Trends and Causes of Educational Inequality in Health-Related Quality of Life in China During the COVID-19 Pandemic

Since the 1980s, there has been a steady increase in the inequality of health-related quality of life in China. However, there has been no reliable evaluation of recent trends, especially during the COVID-19 pandemic. To bridge the knowledge gap, we analyzed current trends in educational inequality in health-related quality of life and explored potential causes. According to the Zhejiang Behavioral Risk Factor Surveillance Program (n = 55,560) and the Recentered Influence Function decomposition method, we found that although the health-related quality of life has remained relatively stable over the past two decades, health inequality has risen. Moreover, during the COVID-19 pandemic, the already existing inequality in mental health has worsened significantly. Further analysis indicated that the group with the lowest education level might contribute to the rapid increase in mental health inequality during the epidemic due to their inability to obtain a relatively stable income. Our study highlights the necessity of social policies to curb the rise of inequality in health-related quality of life.