Geographic Distribution of Health-Related Quality of Life in Iran
-
Fakhraddin Daastari
,
Abdoreza Mousavi
,
Ali Akbari Sari
,
Hedieh Sadat Zekri
,
Alireza Darrudi
,
Rajabali Daroudi
Abstract
Introduction: This study aimed to evaluate the HRQoL of the general Iranian population across all provinces using the European QoL 5-Dimension (EQ-5D) questionnaire.
Methods: Data were collected from a nationwide survey conducted in 2021 across all 31 provinces of Iran, involving 27,704 adults. The intended data included responses to EQ-5D-3L health states, EuroQol Visual Analogue Scale scores, and participants’ socioeconomic characteristics. Finally, descriptive analyses were conducted using Stata 14 and Microsoft Excel 2019.
Results: Pain/discomfort and anxiety/depression were the most prevalent problems across all provinces. In addition, the mean EQ-5D utility score was 0.87 (±0.15), ranging from 0.80 in North Khorasan to 0.91 in Alborz, Kermanshah, and Zanjan. For women, the mean score was 0.84 (±0.20), with a range of 0.77–0.90, indicating notable variation. In contrast, men demonstrated a higher mean score with less variation, at 0.90 (±0.14), ranging from 0.84 to 0.93.
Conclusion: This study provided HRQoL scores for the general population across the provinces of Iran, revealing significant variations. These values can inform healthcare research and policymaking by identifying disparities in health status across regions. Given the relatively low HRQoL scores observed in certain provinces, it is imperative to plan and implement strategies to enhance health outcomes, particularly in vulnerable groups within those regions.
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general population: results using the EQ-5D-3L and EQ-5D-5L instruments. Epidemiol Biostat Public Health 2015;12(3):1- 15. doi:10.2427/11457
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6. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new
five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 2011;20(10):1727-36. doi:10.1007/s11136-011-9903-x
7. Devlin N, Parkin D, Janssen B. Methods for Analysing and Reporting EQ-5D Data. Springer Nature; 2020.
8. Sun S, Chen J, Johannesson M, Kind P, Xu L, Zhang Y, et al. Regional differences in health status in China: population
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doi:10.1016/j.healthplace.2011.01.007
9. Emrani Z, Akbari Sari A, Zeraati H, Olyaeemanesh A, Daroudi R. Health-related quality of life measured using the EQ-
5D-5L: population norms for the capital of Iran. Health Qual Life Outcomes 2020;18(1):108. doi:10.1186/s12955-020-
01365-5
10. Rezaei S, Hajizadeh M, Kazemi A, Khosravipour M, Khosravi F, Rezaeian S. Determinants of health-related quality of life in Iranian adults: evidence from a cross-sectional study. Epidemiol Health 2017;39:e2017038. doi:10.4178/epih.
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12. Mousavi A, Akbari Sari A, Daastari F, Daroudi R. Healthrelated quality of life measured using the EQ-5D-3L: Iranian population norms. Expert Rev Pharmacoecon Outcomes Res 2024;24(5):643-51. doi:10.1080/14737167.2024.2328061
13. Shirvani Shiri M, Karami H, Ameri H, Akbari Sari A, Tatari M, Emamgholipour S, et al. The influencing factors of
health-related quality of life of the general population of Iran during the COVID-19 pandemic. Front Med (Lausanne)
2023;10:1049642. doi:10.3389/fmed.2023.1049642
14. Rezaei S. Population norms of health-related quality of life in Iran: findings from a national EQ-5D-5L study. Health Qual Life Outcomes 2025;23(1):48. doi:10.1186/s12955-025-02378-8
15. Mousavi A, Daroudi R, Alipour S, Akbari Sari A, Daastari F. Quality-adjusted life expectancy norms for the Iranian
population. Popul Health Metr 2025;23(1):5. doi:10.1186/s12963-025-00366-0
16. Statistics Center of Iran. Available from: https://www.amar.org.ir/statistical-information. Accessed January 15,
2024.
17. Djalalinia S, Azadnajafabad S, Ghasemi E, Yoosefi M, Rezaei N, Farzi Y, et al. Protocol design for surveillance of risk
factors of non-communicable diseases during the COVID-19 pandemic: an experience from Iran STEPS Survey 2021. Arch Iran Med 2022;25(9):634-46. doi:10.34172/aim.2022.99
18. Goudarzi R, Akbari Sari A, Zeraati H, Rashidian A, Mohammad K, Amini S. Valuation of quality weights for EuroQol
5-dimensional health states with the time trade-off method in the capital of Iran. Value Health Reg Issues 2019;18:170-5.
