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1. Key messages

  • Chronic diseases have a substantial impact on a person’s health-related quality of life and well-being in terms of pain, discomfort, anxiety, depression, and loneliness.
  • Persons with a chronic disease have a lower health-related quality of life score compared to the general Belgian population.
  • At population level, dorsopathies, arthropathies, and cardiometabolic risk factors account for the greatest loss in quality-adjusted life years. For individual persons, the greatest losses in HRQoL were linked to stroke, depression, and chronic fatigue.

2. Health-related quality of life in chronic diseases

Chronic diseases are defined by the World Health Organization (WHO) as long-lasting (more than six months) medical health conditions with a generally slow progression [1]. The term “chronic disease” is often used as a synonym for “non-communicable disease” (NCD), referring to conditions that are not acquired by transmission between persons. The four most prevalent chronic diseases are cardiovascular disease, cancer, chronic respiratory disease, and diabetes. However, during the last decades, the prevalence of neurodegenerative disorders such as dementia or Parkinson's disease as well as various mental illnesses has increased sharply.

Chronic diseases are by far the most important causes of death. In addition, they also have a substantial impact on health-related quality of life (HRQoL) and well-being. This is due to the fact that chronic diseases have negative effects on physical (e.g., pain, discomfort), mental (e.g., anxiety, depression), and social (e.g., loneliness, social isolation) health. In recent decades, interest in optimal quality of life in chronic diseases has increased, mainly because most chronic diseases are incurable. Several studies confirm that chronically ill persons have a reduced HRQoL compared to the general population [2]. More specifically, it was shown that people with a chronic disease score worse on all five domains of HRQoL. For example, these persons more often experience problems with mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. In addition, it has also been found that female patients and patients with a low socio-economic status have a higher risk of a lower HRQoL.

In Belgium, recent research was conducted into the impact of chronic diseases on HRQoL. Results from the Belgian Health Interview Survey (BHIS) showed that the mean HRQoL scores for chronically ill patients (0.81 on 1) were lower compared to the Belgian reference value of 0.83 on 1 in 2018 [3], taking into account the age profiles of the population. In addition, it was calculated how many quality-adjusted life years (QALYs) were lost due to chronic diseases [4]. For both men and women, dorsopathies (low back pain and neck pain), arthropathies (rheumatoid arthritis and osteoarthritis), and cardiovascular risk factors accounted for the greatest loss of QALYs.

Annual quality-adjusted life-year (QALY) loss per 100,000 individuals associated with 23 chronic diseases, by gender, for the Belgian population aged 15 years and older, Belgium, 2018
Source: Van Wilder et al. [4]

The following figure presents the evolution over time of the ranking of causes of total QALY loss for 2013 and 2018. The top 4 stayed the same between 2013 and 2018.

Annual quality-adjusted life-year (QALY) loss per 100,000 individuals by rank, Belgium, 2013 and 2018
Source: Van Wilder et al. [4]

For individual persons, the greatest losses in HRQoL were linked to stroke, depression, and chronic fatigue.

Individual losses in HRQoL linked to chronic diseases, Belgium, 2018
Source: Van Wilder et al. [4]

3. Read more

Discover the full study


Health-related quality of life (HRQoL) captures a person’s self-perceived impact of a medical condition, its symptoms, and its treatment on their physical, mental and social well-being [5]. The HRQoL is measured with the EQ-5D instrument. EQ-5D scores range between 0 (death) and 1 (perfect health).
Quality-adjusted life years (QALY) measure the burden of disease, including both quantity (i.e. life expectancy) and quality of life (i.e. HRQoL). One QALY equates to one year in perfect health [6].


  1. World Health Organization (WHO). Noncommunicable diseases. 2018;
  2. Van Wilder L, Rammant E, Clays E, Devleesschauwer B, Pauwels N, De Smedt D. A comprehensive catalogue of EQ-5D scores in chronic disease: results of a systematic review. Qual Life Res. 2019.
  3. Van Wilder L, Charafeddine R, Beutels P, Bruyndonckx R, Cleemput I, Demarest S, De Smedt D, Hens N, Scohy A, Speybroeck N, Van der Heyden J, Yokota R, Van Oyen H, Bilcke J & Devleesschauwer B. Belgian population norms for the EQ-5D-5L, 2018. Quality of Life Research. 2022.
  4. Van Wilder L, Devleesschauwer B, Clays E, Van der Heyden J, Charafeddine R, Scohy A, et al. QALY losses for chronic diseases and its social distribution in the general population: results from the Belgian Health Interview Survey. BMC Public Health. 2022 Jul 7.
  5. Schipper H CJ, Olweny C. Quality of life studies: definitions and conceptual issues. Quality of Life and Pharmacoeconomics in Clinical Trials. 1996.
  6. Hyder AA, Puvanachandra P, Morrow RH. Measuring the health of populations: explaining composite indicators. Journal of Public Health Research. 2012.