International Journal of Health Policy and Management

International Journal of Health Policy and Management

Inequalities in Health Status from EQ-5D Findings: A Cross-Sectional Study in Low-Income Communities of Bangladesh

Document Type : Original Article

Authors
Marufa Sultana 1
Abdur Razzaque Sarker 1
Rashidul Alam Mahumud 1
Sayem Ahmed 1
Wahid Ahmed 1
Sanchita Chakrovorty 1
Hafizur Rahman 2
Ziaul Islam 1
Jahangir A. M. Khan 3
1 Health Economics and Financing Research Group, Center for Equity and Health Systems, icddr,b, Dhaka, Bangladesh
2 Health Economics Unit, Ministry of Health and Family Welfare, Dhaka, Bangladesh
3 Liverpool School of Tropical Medicine, Liverpool, UK; Health Economics Unit, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
10.15171/ijhpm.2016.06
Abstract
Background
Measuring health status by using standardized and validated instrument has become a growing concern over the past few decades throughout the developed and developing countries. The aim of the study was to investigate the overall self-reported health status along with potential inequalities by using EuroQol 5 dimensions (EQ-5D) instrument among low-income people of Bangladesh.
 
Methods
A cross-sectional household survey was conducted in Chandpur district of Bangladesh. Bangla version of the EQ-5D questionnaire was employed along with socio-demographic information. EQ-5D questionnaire composed of 2-part measurements: EQ-5D descriptive system and the visual analogue scale (VAS). For measuring health status, UK-based preference weights were applied while higher score indicated better health status. For facilitating the consistency with EQ-5D score, VASs were converted to a scale with scores ranging from 0 to 1. Multiple logistic regression models were also employed to examine differences among EQ-5D dimensions.
 
Results
A total of 1433 respondents participated in the study. The mean EQ-5D and VAS score was 0.76 and 0.77, respectively. The females were more likely to report any problem than the males (P < 0.001). Compared to the younger, elderly were more than 2-3 times likely to report any health problem in all EQ-5D dimensions (OR [odds ratio] = 3.17 for mobility, OR = 3.24 for self-care). However, the respondents of the poorest income group were significantly suffered more from every EQ-5D dimension than the richest income quintile.
 
