Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2026
The Social Distribution of Quality-Adjusted Life Expectancy Among Social Deprivation Subgroups in China.
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He Xiaoning, Dong Peisong, Xin Yuhang, Wang Lijun, Qi Jinlei, Wu Jing, Cookson Richard
Аннотация
OBJECTIVES: To estimate disparities in quality-adjusted life expectancy (QALE) across social deprivation subgroups in China using the County-level Social Deprivation Index 2020 (CSDI 2020).
METHODS: Mortality data from the 2021 Chinese Death Surveillance System were linked with a national EQ-5D-5L health utility survey. Mortality underreporting was calibrated using model life tables and benchmarked against official statistics. Health utilities were modeled using ordinary least squares regression incorporating age-deprivation interactions. QALE was estimated via the Sullivan method. Additional analyses examined the interaction between geographic regions and deprivation quintiles.
RESULTS: QALE declined progressively as social deprivation increased. The national QALE gap at birth between the least- and most-deprived quintiles was estimated to be at least 7.73 quality-adjusted life-years (QALYs) (95% CI: 7.12-8.32), with 77.4 QALYs in the least-deprived group versus 69.6 QALYs in the most deprived. Men experienced larger disparities (7.98 QALYs) than women (7.31 QALYs). Sensitivity analyses confirmed a robust gradient, with gaps ranging from 7.45 to 8.71 QALYs. When accounting for region-deprivation interactions, this disparity widened to 10.65 QALYs between the least-deprived Eastern and most-deprived Western subgroups.
CONCLUSIONS: Substantial, graded inequalities in QALE exist in China, significantly compounded by regional development gaps. These findings provide a critical empirical foundation for equity-informed health policy and distributional cost-effectiveness analysis.
METHODS: Mortality data from the 2021 Chinese Death Surveillance System were linked with a national EQ-5D-5L health utility survey. Mortality underreporting was calibrated using model life tables and benchmarked against official statistics. Health utilities were modeled using ordinary least squares regression incorporating age-deprivation interactions. QALE was estimated via the Sullivan method. Additional analyses examined the interaction between geographic regions and deprivation quintiles.
RESULTS: QALE declined progressively as social deprivation increased. The national QALE gap at birth between the least- and most-deprived quintiles was estimated to be at least 7.73 quality-adjusted life-years (QALYs) (95% CI: 7.12-8.32), with 77.4 QALYs in the least-deprived group versus 69.6 QALYs in the most deprived. Men experienced larger disparities (7.98 QALYs) than women (7.31 QALYs). Sensitivity analyses confirmed a robust gradient, with gaps ranging from 7.45 to 8.71 QALYs. When accounting for region-deprivation interactions, this disparity widened to 10.65 QALYs between the least-deprived Eastern and most-deprived Western subgroups.
CONCLUSIONS: Substantial, graded inequalities in QALE exist in China, significantly compounded by regional development gaps. These findings provide a critical empirical foundation for equity-informed health policy and distributional cost-effectiveness analysis.