Skip to main content

Health-Related Quality of Life in a Low-Socioeconomic Status Public Rental-Flat Population in Singapore

Abstract

Health-related quality of life (HRQoL) is a well-established measure of health and general well-being. Socioeconomic status (SES) can affect HRQoL. We sought to determine whether there were differences in HRQoL between low versus higher area-SES flat communities in Singapore. Residents in two integrated public housing precincts comprising of rental-flat blocks (low area-SES neighborhood) and neighboring owner-occupied blocks (higher area-SES neighborhood) were asked to rate their self-perceived HRQoL using the EuroQol Group five dimensions (EQ-5D) instrument. The EQ-5D assesses HRQoL in five domains (mobility, self-care, usual activities, anxiety/mood and pain) and with a global visual analogue scale (EQ-VAS). We evaluated differences in HRQoL between the rental and owner-occupied neighborhoods, and factors associated with anxiety/depression in the rental-flat neighborhood using multivariate logistic regression. The participation rate was 89.1% (634/711). In the owner-occupied neighborhood, 56.7% (216/381) were in full health, compared with 54.2% (137/253) in the rental-flat population (OR = 0.90, 95%CI = 0.66–1.24, p = 0.568). Across the five domains, staying in a rental-flat neighborhood was independently associated with anxiety/depression (adjusted odds ratio [aOR] = 1.79, 95%CI = 1.10–2.92, p = 0.019). In the rental-flat population, having anxiety/depression was independently associated with minority ethnicity, problems with self –care, pain/discomfort, difficulty with healthcare costs, and not being on subsidized primary care (p < 0.05). There was no significant difference on the EQ-VAS between the two neighborhoods (p = 0.627). Staying in a low area-SES neighborhood was associated with more mental health problems. In the rental-flat population, self-reported anxiety/depression was associated with minority ethnicity, physical health problems, and financial disadvantage in healthcare.

This is a preview of subscription content, access via your institution.

References

  1. Browne-Yung, K., Ziersch, A., & Baum, F. (2013). 'Faking til you make it': Social capital accumulation of individuals on low incomes living in contrasting socio-economic neighbourhoods and its implications for health and wellbeing. Social Science & Medicine, 85, 9–17.

    Article  Google Scholar 

  2. Callahan, L., Martin, K., Shreffler, J., Kumar, D., Schoster, B., Kaufman, J., & Schwartz, T. (2011). Independent and combined influence of homeownership, occupation, education, income, and community povertyon physical health in persons with arthritis. Arthritis Care Res (Hoboken), 63, 643–653.

    Article  Google Scholar 

  3. Charlson, M., Pompei, P., Ales, K., & MacKenzie, C. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40, 373–383.

    Article  Google Scholar 

  4. Choi, Y., Kim, J., & Park, E. (2015). The effect of subjective and objective social class on health-related quality of life: New paradigm using longitudinal analysis. Health and Quality of Life Outcomes, 13, 121.

    Article  Google Scholar 

  5. Delpierre, C., Kelly-Irving, M., Munch-Petersen, M., Lauwers-Cances, V., Datta, G., Lepage, B., & Lang, T. (2012). SRH and HrQOL: Does social position impact differently on their link with health status? BMC Public Health, 12, 19.

    Article  Google Scholar 

  6. Department of Statistics Singapore (2015). Home Ownership Rate of Resident Households. http://www.singstat.gov.sg/statistics/visualising-data/charts/home-ownership-rate-of-resident-households. Accessed 22 June 2015.

  7. Drukker, M., & van Os, J. (2003). Mediators of neighbourhood socioeconomic deprivation and quality of life. Social Psychiatry and Psychiatric Epidemiology, 38, 698–706.

    Article  Google Scholar 

  8. Feng, X., & Thomas, A. (2013). Neighborhood socioeconomic circumstances and the Co-occurrence of unhealthy lifestyles: Evidence from 206,457 Australians in the 45 and up study. PloS One, 8, e72643.

    Article  Google Scholar 

  9. George, P., Heng, B., Wong, L., & Ng, C. (2014). Determinants of health-related quality of life among community dwelling elderly. Annals of the Academy of Medicine, Singapore, 43, 3–10.

    Google Scholar 

  10. Hartog, L., Landman, G., Cimzar-Sweelssen, M., Knipscheer, A., Groenier, K., Kleefstra, N., et al. (2016). Health-related quality of life, rehabilitation and mortality in a nursing home population. The Netherlands Journal of Medicine, 74(6), 247–256.

