Assessing inequalities in health utility scores among cancer patients undergoing systemic and radiation therapy

BACKGROUND: Cancer remains a leading cause of morbidity and mortality worldwide, with low- and middle-income countries like Bangladesh facing a dual burden of rising incidence and limited healthcare infrastructure. Socioeconomic disparities, particularly economic social class, may exacerbate the adverse effects of cancer on health-related quality of life (HRQoL) (e.g., health utility scores). This study aimed to evaluate inequalities in health utility scores among cancer patients receiving systemic and/or radiation therapy. METHODS: This cross-sectional study included 607 patients with a confirmed cancer diagnosis who were receiving systemic and/or radiation therapy treatment in two tertiary hospitals in Bangladesh. Patients were grouped into income quintiles, and health utility scores were assessed using EQ-5D-5L instrument. Socioeconomic inequalities were assessed using relative (rich-poor ratio) and absolute (rich-poor difference) measures, the concentration index, and regression-based decomposition analysis. Associations between health utility scores and key factors such as cancer stage, type, treatment facility, and physical activity, were examined using a generalise linear model with a Gamma distribution and log link function. RESULTS: Patients in the highest income quintile had significantly higher health utility scores compared with those in the lowest income quintile (relative inequality = 1.10; absolute difference = 0.07). The concentration index indicated a pro-rich distribution of health utility scores (CI = 0.025, SE = 0.019). Subgroup analyses demonstrated pronounced disparities by cancer stage, cancer type, and treatment facility. Advanced-stage disease, cancers of the female reproductive organs, and lung cancer were associated with larger income-related gaps. Inequalities were most evident self-care and usual activities dimensions of the EQ-5D-5L instrument, where the poorest patients had substantially higher risks of severe/extreme problems. Decomposition analysis identified advanced cancer stage, treatment in public hospitals, and physical inactivity as major contributors to lower utility scores, underscoring the compounded disadvantage among low-income patients. CONCLUSION: Socioeconomic disparities, measured by income quintiles, were associated with significant differences in HRQoL (i.e. health utility scores) among Bangladeshi cancer patients. Inequalities were most pronounced in specific subgroups, particularly those with advanced disease, certain cancer types, and limited physical activity. Targeted, equity-focused interventions or strategies such as enhanced supportive and palliative care, rehabilitation and physical activity programs and improved access to quality services in public facilities, may help reduce income-related gaps in quality of life.