Abstract
Aim
To analyze the association between ceiling effects on the EQ-5D 5L and morbidity in a general population sample.
Methods
We used a cross-sectional sample of the German general population (n = 5007) to describe the frequency of health state “11111” and “no problems”-answers on the five single dimensions stratified by the number of diseases for which participants utilized health care during the last 6 months. For the five single dimensions we also used specific criteria to analyze their discriminative ability. A logit-model was applied for a multivariate analysis of ceiling effects.
Results
31% of participants reported the health state “11111.” This percentage strongly decreased with increasing morbidity, down to 4.9% if four or more diseases were present. The dimensions “mobility,” “usual activities,” and “pain/discomfort” showed good discriminative abilities. The dimensions “anxiety/depression” and “self -care” were able to discriminate between different levels of morbidity, but nevertheless showed strong ceiling effects, in particular “self-care.”
Conclusion
When analyzing ceiling effects of the EQ-5D 5L, one has to draw attention to morbidity since high proportions of participants indicating the best health state might result from being healthy regarding the dimensions assessed by the EQ-5D, in particular in general population datasets.
References
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.
Herdman, M., Gudex, C., Lloyd, A., Janssen, M., Kind, P., Parkin, D., et al. (2011). Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 20(10), 1727–1736.
Feng, Y., Devlin, N., & Herdman, M. (2015). Assessing the health of the general population in England: How do the three- and five-level versions of EQ-5D compare?. Health and Quality of Life Outcomes, 13, 171.
Ferreira, L. N., Ferreira, P. L., Ribeiro, F. P., & Pereira, L. N. (2016). Comparing the performance of the EQ-5D-3L and the EQ-5D-5L in young Portuguese adults. Health and Quality of Life Outcomes, 14, 89.
Gracia-Gordillo, M. A., Adsuar, J. C., & Olivares, P. R. (2016). Normative values of EQ-5D-5L: In a Spanish representative population sample from Spanish Health Survey, 2011. Quality of Life Research, 25, 1313–1321.
Hinz, A., Kohlmann, T., Stöbel-Richter, Y., Zenger, M., & Brähler, E. (2014). The quality of life questionnaire EQ-5D-5L: Psychometric properties and normative values for the general German population. Quality of Life Research, 23, 443–447.
Huber, M. B., Reitmeir, P., Vogelmann, M., & Leidl, R. (2016). EQ-5D-5L in the General German Population: Comparison and evaluation of three yearly cross-section surveys. International Journal of Environmental Research and Publich Health, 13, 343.
Kim, T. H., Jo, M.-W., Lee, S.-I., Kim, S. H., & Chung, S. M. (2013). Psychometric properties of the EQ-5D-5L in the general population of South Korea. Quality of Life Research, 22, 2245–2253.
H., K. S., Kim, H. J., Lee, S.-I., & Jo, M.-W. (2012). Comparing the psychometric properties of the EQ-5D-3L and EQ-5D-5L in cancer patients in Korea. Quality of Life Research, 21, 1065–1073.
Grupp, H., Konig, H. H., & Konnopka, A. (2016). Health care utilisation and costs in the general population in Germany. Health Policy (Amsterdam, Netherlands), 120(2), 159–169.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest.
Ethical approval
All procedures were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all participants.
Rights and permissions
About this article
Cite this article
Konnopka, A., Koenig, HH. The “no problems”-problem: an empirical analysis of ceiling effects on the EQ-5D 5L. Qual Life Res 26, 2079–2084 (2017). https://doi.org/10.1007/s11136-017-1551-3
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-017-1551-3