Health inequity assessment in Brazil: is EQ-5D-3L sensible enough to detect differences among distinct socioeconomic groups?
Abstract Background Multidimensional health-related quality of life (HRQOL) instruments, such as the EQ-5D, are increasingly used to assess inequalities in health. However, it is necessary to explore the ability of these instruments to capture differences between population groups, especially in low...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-02-01
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| Series: | Health and Quality of Life Outcomes |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12955-024-02235-0 |
| _version_ | 1797273209480937472 |
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| author | Bernardo Rangel Tura Milene Rangel da Costa Sylvia Lordello Danillo Barros Yuri Souza Marisa da Silva Santos |
| author_facet | Bernardo Rangel Tura Milene Rangel da Costa Sylvia Lordello Danillo Barros Yuri Souza Marisa da Silva Santos |
| author_sort | Bernardo Rangel Tura |
| collection | DOAJ |
| description | Abstract Background Multidimensional health-related quality of life (HRQOL) instruments, such as the EQ-5D, are increasingly used to assess inequalities in health. However, it is necessary to explore the ability of these instruments to capture differences between population groups, especially in low/middle-income countries. This study aimed to investigate whether the EQ-5D-3L instrument can detect differences in HRQOL between groups of different socioeconomic status (SES) in Brazil. Methods Data collection occurred during the Brazilian EQ-5D-3L valuation study and included respondents aged 18 to 64 years enrolled in urban areas. SES was aggregated into three categories: “higher” (A and B), “intermediate” (C) and “lower” (D and E). EQ-5D-3L index was calculated considering the Brazilian value set. A mixed-effects regression model was estimated with random effects on individuals and marginal effects on SES, sex, and educational attainment. Odds ratios for the chance of reporting problems for each EQ-5D dimension were estimated by logistic regression. Results A total of 9,148 respondents were included in the study. Mean age was 37.80 ± 13.13 years, 47.4% were men and the majority was ranked as classes B or C (38.4% and 50.7%, respectively). Participants in lower SES classes reported increasingly poorer health compared to individuals in higher classes. The mean EQ-5D-3L index decreased as SES deteriorates being significantly higher for classes A and B (0.874 ± 0.14) compared to class C (0.842 ± 0.15) and classes D and E (0.804 ± 0.17) (p < 0.001). The same was observed for the mean EQ-VAS scores (84.0 ± 13.8 in classes A and B, 81.0 ± 17 in class C and 78.3 ± 18.7 in class C [p < 0.001]). The multivariate analysis confirmed that SES is an independent factor that effects EQ-5D-3L index measures. Participants in intermediate and lower SES classes have a statistically significant lower EQ-5D-3L index compared to participants in classes A and B, regardless of age, sex, and educational attainment. Conclusion In a Brazilian population sample, the EQ-5D-3L instrument was able to detect important differences between groups with distinct socioeconomic statuses (SES). The EQ-5D-3L is useful for exploring inequities in health. |
| first_indexed | 2024-03-07T14:40:17Z |
| format | Article |
| id | doaj.art-efde808bd2c841fc8d4cbfe1f9730365 |
| institution | Directory Open Access Journal |
| issn | 1477-7525 |
| language | English |
| last_indexed | 2024-03-07T14:40:17Z |
| publishDate | 2024-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Health and Quality of Life Outcomes |
| spelling | doaj.art-efde808bd2c841fc8d4cbfe1f97303652024-03-05T20:26:13ZengBMCHealth and Quality of Life Outcomes1477-75252024-02-012211710.1186/s12955-024-02235-0Health inequity assessment in Brazil: is EQ-5D-3L sensible enough to detect differences among distinct socioeconomic groups?Bernardo Rangel Tura0Milene Rangel da Costa1Sylvia Lordello2Danillo Barros3Yuri Souza4Marisa da Silva Santos5Centre of Health Technology Assessment, National Institute of CardiologyCentre of Health Technology Assessment, National Institute of CardiologyInstituto DaraInstituto DaraInstituto DaraCentre of Health Technology Assessment, National Institute of CardiologyAbstract Background Multidimensional health-related quality of life (HRQOL) instruments, such as the EQ-5D, are increasingly used to assess inequalities in health. However, it is necessary to explore the ability of these instruments to capture differences between population groups, especially in low/middle-income countries. This study aimed to investigate whether the EQ-5D-3L instrument can detect differences in HRQOL between groups of different socioeconomic status (SES) in Brazil. Methods Data collection occurred during the Brazilian EQ-5D-3L valuation study and included respondents aged 18 to 64 years enrolled in urban areas. SES was aggregated into three categories: “higher” (A and B), “intermediate” (C) and “lower” (D and E). EQ-5D-3L index was calculated considering the Brazilian value set. A mixed-effects regression model was estimated with random effects on individuals and marginal effects on SES, sex, and educational attainment. Odds ratios for the chance of reporting problems for each EQ-5D dimension were estimated by logistic regression. Results A total of 9,148 respondents were included in the study. Mean age was 37.80 ± 13.13 years, 47.4% were men and the majority was ranked as classes B or C (38.4% and 50.7%, respectively). Participants in lower SES classes reported increasingly poorer health compared to individuals in higher classes. The mean EQ-5D-3L index decreased as SES deteriorates being significantly higher for classes A and B (0.874 ± 0.14) compared to class C (0.842 ± 0.15) and classes D and E (0.804 ± 0.17) (p < 0.001). The same was observed for the mean EQ-VAS scores (84.0 ± 13.8 in classes A and B, 81.0 ± 17 in class C and 78.3 ± 18.7 in class C [p < 0.001]). The multivariate analysis confirmed that SES is an independent factor that effects EQ-5D-3L index measures. Participants in intermediate and lower SES classes have a statistically significant lower EQ-5D-3L index compared to participants in classes A and B, regardless of age, sex, and educational attainment. Conclusion In a Brazilian population sample, the EQ-5D-3L instrument was able to detect important differences between groups with distinct socioeconomic statuses (SES). The EQ-5D-3L is useful for exploring inequities in health.https://doi.org/10.1186/s12955-024-02235-0EQ-5D-3LEuroQolHealth-related quality of lifeSelf-reported healthHealth inequityEquity |
| spellingShingle | Bernardo Rangel Tura Milene Rangel da Costa Sylvia Lordello Danillo Barros Yuri Souza Marisa da Silva Santos Health inequity assessment in Brazil: is EQ-5D-3L sensible enough to detect differences among distinct socioeconomic groups? Health and Quality of Life Outcomes EQ-5D-3L EuroQol Health-related quality of life Self-reported health Health inequity Equity |
| title | Health inequity assessment in Brazil: is EQ-5D-3L sensible enough to detect differences among distinct socioeconomic groups? |
| title_full | Health inequity assessment in Brazil: is EQ-5D-3L sensible enough to detect differences among distinct socioeconomic groups? |
| title_fullStr | Health inequity assessment in Brazil: is EQ-5D-3L sensible enough to detect differences among distinct socioeconomic groups? |
| title_full_unstemmed | Health inequity assessment in Brazil: is EQ-5D-3L sensible enough to detect differences among distinct socioeconomic groups? |
| title_short | Health inequity assessment in Brazil: is EQ-5D-3L sensible enough to detect differences among distinct socioeconomic groups? |
| title_sort | health inequity assessment in brazil is eq 5d 3l sensible enough to detect differences among distinct socioeconomic groups |
| topic | EQ-5D-3L EuroQol Health-related quality of life Self-reported health Health inequity Equity |
| url | https://doi.org/10.1186/s12955-024-02235-0 |
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