Socioeconomically advantaged Australians get 12 more years of good health than their countrymen living in disadvantage. We can and should work this into HTA assessments, researchers say.
We have known for a while that social determinants of health affect who gets a long time and who gets a good time, but until now, we haven’t had the detail.
Now, research from Monash University, published in the journal Value in Health, shows us that the most disadvantaged Australians not only have lower life expectancy (78.7 years v 86.3 years), but, on average, 12 fewer years of good health than their compatriots living in high advantage.
The study looked specifically at sex-specific life expectancy and quality-adjusted life expectancy, which is the number of years a person has before chronic conditions set in, based on socioeconomic status and location.
The most disadvantaged Australians have a life expectancy of 78.7 years, 43.9 of them healthy, compared to 86.3 and 55.6 years respectively for the most advantaged.
“A baby boy born in the most socioeconomically disadvantaged group in Australia can expect 45.9 years of healthy life, compared to the nation’s least disadvantaged who can expect 56.8 quality health years,” said Sheridan Rodda, the study’s lead author, clinical pharmacist and Monash Centre for Medicine Use and Safety (CMUS) PhD candidate in Health Economics.
“The gap with women is even more staggering. If you are among Australia’s most disadvantaged women then your QALE at birth is estimated to be 41.9, compared with the least disadvantaged women who have an estimated QALE of 54.2 years – an eye-opening 12.3-year disparity,” Ms Rodda said.
“While women have an overall higher life expectancy than men, they generally report lower health-related quality of life – they are living longer but with chronic conditions and these gaps based on socioeconomic status remain unacceptably high.”
The way we traditionally do health technology assessment does not take health equity into account, the paper says.
“[T]traditional analyses … view[s] all health gains as equal, no matter to whom they accrue.”
But there’s inequity related to illness severity, age, race or ethnicity, socioeconomic status and geography and HTA agencies around the world are starting to consider it formally, using quantitative measures and new methods, the authors say.
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“While quantitative analyses of equity are not currently considered within Australian HTA, this approach could be applied to the evaluation of equity-relevant interventions in the future.”
Quantity of years is not a good enough benchmark, they say. Inequity is reflected in the quality of those years lived, and getting a baseline makes it possible to see the effects of interventions on specific populations.
Using data from 14,366 responses to the HILDA survey and ABS data, their findings confirm that while women across the whole population live longer than men (84.6 years vs 80.7), fewer of them are lived without chronic illness 48.8 vs 51.4).
The difference between healthy years for the most advantaged and most disadvantaged is 11.7 years (12.3 years for women, 10.9 for men).
Living in outer regional to remote areas meant a life expectancy 2.6 years lower than for metropolitan people, and there’s a 3.80year difference in life lived without chronic illness.
And that’s just using the two characteristics they take into account in this study.
“The results do not reflect disparities across other equity relevant strata such as non-binary gender identities, First Nations people or those disadvantaged due to ethnicity or migrant status,” the study points out.
“There is considerable scope and justification to similarly investigate disparities among these groups in the future.”