Quality of life

1. Key messages

In 2018, 77% of the Belgian population reported their health to be good or very good. This proportion is slightly higher in men (79%) than in women (75%), and decreases with age. More people report being in good health in Flanders (78.5%) and Brussels (78.4%) than in Wallonia (74.0%). Finally, there is an important socio-economic gradient, with the proportion of people reporting to be in good health increasing as the socio-economic status increases.
The mean Health-Related Quality of Life (HRQoL) score is 0.79 in Belgium, which is a decrease since 2013, where it was 0.81. HRQoL is higher in men (0.82) than in women (0.77) and strongly decreases with age. People in Flanders have a better HRQoL (0.82) than people in Brussels (0.79) or Wallonia (0.75). As for self-rated health, there is an important socio-economic gradient in 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]. This domain has been explored here via two different concepts: the Self-Rated Health (SRH) and Health-Related Quality of Life (HRQoL) score.

Self-rated health is defined as an individual’s appreciation of its own health status. Despite its subjective nature, self-rated health is a good predictor of people’s future morbidity, disability, healthcare use, and mortality. Information has been drawn here from the percentage of people rating their health as good or very good as reported in the Belgian Health Interview Survey for national results. For the international comparisons, however, the data were derived from the OECD database and were coming from the EU-SILC surveys.

Health-Related Quality of Life (HRQOL) refers to the effects that the health 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 Belgian Health Interview survey. This tool is allowing to assess HRQoL with 5 dimensions: mobility, self-care, usual activity, pain/discomfort, anxiety/depression. The answers to these dimensions are weighted with preference values drawn from the Belgian population to produce an HRQoL score (on a scale where 1 corresponds to perfect health, and 0 to death). No international comparison is presented for this indicator due to the lack of international data.

3. Self-rated health

Belgium

In 2018, 77% of the population aged 15 years or older rated their health as good or very good. Self-rated health is higher in men (78.7%) than in women (76.2%). This difference is reversed among the younger people but starting from the age group 45-54, men are more frequently rating their health as good or very good than women.

As expected, the prevalence of good self-rated health decreases strongly with age: from 91.8% among the people aged 15-24 rate to only 58.3% of people aged 75 and over.

Prevalence of (very) good self-rated health by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [3]

Trends and regional differences

After the improvements observed between 1997 and 2013, the age-standardized proportions of Belgians reporting good self-rated health remained stable with 78.1% in 2013 and 77.3% in 2018. A higher age-standardized prevalence is observed in Flanders and in Brussels compared to Wallonia and this difference is statistically significant.

Between 1997 and 2013, the percentage of people reporting good health increased in Wallonia (from 68.3% to 74.7%) and in Flanders (from 77.0% to 80.2%). This evolution is not observed anymore in 2018 as the rate stayed stable when compared to 2013: 74% in Wallonia and 79.3% in Flanders. In Brussels however, the percentage of people reporting good health increased between 2013 and 2018, from 73.7% to 77.2%.

  • Men
  • Women

Age-standardized prevalence of (very) good self-rated health in men aged 15 and older, by region, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano [3]

Age-standardized prevalence of (very) good self-rated health in women aged 15 and older, by region, 1997-2018
Source: Own calculations based on Health Interview Survey, Sciensano [3]

Socio-economic differences

An important socio-economic gradient, measured by educational level, is observed in the self-rated health in Belgium. After standardization for age, only 57% of people with a primary education level rate their health positively versus 84% of the people with tertiary education.

Age-standardized prevalence of (very) good self-rated health by level of education, Belgium, 2018
Source: Own calculations based on Health Interview Survey, Sciensano [3]

International comparison

The prevalence of self-rated health in Belgium ranks favorably among the EU-15 countries since 2004. In 2017, men ranked fifth among the EU-15, while women were just above the EU-15 average.

  • Men
  • Women

Prevalence of (very) good self-rated health among men aged 15 and older, EU-15, 2017
Source: OECD Health Statistics (based on EU-SILC) [5]

Prevalence of (very) good self-rated health among women aged 15 and older, EU-15, 2017
Source: OECD Health Statistics (based on EU-SILC) [5]

Evolution of the prevalence of (very) good self-rated health among people aged 15 and older, Belgium and EU-15 mean, 2005-2017
Source: OECD Health Statistics (based on EU-SILC) [5]

4. Health-related quality of life

Belgium

In 2018, the population aged 15 years or more had an average HRQOL score of 0.79, as measured by the EQ-5D questionnaire. The quality of life score is significantly higher for men (0.82) than for women (0.77).

The HRQoL score is significantly decreasing with age. The decrease is more pronounced in women: between the two extreme age groups, women are losing about 26% of their HRQoL score (from 0.84 to 0.62) while men are losing only 17% (from 0.86 to 0.71).

Health-related quality of life score by age and sex, Belgium, 2018
Source: Health Interview Survey, Sciensano [4]

Trends and regional differences

The average HRQoL score measured by the EQ-5D questionnaire in 2018 (0.79) was lower than in 2013 (0.81).

Despite the important proportion of people reporting problems of pain/discomfort and anxiety/depression in 2013, these proportions have further increased in 2018:

  • pain/discomfort was reported by 56% of the population in 2018 versus 50% in 2013.
  • anxiety/depression was reported by 31% in 2018 versus 26% in 2013.

In 2018, the HRQoL score was higher in Flanders (0.82) than in Brussels (0.79) and Wallonia (0.75).

The HRQoL score decreased in Flanders (from 0.83 in 2013 to 0.82 in 2018) and in Wallonia (from 0.78 to 0.75). In Wallonia, the decrease was more substantial in women (0.76 to 0.72) than in men. The gaps between Wallonia and the two other regions have increased between 2013 and 2018.

  • Men
  • Women

Average health-related quality of life score among men aged 15 years or older, by region, 2013-2018
Source: Health Interview Survey, Sciensano [4]

Average health-related quality of life score among women aged 15 years or older, by region, 2013-2018
Source: Health Interview Survey, Sciensano [4]

Socio-economic differences

The average HRQoL score increases with educational level: from 0.65 for people from the lowest educational group to 0.83 for people with a high education level.

Health-related quality of life score by education level, Belgium, 2018
Source: Health Interview Survey, Belgium, 2018 [4]

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: Subjective Health, Sciensano, 1997-2018. https://his.wiv-isp.be/fr/Documents%20partages/SH_FR_2018.pdf
  4. Health Interview Survey: Health-Related Quality of Life, Sciensano, 2013-2018. https://his.wiv-isp.be/fr/Documents%20partages/QL_FR_2018.pdf
  5. OECD Health Statistics, 2005-2017. http://stats.oecd.org/