Quality of life

1. Key messages

In 2013, 78% of the Belgian population reported their health to be good or very good. This proportion is slightly higher in men. In Flanders, more people report to be in good health than in Wallonia or Brussels. There is an important socio-economic gradient, with persons from the highest socio-economic level reporting better health than people from the lowest level. Belgium ranks favorably among the EU-15 countries for the level of self-rated health.
Quality of life, as measured by the Health-Related Quality of Life (HRQOL) score, appears to be higher for men than for women. Quality of life is strongly decreasing with age: when people get older, their HRQOL score declines, regardless of sex. People in Flanders seem to have a better HRQOL than people in Brussels or Wallonia. There is also an important socio-economic gradient: persons from the lowest socio-economic level have a lower HRQOL.

2. Background

Quality of life is a subjective perception of the individual about his life in his own context and value system, according to his goals and expectations. This perception can be influenced by several factors like physical and mental health but also by the social relationships for example [1]. We explore the quality of life here throughout two indicators, self-rated health and Health-Related Quality of Life score.

Self-rated health is defined as an individual’s appreciation of their own health status. Despite its subjective nature, self-rated health is a good predictor of people’s future morbidity, disability, healthcare use, and mortality. In this report, we describe the percentage of people rating their health as good or very good as reported in the Health Interview Surveys. International comparisons come from Eurostat and are derived from the EU-SILC surveys.

Health-Related Quality of Life (HRQOL) refers to the effects that the health status can have on quality of life. Different tools exist to measure HRQOL, we will focus here on the EuroQol 5 Dimensions questionnaire (EQ-5D) [2], as measured in the Health Interview survey.

3. Self-rated health

Belgium

The successive Health Interview Surveys from 1997 to 2008 showed a significant gender difference, with men rating their health better than women. In 2013, 79.6% of men and 76.4% of women declared to be in good or very good health, but this gender difference was no longer significant. As expected, the prevalence of good self-rated health decreases strongly with age: 93% of the people aged 15-24 rate their health as good or very good, compared to only 56% of people aged 75 and over.

Prevalence of (very) good self-rated health by age group and sex, Belgium, 2013
Source: Health Interview Survey, Sciensano, 2013 [3]

Trends and regional disparities

The evolution over time shows a slight but significant increase of people rating their health as (very) good in Belgium between 1997 (77.1%, age adjusted prevalence) and 2013 (80.4%). This evolution is sharper in Wallonia (from 71.5% in 1997 to 77.8% in 2013).

In all Health Interview Surveys, important regional disparities are observed with higher rates of good self-rated health in Flanders than in Wallonia or Brussels. In 2013, these regional disparities had reduced, but still existed: the age-adjusted prevalence of people perceiving their health as (very) good was higher in Flanders (82.3%) than in Wallonia (77.8%) or Brussels (76.2%). This reduction of the regional disparity was mainly due to a sharp increase of the women with a good self-rated health in Wallonia (from 67.1% in 1997 to 78% in 2013).

  • Men
  • Women

Prevalence of (very) good self-rated health among men, for regions and Belgium, 1997-2013
Source: Health Interview Survey, Sciensano, 1997-2013 [3]

Prevalence of (very) good self-rated health among women, for regions and Belgium, 1997-2013
Source: Health Interview Survey, Sciensano, 1997-2013 [3]

Disparities by educational level

Using education level as indicator of socio-economic level, an important socio-economic gradient is observed: after adjustment for age, only 61% of people with a low educational level rate their health positively, versus 86% of the people in the highest level.

Prevalence of (very) good self-rated health by level of education, Belgium, 2013
Source: Health Interview Survey, Sciensano, 2013 [3]

International comparison

Belgium ranks favorably among the EU-15 countries for the proportion of people rating their health favorably, in both sexes, and this since 2004.

  • Men
  • Women

Prevalence of (very) good self-rated health among men, EU-15, 2016
Source: OECD Health Statistics, 2016 [4]

Prevalence of (very) good self-rated health among women, EU-15, 2016
Source: OECD Health Statistics, 2016 [4]

Evolution of the prevalence of (very) good self-rated health, Belgium and EU-15 mean, 2004-2016
Source: OECD Health Statistics, 2004-2016 [4]

4. Health-related quality of life

In 2013, Belgians reported an average HRQOL score of 81.5, as measured by the EQ-5D questionnaire. The quality of life score appears to be significantly higher for men (83.8) than for women (79.4), and in Flanders (83.6) than in Brussels (80.3) or Wallonia (77.7).

There is a strong decreasing gradient with age. When people get older, their HRQOL declines. The decrease is more pronounced in women, with a relative decrease of more than 25% (from 87.4 to 65 between the two extreme age groups), while the relative difference is of 20% only in men (from 91.9 to 73.6).

Health-related quality of life score by sex and age, Belgium, 2013
Source: Health Interview Survey, Sciensano, 2013 [3]

Differences by educational level

HRQOL scores increase with education level: from 67 for the lowest educated group compared to 85 for the highest educated group. This socio-educational gradient remains significant after standardization for age and sex.

Health-related quality of life score by education level, Belgium, 2013
Source: Health Interview Survey, Belgium, 2013 [3]

5. Read more

View the metadata for Self-rated health

View the metadata for Health-related quality of life

HISIA: Interactive Analysis of Belgian Health Interview Survey

Definitions

EU-15
The EU-15 corresponds to all countries that belonged to the European Union between 1995 and 2004: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, the Netherlands, Portugal, Spain, Sweden and the United Kingdom. We compare the Belgian health status to that of the EU-15 because these countries have similar socioeconomic conditions.
EuroQol Five Dimensions Questionnaire (EQ-5D)
The EuroQol Five Dimensions questionnaire is a quick and simple instrument that assesses the impact of health status on the quality of life. The EQ-5D comprises two components, i.e., the EQ-5D-5L descriptive system and the EQ-5D visual analogue scale. The descriptive system covers five dimensions (mobility, personal autonomy, daily activities, pain/discomfort and anxiety/depression), each having five possible response levels (ranging from no problems to extreme problems).
EQ-5D score
Combining the reply to each of the items of the EQ-5D questionnaire, a global score is produced and is scaled by two anchor points: 0, representing death, and 100, representing the best imaginable health state. Negative score is possible, representing a health state worse than death.
Health-related quality of life
Quality of Life is an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the person's physical health, psychological state, personal beliefs, social relationships and their relationship to salient features of their environment. When the quality of life concept is restricted to the effects of health status, it is called health-related quality of life.
Prevalence of good self-rated health
Percentage of people rating their health as good or very good.
Self-rated health
Self-rated health is the individual's subjective assessment of their own health status. To answer the question “How is your general health status?” people have to choose between five categories: very good, good, fair, bad, or very bad.

References

  1. World Health Organization, Measuring Quality of Life. http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/
  2. EuroQol Five Dimensions Questionnaire. https://euroqol.org/
  3. Health Interview Survey, Sciensano, 1997-2013. https://his.wiv-isp.be/fr/Documents%20partages/SH_FR_2013.pdf
  4. OECD Health Statistics, 2004-2016. http://stats.oecd.org/