Health-related quality of life in seven European countries throughout the course of the COVID-19 pandemic: Evidence from the European COvid Survey (ECOS)

Hans Helmut König, Sebastian Neumann-Böhme, Iryna Sabat, Jonas Schreyögg, Aleksandra Torbica, Job van Exel, Pedro Pita Barros, Tom Stargardt, André Hajek

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)
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Purpose: To investigate health-related quality of life (HRQoL) over the course of the COVID-19 pandemic in seven European countries and its association with selected sociodemographic as well as COVID-19-related variables. Methods: We used longitudinal data from nine quarterly waves collected between April 2020 and January 2022 (sample size per wave ranging from N = 7025 to 7300) of the European COvid Survey (ECOS), a representative survey of adults in Germany, United Kingdom, Denmark, Netherlands, France, Portugal and Italy. HRQoL was measured using the EQ-5D-5L. The association of self-reported COVID-19 infection, perceived health risk from COVID-19, selected sociodemographic variables and the COVID-19 stringency index with HRQoL was analyzed by logistic and linear fixed effects regressions. Results: On average across all nine waves, the proportion of respondents reporting any problems in at least one of the EQ-5D dimensions ranged between 63.8% (Netherlands) and 71.0% (Denmark). Anxiety/depression was the most frequently affected EQ-5D dimension in four countries (Portugal: 52.0%; United Kingdom: 50.2%; Italy: 49.2%; France: 49.0%), whereas pain/discomfort ranked first in three countries (Denmark: 58.3%; Germany: 55.8%; Netherlands: 49.0%). On average across all nine waves, the EQ-VAS score ranged from 70.1 in the United Kingdom to 78.4 in Portugal. Moreover, the EQ-5D-5L index ranged from.82 in Denmark to.94 in France. The occurrence of COVID-19 infection, changes in the perceived risk to one’s own health from COVID-19, the occurrence of income difficulties and an increase in the COVID-19 stringency index were associated with increased likelihood of problems in EQ-5D dimensions, reduced EQ-VAS score and reduced EQ-5D-5L index. Conclusions: Across seven European countries, we found large proportions of respondents reporting problems in HRQoL dimensions throughout the pandemic, especially for anxiety/depression. Various sociodemographic and COVID-19-related variables were associated with HRQoL in longitudinal analysis.

Original languageEnglish
Pages (from-to)1631-1644
Early online date5 Feb 2023
Publication statusPublished - Jun 2023


  • Corona
  • COVID-19
  • EQ-5D
  • Health-related quality of life
  • SARS-CoV-2


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