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Muszyńska-Spielauer M, Luy M. Well-Being Adjusted Health Expectancy: A New Summary Measure of Population Health. EUROPEAN JOURNAL OF POPULATION = REVUE EUROPEENNE DE DEMOGRAPHIE 2022; 38:1009-1031. [PMID: 36507236 PMCID: PMC9726765 DOI: 10.1007/s10680-022-09628-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 06/13/2022] [Indexed: 12/15/2022]
Abstract
We propose a new summary measure of population health (SMPH), the well-being-adjusted health expectancy (WAHE). WAHE belongs to a subgroup of health-adjusted life expectancy indicators and gives the number of life years equivalent to full health. WAHE combines health and mortality information into a single indicator with weights that quantify the reduction in well-being associated with decreased health. WAHE's advantage over other SMPHs lies in its ability to differentiate between the consequences of health limitations at various levels of severity and its transparent, simple valuation function. Following the guidelines of a Committee on Summary Measures of Population Health, we discuss WAHE's validity, universality, feasibility sensitivity and ensure its reproducibility. We evaluate WAHE's performance compared to life expectancy, the most commonly used indicators of health expectancy (HE) and disability-adjusted life expectancy (DALE) in an empirical application for 29 European countries. Data on health and well-being are taken from the 2018 EU-SILC, and the life tables are from Eurostat. DALE is taken from the database of the Global Burden of Disease Programme. WAHE's sensitivity to univariate and multivariate state specifications is studied using the three Minimum European Health Module health dimensions: chronic morbidity, limitations in activities of daily living, and self-rated health. The empirical tests of the indicators' correspondence reveal that WAHE has the strongest correlation with the other SMPHs. Moreover, WAHE estimates are in agreement with all other SMPHs. Additionally, WAHE and all other SMPHs form a group of reliable indicators for studying population health in European countries. Finally, WAHE estimates are robust, regardless of whether health is defined across one or multiple simultaneous dimensions of health. We conclude that WAHE is a useful and reliable indicator of population health and performs at least as well as other commonly used SMPHs. Supplementary Information The online version contains supplementary material available at 10.1007/s10680-022-09628-1.
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Affiliation(s)
- Magdalena Muszyńska-Spielauer
- Vienna Institute of Demography (OeAW), Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna, Austria
| | - Marc Luy
- Vienna Institute of Demography (OeAW), Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna, Austria
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Joundi RA, Adekanye J, Leung AA, Ronksley P, Smith EE, Rebchuk AD, Field TS, Hill MD, Wilton SB, Bresee LC. Health State Utility Values in People With Stroke: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2022; 11:e024296. [PMID: 35730598 PMCID: PMC9333363 DOI: 10.1161/jaha.121.024296] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/21/2022] [Indexed: 12/25/2022]
Abstract
Background Health state utility values are commonly used to provide summary measures of health-related quality of life in studies of stroke. Contemporaneous summaries are needed as a benchmark to contextualize future observational studies and inform the effectiveness of interventions aimed at improving post-stroke quality of life. Methods and Results We conducted a systematic search of the literature using Medline, EMBASE, and Web of Science from January 1995 until October 2020 using search terms for stroke, health-related quality of life, and indirect health utility metrics. We calculated pooled estimates of health utility values for EQ-5D-3L, EQ-5D-5L, AQoL, HUI2, HUI3, 15D, and SF-6D using random effects models. For the EQ-5D-3L we conducted stratified meta-analyses and meta-regression by key subgroups. We screened 14 251 abstracts and 111 studies met our inclusion criteria (sample size range 11 to 12 447). EQ-5D-3L was reported in 78% of studies (study n=87; patient n=56 976). The pooled estimate for EQ-5D-3L at ≥3 months following stroke was 0.65 (95% CI, 0.63-0.67), which was ≈20% below population norms. There was high heterogeneity (I2>90%) between studies, and estimates differed by study size, case definition of stroke, and country of study. Women, older individuals, those with hemorrhagic stroke, and patients prior to discharge had lower pooled EQ-5D-3L estimates. Conclusions Pooled estimates of health utility for stroke survivors were substantially below population averages. We provide reference values for health utility in stroke to support future clinical and economic studies and identify subgroups with lower healthy utility. Registration URL: https://www.crd.york.ac.uk/prospero/. Unique Identifier: CRD42020215942.