doi:10.1016/j.vhri.2019.01.007
19. Sullivan T, Turner RM, Derrett S, Hansen P. New Zealand population norms for the EQ-5D-5L constructed from the
personal value sets of participants in a national survey. Value Health 2021;24(9):1308-18. doi:10.1016/j.jval.2021.04.1280
20. Buchholz I, Janssen MF, Kohlmann T, Feng YS. A systematic review of studies comparing the measurement properties
of the three-level and five-level versions of the EQ-5D. Pharmacoeconomics 2018;36(6):645-61. doi:10.1007/
s40273-018-0642-5
21. Grochtdreis T, Dams J, König HH, Konnopka A. Healthrelated quality of life measured with the EQ-5D-5L: estimation
of normative index values based on a representative German population sample and value set. Eur J Health Econ
2019;20(6):933-44. doi:10.1007/s10198-019-01054-1
22. Santos M, Monteiro AL, Santos B. EQ-5D Brazilian population norms. Health Qual Life Outcomes 2021;19(1):162.
doi:10.1186/s12955-021-01671-6
23. Encheva M, Djambazov S, Vekov T, Golicki D. EQ-5D-5L Bulgarian population norms. Eur J Health Econ
2020;21(8):1169-78. doi:10.1007/s10198-020-01225-5
24. Ferreira PL, Pereira LN, Antunes P, Ferreira LN. EQ-5D-5L Portuguese population norms. Eur J Health Econ
2023;24(9):1411-20. doi:10.1007/s10198-022-01552-9
25. McCaffrey N, Kaambwa B, Currow DC, Ratcliffe J. Healthrelated quality of life measured using the EQ-5D-5L: South
Australian population norms. Health Qual Life Outcomes 2016;14(1):133. doi:10.1186/s12955-016-0537-0
26. Karimi M, Brazier J. Health, Health-related quality of life, and quality of life: what is the difference? Pharmacoeconomics 2016;34(7):645-9. doi:10.1007/s40273-016-0389-9
27. Tourani S, Behzadifar M, Martini M, Aryankhesal A, Taheri Mirghaed M, Salemi M, et al. Health-related quality of life
among healthy elderly Iranians: a systematic review and meta-analysis of the literature. Health Qual Life Outcomes
2018;16(1):18. doi:10.1186/s12955-018-0845-7
28. Farajzadeh M, Ghanei Gheshlagh R, Sayehmiri K. Health related quality of life in Iranian elderly citizens: a systematic
review and meta-analysis. Int J Community Based Nurs Midwifery 2017;5(2):100-11.
29. Mosadeghrad AM, Mousavi A. The futurology of aging population in Iran: letter to the editor. Tehran Univ Med J
2021;79(3):248-9.
testing of a one-factor model. Popul Health Metr 2016;14:22. doi:10.1186/s12963-016-0091-3
2. Scalone L, Cortesi PA, Ciampichini R, Cesana G, Mantovani LG. Health related quality of life norm data of the Italian
general population: results using the EQ-5D-3L and EQ-5D-5L instruments. Epidemiol Biostat Public Health 2015;12(3):1- 15. doi:10.2427/11457
3. Stenman U, Hakama M, Knekt P, Aromaa A, Teppo L, Leinonen J, et al. Measurement and modeling of health-related quality of life. In: Epidemiology and Demography in Public Health. Academic Press; 2010. p. 130-5.
4. Hickey A, Barker M, McGee H, O’Boyle C. Measuring healthrelated quality of life in older patient populations: a review of current approaches. Pharmacoeconomics 2005;23(10):971-93. doi:10.2165/00019053-200523100-00002
5. Gusi N, Olivares PR, Rajendram R. The EQ-5D health-related quality of life questionnaire. In: Preedy VR, Watson RR, eds. Handbook of Disease Burdens and Quality of Life Measures. New York, NY: Springer; 2010. p. 87-99. doi:10.1007/978-0-387-78665-0_5
6. Herdman M, Gudex C, Lloyd A, Janssen M, Kind P, Parkin D, et al. Development and preliminary testing of the new
five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 2011;20(10):1727-36. doi:10.1007/s11136-011-9903-x
7. Devlin N, Parkin D, Janssen B. Methods for Analysing and Reporting EQ-5D Data. Springer Nature; 2020.
8. Sun S, Chen J, Johannesson M, Kind P, Xu L, Zhang Y, et al. Regional differences in health status in China: population
health-related quality of life results from the National Health Services Survey 2008. Health Place 2011;17(2):671-80.
doi:10.1016/j.healthplace.2011.01.007
9. Emrani Z, Akbari Sari A, Zeraati H, Olyaeemanesh A, Daroudi R. Health-related quality of life measured using the EQ-
5D-5L: population norms for the capital of Iran. Health Qual Life Outcomes 2020;18(1):108. doi:10.1186/s12955-020-
01365-5
10. Rezaei S, Hajizadeh M, Kazemi A, Khosravipour M, Khosravi F, Rezaeian S. Determinants of health-related quality of life in Iranian adults: evidence from a cross-sectional study. Epidemiol Health 2017;39:e2017038. doi:10.4178/epih.
