Health-related quality of life of a conflict-affected population in Colombia

Abstract

Purpose We assessed the validity of the EQ-5D instrument; explored correlations between area of residence’s conflict intensity and individual health-related quality of life (HRQoL); and identified factors associated with HRQoL in a conflict-affected population in Colombia. Methods We conducted a household survey among residents of the Meta province, collecting longitudinal information about HRQoL (EQ-5D-3L instrument), health, demographic and socio-economic indicators, for years 2014 (pre-2016 peace accord), 2018 (post-peace accord) and 2019 (follow-up). After examining EQ-5D’s validity, we analysed panel data using multivariate random effects models to explore associations between area conflict levels (and other factors) and HRQoL. We scrutinised these results further through multivariate linear regressions using cross-sectional data, and provided preliminary estimates of quality-adjusted life years (QALYs) gained since the Colombian peace accord. Results In total, 1309 individuals provided information for years 2014 and 2018; 1106 individuals were followed-up in 2019. Mean EQ-5D scores in 2014, 2018 and 2019 were 0.898, 0.846 and 0.902, respectively. The tests confirmed the validity of EQ-5D. Our estimations indicated a dose–response relationship between conflict levels and HRQoL: people in lightly and heavily affected areas had 0.019 and 0.037 lower EQ-5D scores (respectively) than people in non-affected areas. Other relevant factors included age, marital status, education, assets and health status. We estimated QALY gain of 0.0343 per individual and 20,752 for all Meta adults since the peace accord. Conclusion We found EQ-5D to be a valid instrument for HRQoL measurement in a conflict-affected population. Area conflict intensity was negatively associated with individual HRQoL.

Health Workforce Reallocation in the Aftermath of Conflict: Evidence from Colombia

“…10 People living in areas exposed to high violence levels have on average worse health outcomes across a range of dimensions than people living in less exposed municipalities. For instance, several studies document that they exhibit higher mortality from diarrhea (Alvis-Zakzuk et al, 2018), worse mental health (Pérez-Olmos et al, 2005;Sanchez-Padilla et al, 2009;Bell et al, 2012;Tamayo-Agudelo and Bell, 2018;Ricaurte et al, 2019), and worse indicators associated with health-related quality of life (Yang et al, 2021). These differences may be directly associated with the incidence and intensity of conflict-related violence, o with underlying factors that distinguish highly FARC-affected areas from other places.…”

Trends in mental health before and after the onset of the COVID-19 pandemic: a longitudinal survey of a conflict-affected population in Colombia

“…Whilst 10% of the Colombian adult population has a mental health disorder, this prevalence rate is much higher among the large populations directly affected by conflict violence, such as IDPs (56% prevalence) and people living in provinces with high conflict intensity (e.g. 28% prevalence in Meta) [ 11 , 13 ]. The conflict has also contributed to the deterioration of health infrastructure and health inequities due to its heavier burden on poor and rural citizens, with the populations most affected by violence being particularly vulnerable in both the mental health and healthcare access [ 10 – 14 ].…”