title: The Social Distribution of Health: Estimating Quality-Adjusted Life Expectancy in England.
abstract: OBJECTIVE
  To model the social distribution of quality-adjusted life expectancy (QALE) in England by combining survey data on health-related quality of life with administrative data on mortality.
  
  
  METHODS
  Health Survey for England data sets for 2010, 2011, and 2012 were pooled (n = 35,062) and used to model health-related quality of life as a function of sex, age, and socioeconomic status (SES). Office for National Statistics mortality rates were used to construct life tables for age-sex-SES groups. These quality-of-life and length-of-life estimates were then combined to predict QALE as a function of these characteristics. Missing data were imputed, and Monte-Carlo simulation was used to estimate standard errors. Sensitivity analysis was conducted to explore alternative regression models and measures of SES.
  
  
  RESULTS
  Socioeconomic inequality in QALE at birth was estimated at 11.87 quality-adjusted life-years (QALYs), with a sex difference of 1 QALY. When the socioeconomic-sex subgroups are ranked by QALE, a differential of 10.97 QALYs is found between the most and least healthy quintile groups. This differential can be broken down into a life expectancy difference of 7.28 years and a quality-of-life adjustment of 3.69 years.
  
  
  CONCLUSIONS
  The methods proposed in this article refine simple binary quality-adjustment measures such as the widely used disability-free life expectancy, providing a more accurate picture of overall health inequality in society than has hitherto been available. The predictions also lend themselves well to the task of evaluating the health inequality impact of interventions in the context of cost-effectiveness analysis.
authors: Centre for Health Economics, University of York, York, UK; Department of Economics and Related Studies, University of York, York, UK. Electronic address: james.love-koh@york.ac.uk.
authors: James
authors: J
authors: Love-Koh
authors: Centre for Health Economics, University of York, York, UK.
authors: Miqdad
authors: M
authors: Asaria
authors: Centre for Health Economics, University of York, York, UK.
authors: Richard
authors: R
authors: Cookson
authors: Centre for Health Economics, University of York, York, UK.
authors: Susan
authors: S
authors: Griffin
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003198:Computer Simulation; D004739:England / Q000453:epidemiology; D005260:Female; D006304:Health Status; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008017:Life Expectancy / Q000639:trends*; D015993:Life Tables; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009010:Monte Carlo Method; D009026:Mortality / Q000639:trends; D011788:Quality of Life; D017678:Sex Distribution; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult
keywords: health inequalities; health surveys; population health; quality-adjusted life-years