e2017038
11. Kazemi Karyani A, Rashidian A, Emamgholipour Sefiddashti S, Akbari Sari A. Self-reported health-related quality of life (HRQoL) and factors affecting HRQoL among individuals with health insurance in Iran. Epidemiol Health 2016;38:e2016046. doi:10.4178/epih.e2016046
12. Mousavi A, Akbari Sari A, Daastari F, Daroudi R. Healthrelated quality of life measured using the EQ-5D-3L: Iranian population norms. Expert Rev Pharmacoecon Outcomes Res 2024;24(5):643-51. doi:10.1080/14737167.2024.2328061
13. Shirvani Shiri M, Karami H, Ameri H, Akbari Sari A, Tatari M, Emamgholipour S, et al. The influencing factors of
health-related quality of life of the general population of Iran during the COVID-19 pandemic. Front Med (Lausanne)
2023;10:1049642. doi:10.3389/fmed.2023.1049642
14. Rezaei S. Population norms of health-related quality of life in Iran: findings from a national EQ-5D-5L study. Health Qual Life Outcomes 2025;23(1):48. doi:10.1186/s12955-025-02378-8
15. Mousavi A, Daroudi R, Alipour S, Akbari Sari A, Daastari F. Quality-adjusted life expectancy norms for the Iranian
population. Popul Health Metr 2025;23(1):5. doi:10.1186/s12963-025-00366-0
16. Statistics Center of Iran. Available from: https://www.amar.org.ir/statistical-information. Accessed January 15,
2024.
17. Djalalinia S, Azadnajafabad S, Ghasemi E, Yoosefi M, Rezaei N, Farzi Y, et al. Protocol design for surveillance of risk
factors of non-communicable diseases during the COVID-19 pandemic: an experience from Iran STEPS Survey 2021. Arch Iran Med 2022;25(9):634-46. doi:10.34172/aim.2022.99
18. Goudarzi R, Akbari Sari A, Zeraati H, Rashidian A, Mohammad K, Amini S. Valuation of quality weights for EuroQol
5-dimensional health states with the time trade-off method in the capital of Iran. Value Health Reg Issues 2019;18:170-5.
doi:10.1016/j.vhri.2019.01.007
19. Sullivan T, Turner RM, Derrett S, Hansen P. New Zealand population norms for the EQ-5D-5L constructed from the
personal value sets of participants in a national survey. Value Health 2021;24(9):1308-18. doi:10.1016/j.jval.2021.04.1280
20. Buchholz I, Janssen MF, Kohlmann T, Feng YS. A systematic review of studies comparing the measurement properties
of the three-level and five-level versions of the EQ-5D. Pharmacoeconomics 2018;36(6):645-61. doi:10.1007/
s40273-018-0642-5
21. Grochtdreis T, Dams J, König HH, Konnopka A. Healthrelated quality of life measured with the EQ-5D-5L: estimation
of normative index values based on a representative German population sample and value set. Eur J Health Econ
2019;20(6):933-44. doi:10.1007/s10198-019-01054-1
22. Santos M, Monteiro AL, Santos B. EQ-5D Brazilian population norms. Health Qual Life Outcomes 2021;19(1):162.
doi:10.1186/s12955-021-01671-6
23. Encheva M, Djambazov S, Vekov T, Golicki D. EQ-5D-5L Bulgarian population norms. Eur J Health Econ
2020;21(8):1169-78. doi:10.1007/s10198-020-01225-5
24. Ferreira PL, Pereira LN, Antunes P, Ferreira LN. EQ-5D-5L Portuguese population norms. Eur J Health Econ
2023;24(9):1411-20. doi:10.1007/s10198-022-01552-9
25. McCaffrey N, Kaambwa B, Currow DC, Ratcliffe J. Healthrelated quality of life measured using the EQ-5D-5L: South
Australian population norms. Health Qual Life Outcomes 2016;14(1):133. doi:10.1186/s12955-016-0537-0
26. Karimi M, Brazier J. Health, Health-related quality of life, and quality of life: what is the difference? Pharmacoeconomics 2016;34(7):645-9. doi:10.1007/s40273-016-0389-9
27. Tourani S, Behzadifar M, Martini M, Aryankhesal A, Taheri Mirghaed M, Salemi M, et al. Health-related quality of life
among healthy elderly Iranians: a systematic review and meta-analysis of the literature. Health Qual Life Outcomes
2018;16(1):18. doi:10.1186/s12955-018-0845-7
28. Farajzadeh M, Ghanei Gheshlagh R, Sayehmiri K. Health related quality of life in Iranian elderly citizens: a systematic
review and meta-analysis. Int J Community Based Nurs Midwifery 2017;5(2):100-11.
29. Mosadeghrad AM, Mousavi A. The futurology of aging population in Iran: letter to the editor. Tehran Univ Med J
2021;79(3):248-9.
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How to Cite
1.
Daastari F, Mousavi A, Akbari Sari A, Zekri HS, Darrudi A, Daroudi R. Geographic Distribution of Health-Related Quality of Life in Iran. Health Tech Ass Act. 2026;10(2).
