Inequality in quality-adjusted life expectancy by educational attainment in Norway: an observational study
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...
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ftpubmed:oai:pubmedcentral.nih.gov:10155341 2023-06-11T04:17:23+02:00 Inequality in quality-adjusted life expectancy by educational attainment in Norway: an observational study Gutacker, Nils Kinge, Jonas Minet Olsen, Jan Abel 2023-05-03 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10155341/ https://doi.org/10.1186/s12889-023-15663-2 en eng BioMed Central http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10155341/ http://dx.doi.org/10.1186/s12889-023-15663-2 © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. BMC Public Health Research Text 2023 ftpubmed https://doi.org/10.1186/s12889-023-15663-2 2023-05-07T01:24:03Z 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-023-15663-2. Text Tromsø PubMed Central (PMC) Chiang ENVELOPE(162.650,162.650,-77.967,-77.967) Norway Sullivan ENVELOPE(-63.817,-63.817,-69.650,-69.650) Tromsø BMC Public Health 23 1 |
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Research Gutacker, Nils Kinge, Jonas Minet Olsen, Jan Abel Inequality in quality-adjusted life expectancy by educational attainment in Norway: an observational study |
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Research |
description |
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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-023-15663-2. |
format |
Text |
author |
Gutacker, Nils Kinge, Jonas Minet Olsen, Jan Abel |
author_facet |
Gutacker, Nils Kinge, Jonas Minet Olsen, Jan Abel |
author_sort |
Gutacker, Nils |
title |
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_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_sort |
inequality in quality-adjusted life expectancy by educational attainment in norway: an observational study |
publisher |
BioMed Central |
publishDate |
2023 |
url |
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10155341/ https://doi.org/10.1186/s12889-023-15663-2 |
long_lat |
ENVELOPE(162.650,162.650,-77.967,-77.967) ENVELOPE(-63.817,-63.817,-69.650,-69.650) |
geographic |
Chiang Norway Sullivan Tromsø |
geographic_facet |
Chiang Norway Sullivan Tromsø |
genre |
Tromsø |
genre_facet |
Tromsø |
op_source |
BMC Public Health |
op_relation |
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10155341/ http://dx.doi.org/10.1186/s12889-023-15663-2 |
op_rights |
© The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
op_doi |
https://doi.org/10.1186/s12889-023-15663-2 |
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BMC Public Health |
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23 |
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