Inequalities in Quality-Adjusted Life Expectancy in Australia by Educational Attainment.

Introduction: Summary measures such as quality-adjusted life expectancy (QALE) are increasingly used to monitor health inequalities. Socioeconomic inequalities in health are well documented in Australia, including inequalities by education. However, estimates for QALE by level of education are lacking for Australia. We aimed to provide QALE stratified by age and sex across levels of educational attainment for the Australian population aged 25 years and above.

Methods: We categorized educational attainment as low (completed year 11 or below), intermediate (completed year 12 and/or other non-tertiary or vocational qualification) or high (completed a bachelor's degree or above). Mean Short-Form Six-Dimension health utility was estimated for sex- and education-specific subgroups from the Household, Income and Labour Dynamics in Australia survey (2022). We constructed life tables using age-sex-education-specific mortality rates for 2019 obtained from linked 2016 Census and Death Registrations data. Health utility was incorporated into the life tables to derive age- and sex-specific QALE across education levels.

Results: At age 25 years, males with high education had 7.3 years greater life expectancy than those with low education (61.0 versus 53.7 years undiscounted) and larger QALE (39.9 versus 28.8 years undiscounted), a gap of 11.1 years (39% relative difference). Females aged 25 years with a high level of education experienced 3.9 years greater life expectancy (LE; 63.1 versus 59.2 years, undiscounted) and an additional 7.6 years of QALE (36.9 versus 29.3 years, undiscounted), compared with those with low education, a 26% relative difference in QALE.

Conclusions: Significant disparities in QALE by educational attainment exist in Australia. These findings can inform policies aimed at reducing health inequity by guiding resource allocation and supporting future equity-informative economic evaluations.