The COVID-19 pandemic and health-related quality of life across 13 high- and low-middle-income countries: A cross-sectional analysis

Abstract

Background Most research on the Coronavirus Disease 2019 (COVID-19) health burden has focused on confirmed cases and deaths, rather than consequences for the general population’s health-related quality of life (HRQoL). It is also important to consider HRQoL to better understand the potential multifaceted implications of the COVID-19 pandemic in various international contexts. This study aimed to assess the association between the COVID-19 pandemic and changes in HRQoL in 13 diverse countries. Methods and findings Adults (18+ years) were surveyed online (24 November to 17 December 2020) in 13 countries spanning 6 continents. Our cross-sectional study used descriptive and regression-based analyses (age adjusted and stratified by gender) to assess the association between the pandemic and changes in the general population’s HRQoL, measured by the EQ-5D-5L instrument and its domains (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), and how overall health deterioration was associated with individual-level (socioeconomic, clinical, and experiences of COVID-19) and national-level (pandemic severity, government responsiveness, and effectiveness) factors. We also produced country-level quality-adjusted life years (QALYs) associated to COVID-19 pandemic-related morbidity. We found that overall health deteriorated, on average across countries, for more than one-third of the 15,480 participants, mostly in the anxiety/depression health domain, especially for younger people (Conclusions In this study, we observed that the COVID-19 pandemic was associated with a reduction in perceived HRQoL globally, especially with respect to the anxiety/depression health domain and among younger people. The COVID-19 health burden would therefore be substantially underestimated if based only on mortality. HRQoL measures are important to fully capture morbidity from the pandemic in the general population. Author summary Why was this study done? The health burden of the Coronavirus Disease 2019 (COVID-19) pandemic has been closely tracked in terms of confirmed cases and deaths due to the virus, but data on the relationship between the COVID-19 pandemic and health-related quality of life (HRQoL) of the general population globally is still quite limited. Existing studies have mainly focused on single countries and used relatively small convenience samples, making cross-country comparison difficult. It is important to understand similarities and differences in the association between the COVID-19 pandemic and HRQoL in different countries around the world, because this information can help policy-makers to find the most appropriate interventions that work in diverse settings, health conditions, and populations, to combat the ongoing COVID-19 pandemic and potential future pandemics. What did the researchers do and find? We asked 15,536 participants from a diverse group of 13 countries (approx. 1,200 per country) to answer an online survey in which we asked questions about sociodemographic characteristics, health, and perceived HRQoL prior to and during the pandemic. We found that the COVID-19 pandemic was associated with significantly worse HRQoL for more than one-third of respondents, with anxiety/depression being the aspect of health that worsened the most, especially for younger people (What do these findings mean? The health burden of the COVID-19 pandemic may be substantially underestimated if we consider mortality alone. HRQoL measures are important to fully capture the considerable health burden of the COVID-19 pandemic and its associated containment policies. Our results provide benchmark evidence for countries at different stages in the pandemic and can help inform public health measures and economic policies in the event of other health shocks in the future.