Health-related quality of life in central China has been charted in unusual detail by a large cross-sectional study that used the EQ-5D-5L instrument, a widely adopted measure of how people rate their own health. Drawing on the 2023 National Health Services Survey conducted in Hubei and Henan provinces, the researchers analysed responses from 20,192 community-dwelling adults aged 16 years or older, producing updated population norms for a region where such reference values had been lacking since the COVID-19 pandemic.
The study, published in Archives of Public Health, reported a mean utility index of 0.950, with a standard deviation of 0.145 and a median of 1.000. The utility index converts answers across five health dimensions into a single score, and it hit its ceiling value of 1.000 for 71.3 percent of participants. By contrast, the EQ visual analogue scale, on which respondents directly rate their health from 0 to 100, showed a mean of 78.59 with a standard deviation of 16.36 and a median of 80.00, and only 10.6 percent of participants scored a perfect 100.
That gap between the two measures is the study’s central analytical focus. Among the five EQ-5D dimensions, pain or discomfort and anxiety or depression were the most frequently reported problems, while self-care was the least affected. When the researchers calculated an individual difference score by subtracting the rescaled EQ VAS score (the raw score divided by 100) from the utility index, the difference was positive for 85.9 percent of participants and negative for only 4.2 percent, with a median of 0.155.
To probe this discrepancy, the team fitted quantile regression models at the 10th, 25th, 50th, 75th and 90th quantiles of the distribution of difference scores, examining associations with sociodemographic, lifestyle and health-related factors. This approach matters because an average association can hide very different patterns at the low and high ends of a distribution. The results confirmed that heterogeneity: the associations between participant characteristics and the difference score varied across quantiles rather than remaining uniform.
Three factors stood out. Older age, insomnia and chronic conditions were associated with larger differences between the utility index and the EQ VAS score, and these associations were generally more pronounced at the middle and upper quantiles of the distribution. In practical terms, the two instruments diverge most noticeably precisely in the groups whose health status is often of greatest interest to survey designers and health planners.
The authors conclude that the utility index and the EQ VAS score capture related but distinct aspects of health and should be treated as complementary rather than interchangeable measures in population surveys, particularly among older adults and people with insomnia or chronic conditions. The study also delivers its stated first aim: updated, post-pandemic EQ-5D-5L population norms for adults in central China, based on a large community sample rather than a clinical population.
As with any cross-sectional survey, the findings describe associations at a single point in time and cannot establish causal relationships, and the sample is limited to two provinces in central China. The article was published as open access on 16 October 2026 and shared early as a peer-reviewed, accepted version subject to further edits before the final Version of Record.
Subject of Research: Population norms for EQ-5D-5L health-related quality of life and factors associated with differences between the utility index and EQ VAS score among adults in central China
Article Title: Population norms for health-related quality of life and distributional heterogeneity in differences between EQ-5D-5L utility index and EQ VAS score: a large-scale cross-sectional study
Article References: Xiang, C., Fan, J., Zhong, K., Xu, J., Shen, L., Cheng, X., Shen, W., Fu, Q., & Zhang, Z. (2026). Population norms for health-related quality of life and distributional heterogeneity in differences between EQ-5D-5L utility index and EQ VAS score: a large-scale cross-sectional study. Archives of Public Health. https://doi.org/10.1186/s13690-026-02113-9
Image Credits: AI Generated
DOI: 10.1186/s13690-026-02113-9
Keywords: EQ-5D-5L, EQ VAS, health-related quality of life, population norms, cross-sectional study, central China, National Health Services Survey, quantile regression, utility index, chronic conditions, insomnia, public health
News Source: Kristina Jarvis. (October 29, 2026). Large Survey Maps Quality-of-Life Norms for Central China After the Pandemic. Scienmag.