Conclusion
Socio-economic and demographic inequalities in health status was observed in the study. Study suggests to do further investigation with country representative sample to measure the inequalities of overall health status. It would be helpful for policy-maker to find a new way aiming to reduce such inequalities.
Keywords
Health Status
EQ-5D
Visual Analogue Scale (VAS)
Inequality
Population
Subjects
  1. Khan MM, Krämer A, Khandoker A, Prüfer-Krämer L, Islam A. Trends in sociodemographic and health-related indicators in Bangladesh, 1993-2007: will inequities persist? Bull World Health Organ. 2011;89(8):583-593. doi:10.2471/blt.11.087429
  2. Ministry of Health and Family Welfare (MoHFW). Health Bulletin 2013. Dhaka, Bangladesh: Management Information System, Directorate General of Health Services, 2013.
  3. Ministry of Finance (MoF). Bangladesh Economic Review. Dhaka, Bangladesh: Government of the People’s Republic of Bangladesh; 2014.
  4. Bangladesh Bureau of Statistics (BBS). Bangladesh Household Income & Expenditure Survey: preliminary Results. Dhaka, Bangladesh: Statistics Division, Ministry of Planning; 2010
  5. Ministry of Health and Family Welfare (MoHFW). Health Bulletin 2014. Dhaka, Bangladesh: Management Information System,  Directorate General of Health Services; 2014.
  6. Rahman RM. Human rights, health and the state in Bangladesh. BMC Int Health Hum Rights. 2006;6:4.
  7. Chowdhury ME, Ronsmans C, Killewo J, et al. Equity in use of home-based or facility-based skilled obstetric care in rural Bangladesh : an observational study. Lancet. 2001;367:327-332. doi:10.1016/s0140-6736(06)68070-7
  8. Li H, Wei X, Ma A, Chung RY. Inequalities in health status among rural residents: EQ-5D findings from household survey in China. Int J Equity Health. 2014;13(41):1-8. doi:10.1186/1475-9276-13-41
  9. Hoi LV, Chuc NT, Lindholm L. Health-related quality of life , and its determinants , among older people in rural Vietnam. BMC Public Health. 2010;10:459. doi:10.1186/1471-2458-10-549
  10. Sun S, Chen J, Johannesson M, et al. Population health status in China: EQ-5D results, by age, sex and socio-economic status, from the National Health Services Survey 2008. Qual Life Res. 2011;20(3):309-320. doi:10.1007/s11136-010-9762-x
  11. König HH, Bernert S, Angermeyer MC, et al. Comparison of population health status in six european countries: results of a representative survey using the EQ-5D questionnaire. Med Care. 2009;47(2):255-261. doi:10.1097/mlr.0b013e318184759e
  12. Shafie AA, Hassali MA, Liau SY. A cross-sectional validation study of EQ-5D among the Malaysian adult population. Qual Life Res. 2011;20(4):593-600. doi:10.1007/s11136-010-9774-6
  13. Luo N, Johnson JA, Shaw JW, Feeny D, Coons SJ. Self-reported health status of the general adult U.S. population as assessed by the EQ-5D and Health Utilities Index. Med Care. 2005;43(11):1078-1086. doi:10.1097/01.mlr.0000182493.57090.c1
  14. Odil VU, Ugboka LU, Oparah AC. Quality Of Life Of People With Diabetes In Benin City As Measured With WHOQOL- BRE. Internet J Law Healthc Ethics. 2015;6(2):1-10.
  15. Bajunirwe F, Tisch DJ, King CH, Arts EJ, Debanne SM, Sethi AK. Quality of life and social support among patients receiving antiretroviral therapy in Western Uganda. AIDS Care. 2009;21(3):271-279. doi:10.1080/09540120802241863
  16. Saleh F, Mumu SJ, Ara F, Hafez MA, Ali L. Non-adherence to self-care practices & medication and health related quality of life among patients with type 2 diabetes: a cross-sectional study. BMC Public Health. 2014;14:431.
  17. Shaheen R, Lindholm L. Quality of life among pregnant women with chronic energy deficiency in rural Bangladesh. Health Policy. 2006;78(2-3):128-134. doi:10.1016/j.healthpol.2005.11.008
  18. Rabin R, De Charro F. EQ-SD: a measure of health status from. Ann Med. 2001;33:337-343. doi:10.3109/07853890109002087
  19. Szende A, Janssen B, Cabases J. Self-Reported Population Health: An International Perspective Based on EQ-5D. Springer open; 2014.
  20. Sakthong P, Charoenvisuthiwongs R, Shabunthom R. A comparison of EQ-5D index scores using the UK, US, and Japan preference weights in a Thai sample with type 2 diabetes. Health Qual Life Outcomes 2008;6:71. doi:10.1186/1477-7525-6-71
  21. Bharmal M, Thomas J. Comparing the EQ-5D and the SF-6D descriptive systems to assess their ceiling effects in the US general population. Value Health. 2006;9(4):262-271. doi:10.1111/j.1524-4733.2006.00108.x
  22. Hossain M, Saw A, Alam R, Ohtsuki F, Kamarul T. Multiple regression analysis of anthropometric measurements influencing the cephalic index of male Japanese university students. Singapore Med J. 2013;54(9):516-520. doi:10.11622/smedj.2013175
  23. Golicki D, Niewada M, Jakubczyk M, Wrona W, Hermanowski T. Self-assessed health status in Poland: EQ-5D findings from the Polish valuation study. Value Health 2008;11(6): A566–A567. doi:10.1016/s1098-3015(10)66863-5
  24. Ebenbichler GR, Resch KL, Nicolakis P, et al. Ultrasound treatment for treating the carpal tunnel syndrome: randomised “sham” controlled trial. BMJ. 1998;316:731. doi:10.1136/bmj.316.7133.731
  25. Burström K, Johannesson M, Diderichsen F. Swedish population health-related quality of life results using the EQ-5D. Qual Life Res. 2001;10(7):621-635. doi:10.1007/s11136-007-9243-z
  26. Sarker AR, Mahumud RA, Sultana M, Ahmed S, Ahmed W, Khan JA. The impact of age and sex on healthcare expenditure of households in Bangladesh. Springer plus. 2014;3(1):435. doi:10.1186/2193-1801-3-435
  27. Alberts JF, Sanderman R, Eimers JM, van den Heuvel WJ. Socioeconomic inequity in health care: a study of services utilization in Curaçao. Soc Sci Med. 1997;45(2):213-220. doi:10.1016/s0277-9536(96)00338-3
  28. McIsaac W, Goel V, Naylor D. Socio-economic status and visits to physicians by adults in Ontario, Canada. J Health Serv Res Policy. 1997;2(2):94-102.
  29. Ross CE, Wu C. The Links Between Education and Health. Am Sociol Rev. 1995;60(5):719.
  30. Cheung YB. Marital status and mortality in British women: a longitudinal study. Int J Epidemiol. 2000;29(1):93-99. doi:10.1093/ije/29.1.93
  31. Johnson NJ, Backlund E, Sorlie PD, Loveless CA. Marital status and mortality: The National Longitudinal Mortality Study. Ann Epidemiol. 2000;10(4):224-238. doi:10.1016/s1047-2797(99)00052-6
  32. Mackenbach JP, Kunst AE. Measuring the magnitude of socio-economic inequalities in health: An overview of available measures illustrated with two examples from Europe. Soc Sci Med. 1997;44(6):757-771. doi:10.1016/s0277-9536(96)00073-1

 

  • Received Date 02 August 2015
  • Revised Date 14 January 2016
  • Accepted Date 14 January 2016
  • First Published Date 01 May 2016
  • Published Date 01 May 2016