Within elderly people, large quality-of-life differences exist. The proportion reporting problems was rising with increased age, as was also the proportion of persons reporting problems in more than one domain. For most age-groups and both sexes, pain/discomfort was the most frequently reported complaint. Similar to other studies, self-care problems were reported least frequent [
9,
19,
26]. Only in the oldest elderly, mobility problems were more frequently reported than pain/discomfort, while anxiety/depression was the least frequent reported problem. Similar to other studies [
8‐
10,
13‐
19] female sex was associated with more problems on each of the five EQ-5D domains, and consequently also with a lower EQ-5D-index compared to men. Increasing age, female sex, lower education, smoking, having a comorbidity and/or a previous cardio-vascular event, but also geographic factors such as living in the southern region of the Netherlands and living in an urban area, were all associated with lower EQ-5D health status.
The use of national tariffs, different response styles due to social and cultural background and different reference levels all influence the final EQ-5D-indices score [
10,
13,
15,
27]. According to Szende et al. [
8] it is mainly the prior living standards of a country explaining the observed cross-country differences in general health. Therefore, a direct comparison with other countries is hampered by these important cross-country differences in background. König et al. [
10], who compared the health status of elderly in six European countries, namely Belgium, France, Germany, Italy, the Netherlands, and Spain, noted that the Netherlands was the country with the lowest proportion of respondents reporting any problems. This corresponds to the findings of Konerding et al. [
13] who studied the health status in adult type 2 diabetes patients in six European countries, and who noted that the Dutch respondents reported fewer problems in four of the five domains, and only Finland reported fewer problems with depression and/or anxiety. In our study, the tendency of reporting problems, increased with age and was associated with being female and having a low education, similar to other studies (e.g. [
6,
8‐
10,
13‐
16,
19,
27]). Pain/discomfort was the most frequently reported problem, but in the eldest elderly problems with the mobility domain occurred most frequently, similar to findings in a Dutch study of Hoeymans et al. [
9]. Anxiety/depression was reported least frequent like, in other studies [
8‐
10]. Overall, our large sample of respondents appeared to report slightly fewer problems in most domains of EQ-5D compared to previous studies conducted in Dutch elderly [
6‐
8]. The relative largest differences were found for anxiety/depression. According to Szende et al. [
8] 9.9% and 12.5% of the 65–74 years and ≥75 years old reported to be moderately or extremely anxious or depressed, and according to Hoeymans et al. [
9] this was 11.8% (65–79 years) and 13.6% (≥80 years). In our population only 6% reported to be moderately or extremely anxious or depressed, similar to König et al. [
10]. Comparing the mean EQ-5D-index scores found in other Dutch studies, our estimates were slightly higher [
6‐
8] which may be explained from the fact that our sample consisted of a relatively fit and healthy population participating in a clinical trial, with more males and higher education level compared to the general population.
Social and cultural background differences mostly found between countries [
10,
13,
15,
27] could be confirmed to exist also within a small country such as the Netherlands. In particular, respondents living in Southern Netherlands tend to have a slightly lower health status than those living in other regions. This is a consistent finding in many studies on within country differences in health status [
28]. The different cultural and social background and history of the Southern part of the country seems to have an impact up to today.
Strength of our study is the large study population of elderly persons (i.e. ≥65 years), allowing stratification by gender and five age-groups. A further strength of the current study is the data availability of prevalent chronic comorbidities and/or a previous cardio-vascular event.