Appropriate categorisation of inequality to inform policy decisions: Estimating distribution of lifetime health using alternative approaches to socioeconomic stratification

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Abstract

OBJECTIVES: Estimation of gradients in lifetime health, notably quality-adjusted life expectancy (QALE), have largely focussed on index of multiple deprivation (IMD) to categorise the population by socioeconomic position (SEP). In this paper we estimate QALE using alternate, individual rather than area-level, indicators of SEP.

METHODS: Building on previous research methods, the distribution of QALE is estimated across education and income groups based on data from the Health Survey for England and the Office for National Statistics. QALE is estimated for each group by combining multivariate mortality rates and health-related quality (HRQL) of life weights using life tables. HRQL weights were estimated using ordinary least squares and missing data were handled using multiple imputation.

RESULTS: The estimated lifetime HRQL weights decreased with increased age, lower educational attainment, and lower income. For example, the QALE at birth for males in the lowest educational attainment group was 61.69 quality-adjusted life years (QALYs), 1.54 QALYs lower than females in the same group. This is in contrast to 76.58 and 75.89 QALYs for males and females in the highest educational attainment group, respectively. A similar trend was observed across income quintiles albeit the gap was less pronounced.

CONCLUSIONS: The use of IMD to assess health inequalities may be masking important information about individual-level variation. Decisions makers should consider this alongside the merits of using area-level approaches to categorising the population if individual-level approaches are preferable.

Original languageEnglish
JournalValue in Health
DOIs
Publication statusAccepted/In press - 1 Oct 2023

Bibliographical note

Copyright © 2023 International Society for Pharmacoeconomics and Outcomes Research, Inc. Published by Elsevier Inc. All rights reserved.

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