Health-related quality of life and lifetime QALY loss among Indigenous Australians with chronic conditions: an age-stratified analysis.

BACKGROUND

Indigenous Australians in rural and remote areas experience substantial health-related quality of life (HRQoL) impacts alongside persistent healthcare access barriers. Community-led virtual primary care services offer an innovative approach to improving access to health care services for Indigenous Australians in rural and remote areas.

OBJECTIVE

To examine age-stratified HRQoL patterns and estimate the lifetime quality-adjusted life year (QALY) loss among Indigenous Australians with chronic conditions enrolled in a rural virtual primary care service.

METHODS

We conducted a cross-sectional analysis of 75 Indigenous adults residing in rural Queensland. HRQoL was measured using the EQ-5D-5L instrument. Lifetime QALY loss was calculated using Queensland Indigenous life tables and population norms, with sensitivity analyses using Australian norms and varying discount rates.

RESULTS

Overall mean utility was 0.775 (SD = 0.246). Age-stratified analysis revealed significant heterogeneity, with three age groups (18-54, 55-64, 65-74 years) demonstrating lower HRQoL than Queensland norms. The 55-64 age group experienced poorest HRQoL (utility = 0.701, SD = 0.287) and highest projected lifetime QALY loss (4.44 QALYs undiscounted; 2.63 with 5% discount). In contrast, participants aged 75 years and above exceeded population norms (utility = 0.872 vs. 0.863). Chronic disease burden was associated with HRQoL decline in adults aged 18-64 years, while physical activity was associated with higher HRQoL in those aged 65 years and over.

CONCLUSIONS

Indigenous Australians aged 55-64 years represent a critical priority for virtual primary care interventions. Targeted support strategies for this 'at-risk' age group are essential to address substantial lifetime health burdens and improve long-term outcomes within remote delivery models.