STATE-LEVEL QUALITY-ADJUSTED LIFE YEAR AND QUALITY-ADJUSTED LIFE EXPECTANCY AMONG U.S. ADULTS

Purpose: We recently developed an estimation equation of EuroQol EQ-5D index scores from the CDC’s Healthy Days measures in order to generate utility scores that might be used in burden of disease and cost-effectiveness studies for population subgroups as well as at the state and sub-state level. This study estimated EQ-5D scores, QALY, and QALE for all fifty States and the District of Columbia.

Methods: We applied the estimation equation to the 2000-03 Behavioral Risk Factor Surveillance System (BRFSS) data to obtain EQ-5D index scores for all survey respondents based on their age, self-rated health status, and overall number of unhealthy days. With the combination of mortality data, we calculated QALY and QALE lost to morbidity contributed by select health behavioral (obesity/overweight, smoking), socioeconomic (low income), and chronic diseases.

Results: The mean EQ-5D index score for the U.S. adults was 0.870 and Hawaii and West Virginia had the highest and lowest mean scores, respectively (0.902 and 0.826). Smoking contributed from 5.6% QALY lost in Utah to 12.3% in Kentucky; obesity/overweight contributed from 5.4% (South Dakota) to 13.8% (Louisiana) QALY lost; low income contributed from 16.6% (Hawaii) to 39.9% (South Carolina) QALY lost; and chronic diseases contributed from 8.7% (Minnesota) to 22.9% (Tennessee) QALY lost. The life expectancy (LE) for 18-year-old in the general U.S. population was 59.9 years and QALE was 52.0. Hawaii had the greatest LE and QALE (62.4 and 56.2, respectively) and while the District of Columbia had the lowest LE (56.0) and West Virginia had the lowest QALE (48.1). The ordering of percentage contribution of the selected risk factors to lost QALEs in the States was similar to lost QALYs.

Conclusions:  This study estimated mean EQ-5D index scores and state-level burden of disease attributable to important modifiable risk factors. Representative data at the state-level currently are unavailable in the U.S. but are needed for setting targets toward the Healthy People 2020 objectives for reducing health risks and eliminating health disparities for at-risk populations.  We found that the differences in EQ-5D index scores between many states would be considered to be clinically significant. Obesity/overweight, smoking, low income, and chronic diseases contributed the greatest proportion QALY and QALE lost in Kentucky, Tennessee, and South Carolina and the least in Minnesota, Utah, and Hawaii.