Abstract：
OBJECTIVE: This review aims to examine the ceiling effects of EQ-5D-3L (3L) and EQ-5D-5L (5L) in general adult populations and identify the factors influencing these effects.
METHODS: We searched 8 databases for observational studies published in English from inception to 24 July 2023. Ceiling effects were calculated by dividing the number of participants reporting full health at dimension or profile level by the total sample size. Subgroup analysis and meta-regression using the metafor package in R software were performed.
RESULTS: We identified 94 studies from 70 articles, including 4 543 647 adults across 37 countries. The global pooled proportion of individuals reporting full health (\"11111\") was 56% (95% CI 51%-62%) for 3L and 49% (95% CI 44%-54%) for 5L. The self-care dimension showed the highest ceiling effects (3L: 97%; 5L: 94%), whereas pain/discomfort had the lowest (3L: 69%; 5L: 60%). The ceiling effects in East/South-East Asia were higher than in Europe by 25% (95% CI 18%-32%) in 3L and 9% (95% CI -2%-20%) in 5L. Adjusting for mean age and proportion of males, significant regional differences persisted in the overall profile level of 3L, in all 3L dimensions (except for self-care), and 5L dimensions (except for pain/discomfort and anxiety/depression).
CONCLUSIONS: This review highlights significant ceiling effects in the EQ-5D, especially in Asian populations. The 5L version exhibited fewer ceiling effects than the 3L, indicating its superiority for general population surveys. Further research is crucial to understand the disparities in self-reported health outcomes between Asians and other populations.
METHODS: We searched 8 databases for observational studies published in English from inception to 24 July 2023. Ceiling effects were calculated by dividing the number of participants reporting full health at dimension or profile level by the total sample size. Subgroup analysis and meta-regression using the metafor package in R software were performed.
RESULTS: We identified 94 studies from 70 articles, including 4 543 647 adults across 37 countries. The global pooled proportion of individuals reporting full health (\"11111\") was 56% (95% CI 51%-62%) for 3L and 49% (95% CI 44%-54%) for 5L. The self-care dimension showed the highest ceiling effects (3L: 97%; 5L: 94%), whereas pain/discomfort had the lowest (3L: 69%; 5L: 60%). The ceiling effects in East/South-East Asia were higher than in Europe by 25% (95% CI 18%-32%) in 3L and 9% (95% CI -2%-20%) in 5L. Adjusting for mean age and proportion of males, significant regional differences persisted in the overall profile level of 3L, in all 3L dimensions (except for self-care), and 5L dimensions (except for pain/discomfort and anxiety/depression).
CONCLUSIONS: This review highlights significant ceiling effects in the EQ-5D, especially in Asian populations. The 5L version exhibited fewer ceiling effects than the 3L, indicating its superiority for general population surveys. Further research is crucial to understand the disparities in self-reported health outcomes between Asians and other populations.
摘要：
目的：这篇综述旨在研究EQ-5D-3L（3L）和EQ-5D-5L（5L）在一般成人人群中的天花板效应，并确定影响这些效应的因素。
方法：我们在8个数据库中搜索了从开始到2023年7月24日以英文发表的观察性研究。天花板效应是通过将在维度或概况水平上报告完全健康的参与者数量除以总样本量来计算的。使用R软件中的metafor软件包进行亚组分析和meta回归。
结果：我们从70篇文章中确定了94项研究，包括37个国家的4543647名成年人。报告完全健康的个人的全球汇总比例（“11111”）3L为56％（95％CI51％-62％），5L为49％（95％CI44％-54％）。自我护理维度表现出最高的天花板效应(3L:97%；5L:94%)，而疼痛/不适最低（3L：69％；5L：60％）。东亚/东南亚的上限效应在3L和5L分别比欧洲高25％（95％CI18％-32％）和9％（95％CI-2％-20％）。调整男性的平均年龄和比例，3L的整体剖面水平仍然存在显著的区域差异，在所有3L尺寸中（自我护理除外），和5L尺寸（除了疼痛/不适和焦虑/抑郁）。
结论：这篇综述强调了EQ-5D的显著天花板效应，尤其是亚洲人群。5L版本比3L显示更少的天花板效果，表明其在一般人口调查中的优越性。进一步的研究对于了解亚洲人与其他人群之间自我报告健康结果的差异至关重要。
方法：我们在8个数据库中搜索了从开始到2023年7月24日以英文发表的观察性研究。天花板效应是通过将在维度或概况水平上报告完全健康的参与者数量除以总样本量来计算的。使用R软件中的metafor软件包进行亚组分析和meta回归。
结果：我们从70篇文章中确定了94项研究，包括37个国家的4543647名成年人。报告完全健康的个人的全球汇总比例（“11111”）3L为56％（95％CI51％-62％），5L为49％（95％CI44％-54％）。自我护理维度表现出最高的天花板效应(3L:97%；5L:94%)，而疼痛/不适最低（3L：69％；5L：60％）。东亚/东南亚的上限效应在3L和5L分别比欧洲高25％（95％CI18％-32％）和9％（95％CI-2％-20％）。调整男性的平均年龄和比例，3L的整体剖面水平仍然存在显著的区域差异，在所有3L尺寸中（自我护理除外），和5L尺寸（除了疼痛/不适和焦虑/抑郁）。
结论：这篇综述强调了EQ-5D的显著天花板效应，尤其是亚洲人群。5L版本比3L显示更少的天花板效果，表明其在一般人口调查中的优越性。进一步的研究对于了解亚洲人与其他人群之间自我报告健康结果的差异至关重要。