    Google Scholar 

  11. Herdman, M., Gudex, C., Lloyd, A., Janssen, M. F., 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, 20(10), 1727–1736.

    Article  Google Scholar 

  12. Housing & Development Board Singapore (2013a). Public housing in Singapore: Residents' profile, housing satisfaction and preferences: HDB sample household survey 2013. Singapore: Housing & Development Board Singapore.

  13. Housing & Development Board Singapore (2013b, May 15). Rents & deposits. http://www.Hdb.Gov.sg/fi10/fi10323p.Nsf/w/RentDirectHDBRentDeposit?OpenDocument. Acccessed 22 June 2015.

  14. Joshi, V., Chen, Y., & Lim, J. (2009). Public perceptions of the factors that constitute a good healthcare system. Singapore Medical Journal, 50(10), 982–989.

    Google Scholar 

  15. Kim, J., & Park, E. (2015). Impact of socioeconomic status and subjective social class on overall and health-related quality of life. BMC Public Health, 15, 783.

    Article  Google Scholar 

  16. Landman, G., van Hateren, K., Kleefstra, N., Groenier, K., Gans, R., & Bilo, H. (2010). Health-related quality of life and mortality in a general and elderly population of patients with type 2 diabetes (ZODIAC-18). Diabetes Care, 33(11), 2378–2382.

    Article  Google Scholar 

  17. Lee, J., Park, J., & Kim, M. (2015). Social and physical environments and self-rated health in urban and rural communities in Korea. International Journal of Environmental Research and Public Health, 12, 14329–14341.

    Article  Google Scholar 

  18. Leow, M., Griva, K., Choo, R., Wee, H., Thumboo, J., Tai, E., & Newman, S. (2013). Determinants of health-related quality of life (HRQoL) in the multiethnic Singapore population - a National Cohort Study. PloS One, 8, e67138.

    Article  Google Scholar 

  19. Lim, J., & Joshi, V. (2008). Public perceptions of healthcare in Singapore. Annals of the Academy of Medicine, Singapore, 37(2), 91–95.

    Google Scholar 

  20. Lin, H. (2014). Study of the community: rental and owner blocks- discussion of how the built environment affects community bonding among rental blocks residents. (Masters), National University of Singapore, Singapore.

  21. Lubben, J., Blozik, E., Gillmann, G., Iliffe, S., von Rentel, N., Kruse, W., et al. (2006). Performance of an abbreviated version of the Lubben social network scale among three European community-dwelling older adult populations. Gerontologist, 46, 503–513.

    Article  Google Scholar 

  22. Luo, N., Chew, L., Fong, K., Koh, D., Ng, S., Yoon, K., et al. (2003a). Validity and reliability of the EQ-5D self-report questionnaire in Chinese-speaking patients with rheumatic diseases in Singapore. Annals of the Academy of Medicine, Singapore, 32, 685–690.

    Google Scholar 

  23. Luo, N., Chew, L., Fong, K., Koh, D., Ng, S., Yoon, K., et al. (2003b). Validity and reliability of the EQ-5D self-report questionnaire in English-speaking Asian patients with rheumatic diseases in Singapore. Qual Life Research, 12, 87–92.

    Article  Google Scholar 

  24. Luo, N., Wang, P., Thumboo, J., Lim, Y., & Vrijhoef, H. (2014). Valuation of EQ-5D-3L health states in Singapore: Modeling of time trade-off values for 80 empirically observed health states. PharmacoEconomics, 32(5), 495–507.

    Article  Google Scholar 

  25. Luo, N., Wang, Y., How, C., Wong, K., Shen, L., Tay, E., et al. (2015a). Cross-cultural measurement equivalence of the EQ-5D-5L items for English-speaking Asians in Singapore. Quality of Life Research, 24(6), 1565–1574.

    Article  Google Scholar 

  26. Luo, N., Wang, Y., How, C., Wong, K., Shen, L., Tay, E., et al. (2015b). Interpretation and use of EQ-5D-5L response labels varied with survey language among Asians in Singapore. Journal of Clinical Epidemiology, 68(10), 1195–1204.

    Article  Google Scholar 

  27. Meng, T., & Chen, H. (2014). A multilevel analysis of social capital and self-rated health: Evidence from China. Health & Place, 27, 38–44.

    Article  Google Scholar 

  28. Ministry of Health Singapore (2015). What is the Community Health Assist Scheme (CHAS). https://www.chas.sg/content.aspx?id=303. Acccessed 22 June 2015.

