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Purpose <p>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.</p> Methods <p>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.</p> Results <p>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 <i>p</i> &lt; 0.10 in seven, of which four at <i>p</i> &lt; 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.</p> Conclusion <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月15日

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  • Admassu N. Lamu,
  • Gang Chen,
  • Ling Jie Cheng,
  • Jan Abel Olsen

摘要

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.