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Purpose: We developed an estimation equation to predict EuroQol EQ-5D index scores from the CDC’s Healthy Days measures for the U.S. general population as well as targeted population subgroups, thereby generating utility scores that might be used to examine trends in the burden of disease attributable to a given risk factor and/or cost-effectiveness of a policy or intervention.
Methods: We applied the estimation equation to the 1993-2007 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 selected determinants of health outcomes, including behavioral (obesity/overweight, smoking) and social (low income).
Results: Between 1993-2007 mean EQ-5D index scores for U.S. adults decreased from 0.883 to 0.864. Although scores declined the most for persons with an annual income <$20,000, dropping from 0.844 to 0.779, the contribution of low income to the proportion of QALY lost remained stable at ~30%. The contribution of smoking to QALYs lost also was unchanged at ~7%. However, the contribution of overweight/obesity to QALYs lost increased from 8.2% to 14.1%. Although mean EQ-5D scores declined, life expectancy (LE) and QALE increased slightly. The LE of an 18-year-old increased from 58.4 to 60.4 and QALE increased from 50.9 to 51.7 from 1993 to 2005 and gains were seen for both men and women. Similar to the trend noted with QALYs, the contribution of low income and smoking to the proportion of QALE lost was relatively stable, at 30% and 6.7%, respectively, while the percentage due to obesity/overweight increased from 7% to 12%.
Conclusions: This study estimated mean EQ-5D index scores and burden of disease attributable to important risk factors over the past 15 years. Longitudinal data containing the EQ-5D 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. Mean EQ-5D index scores decreased while the contribution of obesity/overweight to the proportion of QALYs and QALE lost increased over 70%.