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Affiliation(s)
- Raed A. Joundi
- Department of Clinical NeurosciencesUniversity of CalgaryAlbertaCanada
- Division of NeurologyHamilton Health SciencesMcMaster University & Population Health Research InstituteHamiltonOntarioCanada
| | | | | | | | | | | | - Thalia S. Field
- University of British ColumbiaVancouverBritish ColumbiaCanada
| | | | | | - Lauren C. Bresee
- Department of Community Health SciencesUniversity of CalgaryAlbertaCanada
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Pickard AS, Jalundhwala YJ, Bewsher H, Sharp LK, Walton SM, Schumock GT, Caskey RN. Lifestyle-related attitudes: do they explain self-rated health and life-satisfaction? Qual Life Res 2018; 27:1227-1235. [PMID: 29302851 DOI: 10.1007/s11136-017-1774-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Strategies to improve public health may benefit from targeting specific lifestyles associated with poor health behaviors and outcomes. The aim of this study was to characterize and examine the relationship between health and lifestyle-related attitudes (HLAs) and self-rated health and life-satisfaction. METHODS Secondary analyses were conducted on data from a 2012 community wellness survey in Kirklees, UK. Using a validated HLA tool, respondents (n = 9130) were categorized into five segments: health conscious realists (33%), balanced compensators (14%), live-for-todays (18%), hedonistic immortals (10%), and unconfident fatalists (25%). Multivariate regression was used to examine whether HLAs could explain self-rated health using the EQ-5D visual analog scale (EQ-VAS) and life-satisfaction. Health conscious realists served as the reference group. RESULTS Self-rated health differed by HLA, with adjusted mean EQ-VAS scores being significantly higher (better) among balanced compensators (1.15, 95% CI 0.27, 2.03) and lower scores among unconfident fatalists (- 9.02, 95% CI - 9.85, - 8.21) and live-for-todays (- 1.96, 95% CI - 2.80, - 1.14). Balanced compensators were less likely to report low life-satisfaction (OR 0.75, 95% CI 0.62, 0.90), while unconfident fatalists were most likely to have low life-satisfaction (OR 3.51, 95% CI 2.92, 4.23). SIGNIFICANCE Segmentation by HLA explained differences in self-rated health and life-satisfaction, with unconfident fatalists being a distinct segment with significantly worse health perceptions and life-satisfaction. Health promotion efforts may benefit from considering the HLA segment that predominates a patient group, especially unconfident fatalists.
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Affiliation(s)
- A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA. .,Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA.
| | - Yash J Jalundhwala
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - Helen Bewsher
- Kirklees Council, The University of Manchester, Huddersfield, West Yorkshire, United Kingdom
| | - Lisa K Sharp
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA.,Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - Surrey M Walton
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA.,Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA.,Center for Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, 833 S Wood St, Chicago, IL, 60612, USA
| | - Rachel N Caskey
- Internal Medicine and Pediatrics, College of Medicine, University of Illinois at Chicago, 840 S Wood St, Chicago, IL, 60612, USA
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Does the relationship between health-related quality of life and subjective well-being change over time? An exploratory study among breast cancer patients. Soc Sci Med 2016; 174:96-103. [PMID: 28013110 DOI: 10.1016/j.socscimed.2016.12.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 12/05/2016] [Accepted: 12/16/2016] [Indexed: 12/25/2022]
Abstract
It has been suggested recently that measures of Subjective Well-Being (SWB) instead of preferences could be employed to determine relative weights for the dimensions of health-related quality of life (HRQol) with the aim of developing health utility indexes for economic evaluation purposes. In this context, this paper addresses the possibility of reprioritization response shift in SWB. It examines whether the association between dimensions of HRQol and SWB changes over time in chronically ill patients. 215 women newly diagnosed for breast cancer in a French hospital between 2010 and 2012 completed the Satisfaction with Life Scale (SWLS) and the EORTC QLQ-C30 HRQol questionnaires over a two-year period. We estimated hierarchical random coefficients models for the repeated SWLS measures while allowing for time-varying parameters for the scales of the QLQ-C30 to test for reprioritization. Our findings suggest that women adapt to breast cancer by giving greater weight over time to the social dimension of HRQol. This possibility of reprioritization response shift should be considered in researches trying to develop SWB-based health utility values to inform the allocation of resources in health care.
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