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Open Access Research article

Smoking and health-related quality of life in English general population: implications for economic evaluations

Matthias Vogl12, Christina M Wenig2, Reiner Leidl12 and Subhash Pokhrel3*

Author affiliations

1 Helmholtz Zentrum München, German Research Centre for Environmental Health, Member of the German Centre for Lung Research, Institute of Health Economics and Health Care Management, Ingolstädter Landstrasse 1, 85764 Neuherberg, Germany

2 Ludwig-Maximilians-Universität München, Institute of Health Economics and Health Care Management & Munich Centre of Health Sciences, Ludwigstrasse 28, 80539 Munich, Germany

3 Health Economics Research Group, Brunel University, West London, UK

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Citation and License

BMC Public Health 2012, 12:203  doi:10.1186/1471-2458-12-203

Published: 19 March 2012



Little is known as to how health-related quality of life (HRQoL) when measured by generic instruments such as EQ-5D differ across smokers, ex-smokers and never-smokers in the general population; whether the overall pattern of this difference remain consistent in each domain of HRQoL; and what implications this variation, if any, would have for economic evaluations of tobacco control interventions.


Using the 2006 round of Health Survey for England data (n = 13,241), this paper aims to examine the impact of smoking status on health-related quality of life in English population. Depending upon the nature of the EQ-5D data (i.e. tariff or domains), linear or logistic regression models were fitted to control for biology, clinical conditions, socio-economic background and lifestyle factors that an individual may have regardless of their smoking status. Age- and gender-specific predicted values according to smoking status are offered as the potential 'utility' values to be used in future economic evaluation models.


The observed difference of 0.1100 in EQ-5D scores between never-smokers (0.8839) and heavy-smokers (0.7739) reduced to 0.0516 after adjusting for biological, clinical, lifestyle and socioeconomic conditions. Heavy-smokers, when compared with never-smokers, were significantly more likely to report some/severe problems in all five domains - mobility (67%), self-care (70%), usual activity (42%), pain/discomfort (46%) and anxiety/depression (86%) -. 'Utility' values by age and gender for each category of smoking are provided to be used in the future economic evaluations.


Smoking is significantly and negatively associated with health-related quality of life in English general population and the magnitude of this association is determined by the number of cigarettes smoked. The varying degree of this association, captured through instruments such as EQ-5D, may need to be fed into the design of future economic evaluations where the intervention being evaluated affects (e.g. tobacco control) or is affected (e.g. treatment for lung cancer) by individual's (or patients') smoking status.

Health-related quality of life (HRQoL); EQ-5D; EuroQol; Socio-economic determinant; Economic evaluation