The Social Distribution of Quality-Adjusted Life Expectancy Among Social Deprivation Subgroups in China

To estimate disparities in quality-adjusted life expectancy (QALE) across social deprivation subgroups in China using the County-level Social Deprivation Index 2020 (CSDI 2020).

Mortality data from the 2021 Chinese Death Surveillance System were linked with a national EQ-5D-5L health utility survey. Mortality underreporting was calibrated using model life tables and benchmarked against official statistics. Health utilities were modeled using ordinary least squares regression incorporating age-deprivation interactions. QALE was estimated via the Sullivan method. Additional analyses examined the interaction between geographic regions and deprivation quintiles.

QALE declined progressively as social deprivation increased. The national QALE gap at birth between the least- and most-deprived quintiles was estimated to be at least 7.73 quality-adjusted life-years (QALYs) (95% CI: 7.12-8.32), with 77.4 QALYs in the least-deprived group versus 69.6 QALYs in the most deprived. Men experienced larger disparities (7.98 QALYs) than women (7.31 QALYs). Sensitivity analyses confirmed a robust gradient, with gaps ranging from 7.45 to 8.71 QALYs. When accounting for region-deprivation interactions, this disparity widened to 10.65 QALYs between the least-deprived Eastern and most-deprived Western subgroups.

Substantial, graded inequalities in QALE exist in China, significantly compounded by regional development gaps. These findings provide a critical empirical foundation for equity-informed health policy and distributional cost-effectiveness analysis.