  29. Pan, C., Wang, X., Ma, Q., Sun, H., Xu, Y., & Wang, P. (2015). Cognitive dysfunction and health-related quality of life among older Chinese. Scientific Reports, 25, 17301.

    Article  Google Scholar 

  30. Poortinga, W., Dunstan, F., & Fone, D. (2007). Perceptions of the neighbourhood environment and self rated health: A multilevel analysis of the Caerphilly health and social needs study. BMC Public Health, 7, 285.

    Article  Google Scholar 

  31. Quah, J., Luo, N., Ng, W., How, C., & Tay, E. (2011). Health-related quality of life is associated with diabetic complications, but not with short-term diabetic control in primary care. Annals of the Academy of Medicine, Singapore, 40(6), 276–286.

    Google Scholar 

  32. van Hout, B., Janssen, M., Feng, Y., Kohlmann, T., Busschbach, J., Golicki, D., et al. (2012). Interim scoring for the EQ-5D-5L: Mapping the EQ-5D-5L to EQ-5D-3L value sets. Value in Health, 15(5), 708–715.

    Article  Google Scholar 

  33. Venkataraman, K., Khoo, C., Wee, H., Tan, C., Ma, S., Heng, D., et al. (2014). Associations between disease awareness and health-related quality of life in a multi-ethnic Asian population. PloS One, 26, e113802.

    Article  Google Scholar 

  34. Wang, Y., Tan, N., Tay, E., Thumboo, J., & Luo, N. (2015). Cross-cultural measurement equivalence of the 5-level EQ-5D (EQ-5D-5L) in patients with type 2 diabetes mellitus in Singapore. Qual Life Outcomes, 13(1), 103.

    Article  Google Scholar 

  35. Wee, L., & Koh, G. (2012). Individual and neighborhood social factors of hypertension management in a low-socioeconomic status population: A community-based case-control study in Singapore. Hypertension Research, 35(3), 295–303.

    Article  Google Scholar 

  36. Wee, H., Loke, W., Li, S., Fong, K., Cheung, Y., Machin, D., et al. (2007). Cross-cultural adaptation and validation of Singapore Malay and Tamil versions of the EQ-5D. Annals of the Academy of Medicine, Singapore, 36, 403–408.

    Google Scholar 

  37. Wee, L., Yeo, W., Yang, G., Hannan, N., Lim, K., Chua, C., et al. (2012). Individual and area level socioeconomic status and its association with cognitive function and cognitive impairment (low MMSE) among community-dwelling elderly in Singapore. Dement Geriatr Cogn Dis Extra, 2(1), 529–542.

    Article  Google Scholar 

  38. Wee, L., Lim, L., Shen, T., Lee, E., Chia, Y., Tan, A., & Koh, G. (2014a). Choice of primary health care source in an urbanized low-income community in Singapore: A mixed-methods study. Family Practice, 31(1), 81–91.

    Article  Google Scholar 

  39. Wee, L., Yong, Y., Chng, M., Chew, S., Cheng, L., Chua, Q., et al. (2014b). Individual and area-level socioeconomic status and their association with depression amongst community-dwelling elderly in Singapore. Aging & Mental Health, 18(5), 628–641.

    Article  Google Scholar 

  40. Wee, L., Sin, D., Cher, W., Li, Z., Shibli, S., & Koh, G. (2016). Chronic pain in a low socioeconomic status population in Singapore: A cross-sectional study. Pain Medicine, 17, 864. doi:10.1093/pm/pnv115.

Download references

Acknowledgements

We thank the Neighborhood Health Screening Organising Committee; Saw Swee Hock School of Public Health; Yong Loo Lin School of Medicine, National University of Singapore for providing the non-financial resources to organize this program and supporting this study.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Liang En Wee.

Ethics declarations

Conflict of Interest

The authors report no conflict of interest.

Funding

Saw Swee Hock School of Public Health provided funding support for the purchasing of medical consumables. WLE was supported by a Pitch-For-Funds grant from the Division of Medicine, Singapore General Hospital, Singapore.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wee, L.E., Daniel, P., Sim, A. et al. Health-Related Quality of Life in a Low-Socioeconomic Status Public Rental-Flat Population in Singapore. Applied Research Quality Life 13, 179–195 (2018). https://doi.org/10.1007/s11482-017-9519-6

Download citation

Keywords

  • Health-related quality of life
  • Low income
  • Socioeconomic status
  • Anxiety