Validation of the EQ-5D in a general population sample in urban China

Institute of Social Medicine and Family Medicine, School of Medicine, Zhejiang University, 866 Yuhang Tang Rd., 310058 Hangzhou, People's Republic of China.
Quality of Life Research (Impact Factor: 2.49). 04/2011; 21(1):155-60. DOI: 10.1007/s11136-011-9915-6
Source: PubMed


To evaluate the reliability and validity of the EQ-5D in a general population sample in urban China.
Thousand and eight hundred respondents in 18 communities of Hangzhou, China were recruited by multi-stage stratified random sampling. Respondents self-administered a questionnaire including the EQ-5D, the SF-36, and demographic questions. Test-retest reliability at 2-week intervals was evaluated using Kappa coefficient, the intraclass correlation coefficient. The standard error of measurement (SEM) was used to indicate the absolute measurement error. Construct validity was established using convergent, discriminant, and known groups analyses.
Complete data for all EQ-5D dimensions were available for 1,747 respondents (97%). Kappa values were from 0.35 to 1.0. The ICCs of test-retest reliability were 0.53 for the EQ-5D index score and 0.87 for the EQ VAS score. The SEM values were 0.13 (9.22% range) and 4.20 (4.20% range) for the EQ-5D index and EQ VAS scores, respectively. The Pearson's correlation coefficients between the EQ-5D and the SF-36 were stronger between comparable dimensions than those between less comparable dimensions, demonstrating convergent and discriminant evidence of construct validity. The Chinese EQ-5D distinguished well between known groups: respondents who reported poor general health and chronic diseases had worse HRQoL than those without. Older people, females, people widowed or divorced, and those with a lower socioeconomic status reported poorer HRQoL. Respondents reporting no problems on any EQ-5D dimension had better scores on the SF-36 summary scores than those reporting problems.
The Chinese version of the EQ-5D demonstrated acceptable construct validity and fair to moderate levels of test-retest reliability in an urban general population in China.

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    • "The Chinese version of three-level EQ-5D was administrated within the NHSS to measure HRQoL (Sun et al. 2011). The validity and reliability of the Chinese version EQ-5D has been demonstrated in mainland China (Sun et al. 2011;Wang et al. 2012). The Chinese-specific tariff developed byLiu et al. (2014)using the time trade-off technique is used to generate the EQ-5D utility score on a 0 (death) to 1 (full health) quality-adjusted life-year scale. "
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    ABSTRACT: The study aims to investigate both income-related health inequality and horizontal equity in urban and rural China. The 4th and 5th National Health Services Survey, and extended samples in Shaanxi Province surveyed in 2008 and 2013, were analysed. Health outcome was measured using the EQ-5D-3L utility, scored by the Chinese-specific tariff. The concentration index was calculated to measure the degree of income-related health inequality and was further decomposed to study the strength of different contributing factors to explain health inequality. The horizontal inequity was further measured based on the decomposition results. The final study sample consists of 15,505 respondents in 2008 and 48,808 respondents in 2013. Descriptive analysis shows that compared to 2008, respondents in both urban and rural China reported worse HRQoL in 2013. There was a pro-rich inequality of HRQoL in both urban and rural China. Controlling for demographic factors, the pro-rich inequity of HRQoL remains. Economic and educational statuses are found to be two key factors explaining the pro-rich inequity. The establishment of basic medical insurance has shown a mixed effect on reducing health inequality. Strategies to reduce the inequality of residents’ economic and educational status, through further implementing the poverty reduction policies, should be prioritised by the local government.
    Full-text · Article · Jan 2016 · Social Indicators Research
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    • "The EQ-5D was developed by the EuroQol Group, a voluntary multinational collaboration of European investigators [18]. The EQ-5D had been translated into Chinese, and shown substantial validity and reliability in various studies [12,19,20]. The EQ-5D defined health in five dimensions, including mobility, self-care, usual activities, pain/discomfort and anxiety/depression. "
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    ABSTRACT: Introduction This study analyzed inequalities in health status among different socioeconomic and demographic rural residents covered by the New Rural Cooperative Medical System in China. Methods A cross-sectional study was conducted in Lian Yungang City, China. A total of 337 respondents, who were selected by using a multistage stratified systematic random sampling method, completed the surveys. A questionnaire consisting of EQ-5D and demographic and socioeconomic information was adopted for data collection, and was administered by face-to-face interviews. Multiple regression models were employed to examine the differences in the Visual Analogue Scale (VAS) score and the EQ-5D dimensions. Results Compared with those with lower education attainment, the respondents with higher education levels tended to report a higher VAS score (β = 2.666, 95% CI: 0.978 to 6.310), and were less likely to suffer from pain/discomfort (OR = 3.968; 95% CI: 1.447 to 10.880). The singles were more likely than the married to report moderate or extreme problems in usual activities (OR = 4.583; 95% CI: 1.188 to 17.676) and mobility (OR = 10.666; 95% CI: 2.464 to 6.171). However, no statistically significant differences were identified between the respondents with different income levels in the VAS score and EQ-5D dimensions. Conclusions This study suggests that the singles and the people with lower education levels are high-risk groups for poorer health status in the Chinese rural population. The findings from this study warrant further investigation.
    Full-text · Article · May 2014 · International Journal for Equity in Health
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    • "Most papers belong to the first group, and they often use the EQ-5D-3 L to assess HRQL. They come, for example, from the USA [3-6], New Zealand [7], Japan [8], China [9], the UK [10-13], Sweden [14], Spain [15,16], Greece [17,18], Denmark [19,20] and the Netherlands [21]; some studies combine data from different Western European countries [22-24]. Of course they also differ in the way the sample was drawn, but despite these differences they consistently show that HRQL increases with increasing SES, in terms of problems reported [9,12,19-21,23,24] and in terms of overall HRQL assessment [3-6,10,13,14,16,17,22]. "
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    ABSTRACT: A number of studies have shown an association between health-related quality of life (HRQL) and socioeconomic status (SES). Indicators of SES usually serve as potential confounders; associations between SES and HRQL are rarely discussed in their own right. Also, few studies assess the association between HRQL and SES among those with a chronic disease. The study focuses on the question of whether people with the same state of health judge their HRQL differently according to their SES, and whether a bias could be introduced by ignoring these differences. The analyses were based on a representative sample of the adult population in Germany (n = 11,177). HRQL was assessed by the EQ-5D-3 L, i.e. the five domains (e.g. 'moderate or severe problems' concerning mobility) and the Visual Analog Scale (VAS). SES was primarily assessed by educational level; age, sex and family status were included as potential confounders. Six chronic diseases were selected, each having a prevalence of at least 1% (e.g. diabetes mellitus). Multivariate analyses were conducted by logistic and linear regression. Among adults with a chronic disease, most 'moderate or severe problems' are reported more often in the low (compared with the high) educational group. The same social differences are seen for VAS values, also in subgroups characterized by 'moderate or severe problems'. Gender-specific analyses show that for women the associations with VAS values can just be seen in the total sample. For men, however, they are also present in subgroups defined by 'moderate or severe problems' or by the presence of a chronic disease; some of these differences exceed 10 points on the VAS scale. Low SES groups seem to be faced with a double burden: first, increased levels of health impairments and, second, lower levels of valuated HRQL once health is impaired. These associations should be analysed and discussed in their own right, based on interdisciplinary co-operation. Social epidemiologists could include measures of HRQL in their studies more often, for example, and health economists could consider assessing whether recommendations based on HRQL scales might include a social bias.
    Full-text · Article · Apr 2014 · Health and Quality of Life Outcomes
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