OP36 Quality-adjusted life expectancy (QALE) and its association with economic inclusion: a study of local authorities in England, Scotland, and Wales

• Published in: Journal of epidemiology and community health (1979) Vol. 77; no. Suppl 1; pp. A18 - A19
• Main Authors: Hoehn, Andreas, Lomax, Nik, Rice, Hugh, Angus, Colin, Brennan, Alan, Brown, Denise, Comrie, Emma, Elsenbroich, Corinna, Hughes, Ceri, Srinivasa Vittal Katikireddi
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.08.2023
• Subjects: Child poverty; Economics; Females; Life expectancy; Life span; Local government; Males; Poverty; Public health; Public transportation; United Kingdom > UK; Wales; England; Scotland
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech-2023-SSMabstracts.36

BackgroundMonitoring geographical inequalities in health can help national and local public health teams to develop appropriately tailored policy approaches. Within the past years, an increasing number of studies has utilised Quality-Adjusted Life Expectancy (QALE) as an outcome measure to quantify the impact of policy interventions on population health. Quality-Adjusted Life Expectancy (QALE) is a holistic population-level health metric which captures mortality alongside mental and physical health. The greater detail in the way that QALE captures health distinguishes it from other health expectancy metrics such as Healthy Life Expectancy or Disability-Free Life Expectancy. We describe an approach to estimate QALE for local authority districts (LAs) in England, Scotland and Wales and examine the association between economic inclusion and QALE as an exemplary case study.MethodsIn a first step, we estimated lifetables for females and males in all LAs using TOPALS and Kannisto models. In a second step, we estimated age- and sex-specific health state utility scores using the Understanding Society main stage survey. For this purpose, we mapped Short Form 12 (SF-12) group averages for mental and physical health to utility scores. We then used the Sullivan method to estimate QALE at birth in years. Indicators on various dimensions of economic inclusion were obtained from the Inclusive Economy dataset which as previously created by the System Science in Public Health and Health Economics Research (SIPHER) consortium.ResultsIn 2018–2020, QALE was lower on average in Scotland (females/males: 65.09 y/64.90 y) and Wales (65.13 y/65.35 y) than in England (67.55 y; 67.69 y). For females, QALE ranged from 56.33 y in Mansfield to 77.76 y in Runnymede. Among males, QALE was lowest in Merthyr Tydfil (57.64 y) and highest in Runnymede (77.44 y). We found that several indicators of economic inclusion were associated with QALE, including digital connectivity, access to public transport, affordability of housing, and child poverty. Indicators of economic inclusion accounted for more than half of the variation in QALE at the LA level (Adjusted R-squared females/males: 51%/58%).ConclusionOur study provides an estimation method for QALE for LAs in England, Scotland, and Wales – allowing further research into spatial health inequalities. Our results indicate that differences in QALE are large across local authorities in Great Britain, indicating substantial area-level inequalities in population health. Economic inclusion might be particularly important in explaining these area-level inequalities in population health. Research and policy design, especially within the context of ‘Levelling Up’ strategies, should consider the importance of economic inclusion for health outcomes.