Inequalities in health-related quality of life: repeated cross-sectional study of trends in general practice survey data

BACKGROUND: After decades of steady progress, life expectancy at birth has stalled in England. Inequalities are also rising, and life expectancy has fallen for females living in the most deprived areas. However, less attention has been given to trends in other measures of population health, particularly health-related quality of life (HRQoL). AIM: To examine trends and inequalities in HRQoL in England between 2012 and 2017. DESIGN AND SETTING: The authors used nationally representative survey data on 3.9 million adults to examine HRQoL (measured by EQ-5D-5L overall score, plus each of the five health domains — mobility, selfcare, usual activity, pain/discomfort, and anxiety/depression). METHOD: The study explored trends across time, and inequalities by sex, age, and deprivation. RESULTS: Although HRQoL seemed steady overall between 2012 and 2017, there is evidence of increasing inequality across population subgroups. There was a rise in sex disparity over time, the female–male gap in EQ-5D-5L increased from −0.009 in 2012 to −0.016 in 2017. Trends for the youngest females and those living in the most deprived areas were of the greatest concern. Females in the most deprived regions suffered a 1.3% decrease in HRQoL between 2012 and 2017, compared with a 0.5% decrease for males. The key contribution to the decline in HRQoL, particularly in females, was a 1.5% increase in reported levels of anxiety/depression between 2012 and 2017. CONCLUSION: Developing interventions to address these worrying trends should be a policy priority. A particular focus should be on mental health in younger populations, especially for females and in deprived areas.