclass correlations: uses in assessing rater reliability. Psychological Bulletin, 86(2), 420–428.PubMedCrossRefGoogle Scholar
  15. 15.
    Staquet, M. J., Hays, R. D., & Fayers, P. M. (1998). Quality of life assessment in clinical trials: Methods and practice (pp. 169–182). Oxford: Oxford University Press.Google Scholar
  16. 16.
    Terwee, C. B., Bot, S. D., de Boer, M. R., van der Windt, D. A., Knol, D. L., Dekker, J., et al. (2007). Quality criteria were proposed for measurement properties of health status questionnaires. Journal of Clinical Epidemiology, 60(1), 34–42.PubMedCrossRefGoogle Scholar
  17. 17.
    de Vet, H. C., Terwee, C. B., Knol, D. L., & Bouter, L. M. (2006). When to use agreement versus reliability measures. Journal of Clinical Epidemiology, 59(10), 1033–1039.PubMedCrossRefGoogle Scholar
  18. 18.
    Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159.PubMedCrossRefGoogle Scholar
  19. 19.
    Tsuchiya, A., Ikeda, S., Ikegami, N., Nishimura, S., Sakai, I., Fukuda, T., et al. (2002). Estimating an EQ-5D population value set: the case of Japan. Health Economics, 11(4), 341–353.PubMedCrossRefGoogle Scholar
  20. 20.
    Johnson, J. A., & Coons, S. J. (1998). Comparison of the EQ-5D and SF-12 in an adult US sample. Quality of Life Research, 7(2), 155–166.PubMedCrossRefGoogle Scholar
  21. 21.
    Kind, P., Dolan, P., Gudex, C., & Williams, A. (1998). Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ, 316(7133), 736–741.PubMedCrossRefGoogle Scholar
  22. 22.
    Kontodimopoulos, N., Pappa, E., Niakas, D., Yfantopoulos, J., Dimitrakaki, C., & Tountas, Y. (2008). Validity of the EuroQoL (EQ-5D) instrument in a Greek general population. Value Health, 11(7), 1162–1169.PubMedCrossRefGoogle Scholar
  23. 23.
    Brazier, J., Jones, N., & Kind, P. (1993). Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire. Quality of Life Research, 2(3), 169–180.PubMedCrossRefGoogle Scholar
  24. 24.
    Hangzhou Bureau of Statistics. (2008). Hangzhou statistical yearbook. http://www.hzstats.gov.cn/web/. Accessed 15th September 2010.
  25. 25.
    Fryback, D. G., Dunham, N. C., Palta, M., Hanmer, J., Buechner, J., Cherepanov, D., et al. (2007). US norms for six generic health-related quality-of-life indexes from the National Health Measurement study. Medical Care, 45(12), 1162–1170.PubMedCrossRefGoogle Scholar
  26. 26.
    König, H. H., Bernert, S., Angermeyer, M. C., Matschinger, H., Martinez, M., Vilagut, G., et al. (2009). Comparison of population health status in six european countries: Results of a representative survey using the EQ-5D questionnaire. Medical Care, 47(2), 255–261.PubMedCrossRefGoogle Scholar
  27. 27.
    Kottner, J. (2009). Interrater reliability and the kappa statistic: a comment on Morris et al. (2008). International Journal of Nursing Studies, 46(1), 140–141.PubMedCrossRefGoogle Scholar
  28. 28.
    Bartko, J. J. (1991). Measurement and reliability: statistical thinking considerations. Schizophrenia Bulletin, 17(3), 483–489.PubMedGoogle Scholar
  29. 29.
    Terwee, C. B., Roorda, L. D., Knol, D. L., De Boer, M. R., & De Vet, H. C. (2009). Linking measurement error to minimal important change of patient-reported outcomes. Journal of Clinical Epidemiology, 62(10), 1062–1067.PubMedCrossRefGoogle Scholar
  30. 30.
    de Boer, M. R., de Vet, H. C., Terwee, C. B., Moll, A. C., Völker-Dieben, H. J., & van Rens, G. H. (2005). Changes to the subscales of two vision-related quality of life questionnaires are proposed. Journal of Clinical Epidemiology, 58(12), 1260–1268.PubMedCrossRefGoogle Scholar
  31. 31.
    Mannion, A. F., Boneschi, M., Teli, M., Luca, A., Zaina, F., Negrini, S., et al. (2011). Reliability and validity of the cross-culturally adapted Italian version of the core outcome measures index. Eur Spine J. [Epub ahead of print].Google Scholar
  32. 32.
    Chang, T. J., Tarn, Y. H., Hsieh, C. L., Liou, W. S., Shaw, J. W., & Chiou, X. G. (2007). Taiwanese version of the EQ-5D: validation in a representative sample of the Taiwanese population. Journal of the Formosan Medical Association, 106(12), 1023–1031.PubMedCrossRefGoogle Scholar
  33. 33.
    Sjöström, O., & Holst, D. (2002). Validity of a questionnaire survey: response patterns in different subgroups and the effect of social desirability. Acta Odontologica Scandinavica, 60(3), 136–140.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  • Hong-Mei Wang
    • 1
  • Donald L. Patrick
    • 2
  • Todd C. Edwards
    • 2
  • Anne M. Skalicky
    • 2
  • Hai-Yan Zeng
    • 1
  • Wen-Wen Gu
    • 1
  1. 1.Institute of Social Medicine and Family Medicine, School of MedicineZhejiang UniversityHangzhouPeople’s Republic of China
  2. 2.Department of Health ServicesUniversity of WashingtonSeattleUSA

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