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Estimating EQ-5D utility values for major health behavioural risk factors in England
  1. Hendramoorthy Maheswaran,
  2. Stavros Petrou,
  3. Karen Rees,
  4. Saverio Stranges
  1. Division of Health Sciences, University of Warwick Medical School, Coventry, UK
  1. Correspondence to Dr Hendramoorthy Maheswaran, Division of Health Sciences, University of Warwick Medical School, Medical School Building, Gibbet Hill Campus, Coventry CV4 7AL, UK; h.maheswaran{at}


Background Major behavioural risk factors, namely obesity, alcohol consumption, smoking, lack of fruit and vegetable intake and physical inactivity negatively impact on self-reported quality of life. However, little is known about their impact on preference-based measures of health-related quality of life commonly used to inform economic evaluations.

Methods Preference-based health-related quality of life outcomes associated with major behavioural risk factors were estimated using the EuroQol EQ-5D responses of 14 117 participants, aged ≥16 years, in the 2008 Health Survey for England. Multivariable linear regression was used to model the relationship between the five risk factors and EQ-5D utility scores. In addition, logistic regression was used to model their relationship to dichotomous reports of problems for each of the five EQ-5D dimensions.

Results Only one-third of participants had a body mass index within normal range, never drank alcohol, consumed at least five portions of fruit or vegetable/day or exercised regularly, while nearly half of participants were smokers or ex-smokers. In the fully adjusted multivariable analyses, reductions in EQ-5D utility scores (95% CI) of 0.105 (0.072 to 0.137), 0.062 (0.042 to 0.082) and 0.142 (0.129 to 0.155) were estimated for a body mass index ≥40 kg/m2, heavy smoking (≥20 cigarettes/day) and physical inactivity, respectively. Hazardous alcohol consumption (men >4 and ≤8 units/day; women >3 and ≤6 units/day) and daily fruit and vegetable intake between three and less than five portions were associated with small positive effects on EQ-5D utility scores (p<0.05).

Conclusions The high prevalence and substantial utility loss associated with obesity, smoking and physical inactivity highlight the potential impact that interventions aimed at their prevention or alleviation may have on population health.

  • EQ-5D utility scores
  • obesity
  • alcohol
  • smoking
  • physical activity
  • cost-effective
  • health behaviour
  • health promotion
  • public health
  • QALY
  • economics
  • perinatal
  • quality of life

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  • Competing interests None.

  • Patient consent Analysis of data accessed from UK Data Archive.

  • Ethics approval This study is an analysis of previously collected data. Permission to use the data was granted by the Economic and Social Data Service, a national data archiving and dissemination service jointly funded by the Economic and Social Research Council (ESRC) and the Joint Information Systems Committee (JISC). The results in this study and any errors contained therein are those of the authors, not the Economic and Social Data Service.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The results of the multivariate regression analysis investigating the relationship between the EQ-5D utility score and the health behavioural risk factors from the other estimators (Tobit, Fractional logit and two-part models) are available from the first author upon request.