The Social Distribution of Health: Estimating Quality-Adjusted Life Expectancy in England

James Love-Koh*, Miqdad Asaria, Richard Cookson, Susan Griffin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To model the social distribution of quality-adjusted life expectancy (QALE) in England by combining survey data on health-related quality of life with administrative data on mortality.

METHODS: Health Survey for England data sets for 2010, 2011, and 2012 were pooled (n = 35,062) and used to model health-related quality of life as a function of sex, age, and socioeconomic status (SES). Office for National Statistics mortality rates were used to construct life tables for age-sex-SES groups. These quality-of-life and length-of-life estimates were then combined to predict QALE as a function of these characteristics. Missing data were imputed, and Monte-Carlo simulation was used to estimate standard errors. Sensitivity analysis was conducted to explore alternative regression models and measures of SES.

RESULTS: Socioeconomic inequality in QALE at birth was estimated at 11.87 quality-adjusted life-years (QALYs), with a sex difference of 1 QALY. When the socioeconomic-sex subgroups are ranked by QALE, a differential of 10.97 QALYs is found between the most and least healthy quintile groups. This differential can be broken down into a life expectancy difference of 7.28 years and a quality-of-life adjustment of 3.69 years.

CONCLUSIONS: The methods proposed in this article refine simple binary quality-adjustment measures such as the widely used disability-free life expectancy, providing a more accurate picture of overall health inequality in society than has hitherto been available. The predictions also lend themselves well to the task of evaluating the health inequality impact of interventions in the context of cost-effectiveness analysis.

Original languageEnglish
Article number1150
Pages (from-to)655-662
Number of pages8
JournalValue in Health
Issue number5
Early online date18 Apr 2015
Publication statusPublished - Jul 2015

Bibliographical note

Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.


  • Health inequalities
  • Health surveys
  • Population health
  • Quality-adjusted life-years

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