Inequality in quality-adjusted life expectancy by educational attainment in Norway: an observational study
Abstract Background Health inequalities are often assessed in terms of life expectancy or health-related quality of life (HRQoL). Few studies combine both aspects into quality-adjusted life expectancy (QALE) to derive comprehensive estimates of lifetime health inequality. Furthermore, little is know...
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| Format: | Article |
| Language: | English |
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BMC
2023-05-01
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| Series: | BMC Public Health |
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| Online Access: | https://doi.org/10.1186/s12889-023-15663-2 |
| _version_ | 1797831902914150400 |
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| author | Nils Gutacker Jonas Minet Kinge Jan Abel Olsen |
| author_facet | Nils Gutacker Jonas Minet Kinge Jan Abel Olsen |
| author_sort | Nils Gutacker |
| collection | DOAJ |
| description | Abstract Background Health inequalities are often assessed in terms of life expectancy or health-related quality of life (HRQoL). Few studies combine both aspects into quality-adjusted life expectancy (QALE) to derive comprehensive estimates of lifetime health inequality. Furthermore, little is known about the sensitivity of estimated inequalities in QALE to different sources of HRQoL information. This study assesses inequalities in QALE by educational attainment in Norway using two different measures of HRQoL. Methods We combine full population life tables from Statistics Norway with survey data from the Tromsø study, a representative sample of the Norwegian population aged ≥ 40. HRQoL is measured using the EQ-5D-5L and EQ-VAS instruments. Life expectancy and QALE at 40 years of age are calculated using the Sullivan-Chiang method and are stratified by educational attainment. Inequality is measured as the absolute and relative gap between individuals with lowest (i.e. primary school) and highest (university degree 4 + years) educational attainment. Results People with the highest educational attainment can expect to live longer lives (men: + 17.9% (95%CI: 16.4 to 19.5%), women: + 13.0% (95%CI: 10.6 to 15.5%)) and have higher QALE (men: + 22.4% (95%CI: 20.4 to 24.4%), women: + 18.3% (95%CI: 15.2 to 21.6%); measured using EQ-5D-5L) than individuals with primary school education. Relative inequality is larger when HRQoL is measured using EQ-VAS. Conclusion Health inequalities by educational attainment become wider when measured in QALE rather than LE, and the degree of this widening is larger when measuring HRQoL by EQ-VAS than by EQ-5D-5L. We find a sizable educational gradient in lifetime health in Norway, one of the most developed and egalitarian societies in the world. Our estimates provide a benchmark against which other countries can be compared. |
| first_indexed | 2024-04-09T13:59:11Z |
| format | Article |
| id | doaj.art-ab2cf0d6d0f14e2bbdf1dad0b5466e2e |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-04-09T13:59:11Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-ab2cf0d6d0f14e2bbdf1dad0b5466e2e2023-05-07T11:26:25ZengBMCBMC Public Health1471-24582023-05-012311910.1186/s12889-023-15663-2Inequality in quality-adjusted life expectancy by educational attainment in Norway: an observational studyNils Gutacker0Jonas Minet Kinge1Jan Abel Olsen2Centre for Health Economics, University of YorkNorwegian Institute of Public HealthNorwegian Institute of Public HealthAbstract Background Health inequalities are often assessed in terms of life expectancy or health-related quality of life (HRQoL). Few studies combine both aspects into quality-adjusted life expectancy (QALE) to derive comprehensive estimates of lifetime health inequality. Furthermore, little is known about the sensitivity of estimated inequalities in QALE to different sources of HRQoL information. This study assesses inequalities in QALE by educational attainment in Norway using two different measures of HRQoL. Methods We combine full population life tables from Statistics Norway with survey data from the Tromsø study, a representative sample of the Norwegian population aged ≥ 40. HRQoL is measured using the EQ-5D-5L and EQ-VAS instruments. Life expectancy and QALE at 40 years of age are calculated using the Sullivan-Chiang method and are stratified by educational attainment. Inequality is measured as the absolute and relative gap between individuals with lowest (i.e. primary school) and highest (university degree 4 + years) educational attainment. Results People with the highest educational attainment can expect to live longer lives (men: + 17.9% (95%CI: 16.4 to 19.5%), women: + 13.0% (95%CI: 10.6 to 15.5%)) and have higher QALE (men: + 22.4% (95%CI: 20.4 to 24.4%), women: + 18.3% (95%CI: 15.2 to 21.6%); measured using EQ-5D-5L) than individuals with primary school education. Relative inequality is larger when HRQoL is measured using EQ-VAS. Conclusion Health inequalities by educational attainment become wider when measured in QALE rather than LE, and the degree of this widening is larger when measuring HRQoL by EQ-VAS than by EQ-5D-5L. We find a sizable educational gradient in lifetime health in Norway, one of the most developed and egalitarian societies in the world. Our estimates provide a benchmark against which other countries can be compared.https://doi.org/10.1186/s12889-023-15663-2Health inequalityHealth-related quality of lifeEducational attainmentQuality adjusted life expectancyNorway |
| spellingShingle | Nils Gutacker Jonas Minet Kinge Jan Abel Olsen Inequality in quality-adjusted life expectancy by educational attainment in Norway: an observational study BMC Public Health Health inequality Health-related quality of life Educational attainment Quality adjusted life expectancy Norway |
| title | Inequality in quality-adjusted life expectancy by educational attainment in Norway: an observational study |
| title_full | Inequality in quality-adjusted life expectancy by educational attainment in Norway: an observational study |
| title_fullStr | Inequality in quality-adjusted life expectancy by educational attainment in Norway: an observational study |
| title_full_unstemmed | Inequality in quality-adjusted life expectancy by educational attainment in Norway: an observational study |
| title_short | Inequality in quality-adjusted life expectancy by educational attainment in Norway: an observational study |
| title_sort | inequality in quality adjusted life expectancy by educational attainment in norway an observational study |
| topic | Health inequality Health-related quality of life Educational attainment Quality adjusted life expectancy Norway |
| url | https://doi.org/10.1186/s12889-023-15663-2 |
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