| Objective: The applicability of the quality of life scale(EBQo L)based on environmental factors to evaluate the quality of life of the general population was analyzed.Four universal quality of life scales(EBQo L,EQ-5D-3L,EQ-5D-5L and ICECAP-A)were used to measure the health utility value of the general population in China,and the correlation and consistency of the results of the four scales were compared and analyzed.Methods: With the method of quota sampling,200 permanent residents aged 18 or above were selected from Shenyang,Nanjing,Shijiazhuang and Guiyang from January to May 2018.The quality of life scale based on environmental factors(EBQo L),two versions of the European five-dimensional health scale(EQ-5D)and the quality of life scale of adult availability(ICECAP-A)were used for the questionnaire survey.The applicability of the EBQo L scale to evaluate the quality of life of the general population in China was analyzed by internal consistency reliability,content validity and structural validity.The utility values of 97 health states selected from EBQo L scale were directly measured by Time Trade-Off method(TTO),and econometric models were constructed based on individual level and mean level data,respectively.The relatively optimal prediction model was selected according to the goodness of fit,predictive power and significance of coefficient of each model.Spearman correlation,factor analysis,intra-group correlation coefficient and Bland-Altman plot consistency analysis were used to compare the results of four life quality scales.The differences between the measurement results of the EQ-5D scale were analyzed from the aspects of ceiling effect,redistribution inconsistency and information discrimination ability.The rank sum test of Wilcoxon and Kruskal Wallis was used to analyze the influence of social demographic characteristics and other factors on the quality of life of the generalpopulation in China.Results: The study actually included 802 general population,201 each in Shenyang and Guiyang,200 each in Nanjing and Shijiazhuang,with an average age of 43.24 ± 15.89 years,407(50.75%)males and 749(93.39%)respondents being ethnic Han.Married respondents accounted for 68.58%(550),most respondents had a high school education or less(465,57.98%),and 750(93.52%)respondents answered their family monthly income,with an average income of9,184.97 yuan(SD=14,285.73).218(27.18%)of the respondents had a doctor-diagnosed chronic disease,and 77.81%(624)felt happy with their lives.The mean time for respondents to complete the EBQo L scale was 1.75±1.01 minutes,and the mean score of self-rated environmental conditions was 74.66(SD=12.36).The Cronbach’s α coefficient of overall internal consistency reliability of the scale was0.607,and the content validity results showed that the Pearson correlation coefficients of water quality,air quality,living environment,social life and social security and the total score of the scale were 0.67,0.69,0.62,0.44 and 0.60,the correlation was statistically significant(P<0.05).Factor analysis was applied to test the structural validity of the scale.The results showed that the water quality,air quality and living environment dimensions of EBQo L scale were mainly loaded on factor 1,reflecting the natural environment in which the respondents lived.The dimensions of social life and social security are mainly attached to factor 2,which reflects the social environment in which the respondents live.Build EBQo L scale results show that the utility value of the integral system according to the model coefficient is significant,the ability to predict and goodness-of-fit criteria,based on personal level compared data using random effects in estimating the effect of the main model(4)model,based on the average level in the data using ordinary least squares estimation of the main effect model(6)model forecast effect is best,and the goodness of fit is higher(0.6569<0.9864),mean absolute error is lower(0.0186<0.0188).The mean and 95%confidence intervals of the health utility values of the general population measured by the EBQo L,EQ-5D-3L,EQ-5D-5L and ICECAP-A were 0.719(0.710,0.728),0.954(0.947,0.959),0.957(0.953,0.962)and 0.862(0.855,0.871).The utility value of EBQo L,EQ-5D-3L and ICECAP-A had significant positive correlation(r=0.087,P<0.05;r=0.285,P<0.001).The utility value of EQ-5D-3L and ICECAP-A also showed a significant positive correlation(r=0.193,P<0.001).Factor analysis results showed that ICECAP-A,EQ-5D-3L and EBQo L were loaded into factor 1,factor 2and factor 3,indicating that the measurement connotations of the three scales were different.The consistency analysis results of the four scales showed that the correlation coefficient between the utility value of EBQo L and ICECAP-A was 0.41,indicating that the consistency between the two scales was moderate.The inter-group correlation coefficient between EQ-5D-3L and EQ-5D-5L is 0.74,indicating a good consistency between the two scales.The consistency between utility values of other scales was poor.From the redistribution of EQ-5D-3L to EQ-5D-5L,the results show that the average inconsistency rate of each dimension of the scale is 2.07%,and the inconsistencies were mainly found in the two dimensions of pain/discomfort and anxiety/depression.The ceiling effect of EQ-5D-5L is 18.46% lower than that of EQ-5D-3L,the Shannon index of all dimensions of EQ-5D-5L is greater than that of EQ-5D-3L,while the Shannon uniform index of relative information is that the two scales have different degrees in five dimensions.Conclusion: In general,EBQo L scale has strong applicability in evaluating the quality of life of the general population in China.It can be widely applied to the study of quality of life in the future,and then the influence of environmental factors and other non-health-related factors on quality of life can be analyzed.The main effect model of ordinary least squares estimation based on mean level data obtained in this study is the optimal model.The utility value integration system of EBQo L scale obtained by this model is of great significance and can provide data basis for cost-utility analysis in domestic health economics evaluation.Compared with EQ-5D,EBQo L and ICECAP-A have lower ceiling effect and can better distinguish different health status of population.EQ-5D-5L also reduces the ceiling effect of EQ-5D-3L to a large extent.EQ-5D-5L has a strong ability to distinguish information,so relevant studies can select the appropriate version of EQ-5D according to actual needs.The results of this study indicate that the four kinds of universal life quality scale measurement connotation is different,life quality evaluation should not only focus on health related quality of life,also shouldpay attention to more wide range of environmental factors and practical ability of health-related quality of life,the future that EBQo L and ICECAP-A can be widely applied to evaluate the quality of life of different people.In addition,it is suggested that researchers select appropriate scales according to research needs and scale attributes.In view of the complementarity of the four scales in the measurement connotation,multiple scales can also be used simultaneously in the study to more comprehensively reflect the effect of intervention measures or the quality of life of interviewees. |
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