Quality-Adjusted Life Expectancy by Socioeconomic Disadvantage and Remoteness Area: Population Norms for Australia

Abstract

Detailed and current information on the social distribution of health across gradients of socioeconomic disadvantage and geographic remoteness in Australia is limited. Quality-adjusted life expectancy (QALE) is a useful summary measure of population health, combining mortality and health-related quality of life. This cross-sectional study estimates QALE by year age for the Australian population across sex, socioeconomic disadvantage, and remoteness groups, providing a baseline for equity-focused health technology assessments. Short Form-6 Dimension data were obtained from the Household, Income, and Labor Dynamics survey for 2022 and 2023, from which mean utility scores by age were estimated using linear regression. Mortality data for 2022 from the Australian Bureau of Statistics were used to construct life tables to generate life expectancy (LE), into which health-related quality of life was incorporated to derive age and sex-specific QALE across quintiles of socioeconomic disadvantage and remoteness areas. At birth, individuals in the most disadvantaged quintile had an undiscounted LE of 78.7 years and QALE of 43.9 years compared with those in the least-disadvantaged quintile with undiscounted LE of 86.3 years and QALE of 55.6 years. A small gradient existed across remoteness areas, with individuals residing in major cities experiencing 2.6 years greater LE and QALE of 3.8 years (both undiscounted) above those in outer regional or remote areas. Our study demonstrates major inequalities associated with socioeconomic disadvantage and remoteness for LE and QALE. The social distribution of health status provided in this study can be used in future equity-informed economic evaluations.