A comparative analysis of EQ-5D-5L general population norms across 23 countries: Gender and age disparities

To explore health disparities among populations across countries, the study compared the 5-level EuroQol 5-dimensions version (EQ-5D-5L) population norms across 23 countries and identified differences in EuroQol 5-dimensions (EQ-5D) health problems, health utility score (HUS), and EQ-5D visual analog scale (VAS) score by country, gender, and age. Guided by the PRISMA systematic review and meta-analysis guidelines, a systematic literature search was conducted in databases of PubMed, Web of Science, MEDLINE, and EMBASE (until January 2025) to extract country, gender, and age-specific population norms reporting ceiling effect, EQ-5D-5L health problems, HUS, and EQ VAS scores. Only nationally representative norms derived from the latest population data were included in this study. The norms revealed significant variation in ceiling effect health problems and health-related quality of life (HRQoL) metrics. The ceiling effect varied substantially, with higher effects in Asian countries, reflecting cultural and demographic influences. Pain/discomfort was the most frequently reported problem, while self-care was the least common across all countries. Mean HUS and EQ VAS scores of the norms were 0.897 and 79.0, respectively, with notable regional, gender, and age-related differences. Females generally reported lower HRQoL than males, though exceptions were observed in specific dimensions and countries. This study compared the EQ-5D-5L population norms globally, providing valuable insights for HRQoL assessments, health policy making, and economic evaluations. The results highlighted the importance of considering cultural and demographic factors when interpreting HRQoL data. • Significant variation in ceiling effect was found, especially in Asian countries. • Pain/discomfort was the most common health problem worldwide, while self-care was the least. • Mean HUS was 0.897 and EQ VAS score was 79.0, with regional and gender differences. • Females generally reported lower HRQoL than males, with some country-specific exceptions. • Cultural and demographic factors must be considered when interpreting HRQoL data.