The COVID-19 pandemic has upended many aspects of daily life, including socializing, office work, and healthcare, but there has been little data quantifying how these changes have affected quality of life during the pandemic and over the long term, especially on a national scale.
Researchers at Hiroshima University in Japan conducted a national survey of adults aged 20 to 85 to assess health-related quality of life (HRQoL) across Japan and within each prefecture or region over three fiscal years (fiscal years): 2017, 2020, and 2024. In Japan, the fiscal year begins on April 1st and ends on March 31st of the following year. The midpoint, labeled 2020 on paper, actually took effect in March 2021, just as Japan was lifting its second state of emergency following the third wave of coronavirus infections.
Using the EQ-5D-3L standardized questionnaire developed by the EuroQol (EQ) group, the research team measured five dimensions (5Ds) of HRQoL: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression by asking respondents to rate each using three levels of severity (3Ls). Surveys are tailored to specific age groups, formats, languages, and country-specific values to ensure culturally appropriate scoring. HRQoL scores in this study were calculated using the EQ-5D-3L value set developed specifically for the Japanese population.
HRQoL is influenced by many factors, including acute events such as earthquakes, tsunamis, and pandemics such as coronavirus disease (COVID-19), as well as broader, long-term changes such as socio-economic conditions, health behaviors, and disease patterns. Although researchers initially initiated this study to identify emerging population health problems, design targeted interventions, and optimize resource allocation within Japan’s health care system, the stratified two-stage random sampling design and three-point timing of the study provided scientists with the first national-level information on Japan’s HRQoL before, during, and after the COVID-19 pandemic.
A transcript of this paper was published June 2 in the journal scientific report.
The results of this study show a gradual but steady decline in HRQoL among Japan’s working-age population over a seven-year period, including before, during, and after the COVID-19 pandemic. These survey results are expected to provide important baseline data for considering health support measures for working-age people in future health care policies and local initiatives. ”
Tomoyuki Akita Lecturer, Graduate School of Biomedical and Health Sciences, Hiroshima University, corresponding author of the research paper
The survey participation rate and distribution of gender, age, and occupation were similar between years, with 34.0%, 44.1%, and 29.5% of surveys sent in 2017, 2020, and 2024 receiving valid responses, respectively. The seven-year national average EQ-5D-3L utility score decreased from 0.9133 in 2017 to 0.8977 in 2020 and 0.8834 in 2024. This survey found that the HRQoL of men in their 40s to 60s and women in their 30s to 50s across the country had a statistically significant decline over the three survey years (FY 2017, FY 2020, and FY 2024).
Importantly, the researchers also analyzed regional differences in HRQoL between Japan’s prefectures, which have relatively small populations. Rather than using traditional statistical approaches, which can yield inaccurate estimates with small sample sizes, the team used Bayesian techniques that incorporate prior knowledge of national HRQoL distributions to make more reliable comparisons between regions with different sample sizes. This prefecture-level information is particularly useful for regional health policy planning.
“A number of indirect effects on HRQoL have been reported during the COVID-19 pandemic, including reduced utilization of health services, decreased physical activity, and worsened mental health. Although this study did not directly examine causality, it is important to note that working age “The marked decline in HRQoL in the population may reflect the cumulative effects of these behavioral and social changes. Particular attention should be paid to the fact that this gradual decline continues over time,” Professor Akita said.
The team’s HRQoL study was fortuitously timed, providing unique insights into quality of life issues that extend far beyond the COVID-19 pandemic, and raising questions about whether these results apply to other countries. Do you think other countries have experienced similar declines in HRQoL during the pandemic, with declines improving in some countries but not in others?
Although it is not possible to conduct large-scale retrospective studies of HRQoL in other countries, this does not negate the importance of the information in health policy development and resource distribution. The researchers plan to continue their research to guide Japan’s medical policy. Akita said, “We need to continue monitoring health-related quality of life (HRQoL) across the country, and conduct a deeper analysis of the causes of the decline and comparisons with other countries.”
A part of this research was supported by Ministry of Health, Labor and Welfare Hepatitis Control Policy Research Project Grant Numbers H25-kanenippan-010, H28-kansei-ippan-001, H29-kansei-shitai-001, JPMH19HC1001, JPMH20HC2002, JPMH22HC1001, JPMH23HC2003, and JPMH25HC1001.
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Reference magazines:
Tetsuya Hirako others. (2026). Long-term changes in health-related quality of life in Japan based on national surveys and Bayesian regional estimates. scientific report. DOI: 10.1038/s41598-026-45692-x. https://www.nature.com/articles/s41598-026-45692-x
