Comparison of trends in US health-related quality of life over the 2000s using the SF-6D, HALex, EQ-5D, and EQ-5D visual analog scale versus a broader set of symptoms and impairments

Abstract

Background: A number of instruments have been developed to measure health-related quality of life (HRQoL), differing in the health domains covered and their scoring. Although few such measures have been consistently included in US national health surveys over time, the surveys have included data on a broad range of symptoms and impairments, which enables the tracking of population health trends.

Objectives: To compare trends in HRQoL as measured using existing instruments versus using a broader range of symptoms and impairments collected in multiple years of nationally representative data.

Data and measures: Data were from the 2000-2010 Medical Expenditure Panel Survey, which is nationally representative of the noninstitutionalized US population. Level of and trends in HRQoL derived from a broad range of survey symptoms and impairments (SSI) was compared with HRQoL from the SF-6D, the HALex, and, between 2000 and 2003, the EuroQol-5D (EQ-5D) and EQ-5D Visual Analog Scale.

Results: Trends in HRQoL were similar using different measures. The SSI scores correlated 0.66-0.80 with scores from other measures and mean SSI scores were between those of other measures. Scores from all HRQoL measures declined similarly with increasing age and with the presence of comorbid conditions.

Conclusions: Measuring HRQoL using a broader range of symptoms and impairments than those in a single instrument yields population health trends similar to those from other measures while making maximum use of existing data and providing rich detail on the factors underlying change.

Figure 1

Comparison of Trends in Health-Related Quality of Life Using Different Measures, Overall Population, Aged 18 and Over, MEPS Survey Years 2000–2010, Age-Adjusted to the 2010 Population by 10-Year Age Group Notes: EQ-5D and VAS trends are truncated at 2003 because they were discontinued from the MEPS in 2004. Trends are shown for those with complete data on HALex, SSI, and SF-6D. Those missing on EQ-5D and VAS from 2000–2003 are not omitted, however trends are almost identical when these additional respondents are omitted (not shown). The notable drop in SF-6D scores in 2003 was at least partially due to the adoption of the new SF-12 questionnaire in that year and the reassignment of responses to role model questions to try to match to the dichotomous response categories in the earlier SF-12 version. All those responding in version 2 that they had any problems (a little of the time, some of the time, most of the time, or all of the time) were assigned as having problems (to match ‘yes’ in version 1), resulting in a higher prevalence of role performance problems in 2003 and beyond. Survey Based Symptom/Impairment scores did not use the role performance questions. They did use other SF-12 questions that changed in 2003 (depressive and anxious symptoms and energy). Adjustments are discussed in the Appendix (Supplemental Digital Content 1, http://links.lww.com/MLR/A757).

Figure 2

Relationships Between SSI and Other Measures in Pooled MEPS Data from 2000-2002 a) Mean SSI Scores by Categories of SF-6D Scores b) Mean SSI Scores by Categories of HALex Scores c) Mean SSI Scores by Categories of EQ-5D Scores d) Mean SSI Scores by Categories of VAS Scores Line connects mean SSI scores among those in each category of the other measure. Box plots depict range of SSI scores from 25th to 75th percentile, and 10 and 90 percent confidence intervals. White line within each bar indicates median SSI score. Percentages in categories may not sum to 100 due to rounding.

Figure 2

Relationships Between SSI and Other Measures in Pooled MEPS Data from 2000-2002 a) Mean SSI Scores by Categories of SF-6D Scores b) Mean SSI Scores by Categories of HALex Scores c) Mean SSI Scores by Categories of EQ-5D Scores d) Mean SSI Scores by Categories of VAS Scores Line connects mean SSI scores among those in each category of the other measure. Box plots depict range of SSI scores from 25th to 75th percentile, and 10 and 90 percent confidence intervals. White line within each bar indicates median SSI score. Percentages in categories may not sum to 100 due to rounding.

Figure 3

Comparison of Trends in Health-Related Quality of Life Using Different Measures in Pooled 2000–2002 Data a) Comparison of Age Trends Across Measures Note: To smooth trends, means by age are depicted using a three year moving average centered around the indicated year. b) Comparison Scores Across Measures Among Those With None, One, or 2+ Self-Reported Health Conditions: Coronary Heart Disease, Myocardial Infarction, Other Heart Disease, Stroke, Diabetes, and Emphysema

Figure 3

Comparison of Trends in Health-Related Quality of Life Using Different Measures in Pooled 2000–2002 Data a) Comparison of Age Trends Across Measures Note: To smooth trends, means by age are depicted using a three year moving average centered around the indicated year. b) Comparison Scores Across Measures Among Those With None, One, or 2+ Self-Reported Health Conditions: Coronary Heart Disease, Myocardial Infarction, Other Heart Disease, Stroke, Diabetes, and Emphysema