Geographical variation in quality-adjusted life expectancy in the North Denmark Region

Abstract

Objective:

This study examined the geographical variations in quality-adjusted life expectancy (QALE) in the North Denmark Region.

Methods:

QALE was used to measure health expectancy within each municipality of the North Denmark Region. Measures of health-related quality of life (HRQoL) were obtained from a representative sample of 19,598 responses to the EQ-5D-5L questionnaire in the 2021 regional health survey. Abridged periodic life tables were constructed using mortality data from Statistics Denmark stratified by age, sex, and municipality. The stepwise replacement algorithm developed by Andreev et al. was applied to decompose QALE into its mortality and HRQoL components and investigate the main drivers of the QALE variations between municipalities.

Results:

The regional average QALE at 16 years of age was 52.6 quality-adjusted life years (QALYs) (95% CI: 52.1–53.0) for men and 53.1 QALYs (95% CI: 52.7–53.5) for women. No statistically significant variations in QALE were found between municipalities. Comparing the highest and lowest scoring municipalities for males, Rebild had 54.5 QALY (95% CI: 51.7–57.2) while Hjørring had 51.9 QALY (95% CI: 49.9–54.1), showing a variation of 2.57 QALE driven by higher HRQoL scores and lower mortality rates. For females, Rebild had 54.3 QALY (95% CI: 52.1–56.5) and Vesthimmerland had 51.3 QALY (95% CI: 49.1–53.4), showing a variation of 3.03 QALE, mostly driven by increased HRQoL scores and to some extent lower mortality rates.

Conclusions:

Variations in QALE, although not statistically significant, existed between the municipalities in the North Denmark Region. Further research should explore the reasons for these variations to inspire future policy development.