Health-related quality of life in residents aged 18 years and older with and without disease: findings from the First Provincial Health Services Survey of Hunan, China

OBJECTIVE Published research has not considered acute diseases and injuries in assessing the impact of varying disease counts on health-related quality of life (HRQoL). We used Chinese value sets of EQ-5D-3L to examine the relationship between the number of diseases individuals had (including chronic diseases, acute diseases and injuries) and their HRQoL. METHODS A total of 19 387 individuals aged 18 years and older were included in the study. Using data from the First Provincial Health Services Survey of Hunan, China, HRQoL was assessed with the EQ-5D-3L scale, a standardized instrument developed by the EuroQoL group. The EQ-5D-3L utility score was calculated using the Chinese EQ-5D-3L value set. This survey coded disease using the list of 133 conditions that was defined by the First Provincial Health Services Survey of Hunan, China, based on the 10th International Classification of Diseases. 126 conditions were disease-related and were therefore included in data analysis. RESULTS Of 15 245 respondents, urban residents and male constituted 53.0% and 48.2%, respectively. 19.3% of respondents had one disease and 5.0% had at least two diseases. Of the five dimensions of the EQ-5D-3L, the pain/discomfort dimension had the highest proportion of moderate or serious problems among the respondents (14.4%, 95% CI 10.5% to 18.2%). The average Visual Analogue Scale (VAS) score and utility score were 78.0 (95% CI 76.9 to 79.1) and 0.958 (95% CI 0.946 to 0.970), respectively. Residents with 1 and ≥2 diseases had higher proportions of moderate or serious problems in five dimensions of the EQ-5D-3L scale during the previous 2 weeks than those without disease after controlling for location (urban/rural), sex, age, education level and household income, respectively (adjusted ORs: 3.1-3.7 and 4.4-6.6, respectively). The mean of the EQ VAS score was 8.4 and 13.6 points lower in respondents with 1 and ≥2 diseases than in respondents without disease; the corresponding mean score difference was 0.048 and 0.086 in EQ-5D-3L utility score. Disease-specific analyses were not conducted due to the inadequacy of sample size. CONCLUSIONS The HRQoL of residents aged 18 years and older declines distinctly as the number of diseases increases. Actions should be taken to improve the HRQoL of residents with multiple diseases in China (including acute diseases, chronic diseases and injuries).