Health-related quality of life in lebanon: a cross-sectional population-level assessment and psychometric evaluation of the EQ-5D-5L in a crisis-affected context

Lebanon, a low- to middle-income country facing ongoing political, economic, and humanitarian crises, lacks population-level data on patient-reported outcomes and health-related quality of life (HRQoL). Understanding population health in such fragile contexts is critical for informing public health strategies and recovery efforts. This study aimed to assess HRQoL in the general adult population in Lebanon using the EQ-5D-5 L and evaluate its measurement properties. A cross-sectional online and in-person survey was conducted between March and September 2024 among 519 adults (mean age 38.2 ± 16.5 years; 55.5% female). Participants completed the EQ-5D-5 L, SF-12 v1, Beirut Distress Scale-22, and the Food Insecurity Experience Scale. Descriptive analyses summarized demographic characteristics and HRQoL outcomes. Construct validity was examined through convergent, divergent, and known-groups analyses using Spearman correlations and Cohen’s d effect sizes. Ceiling effects were modest (21.8%), with low floor effects (0.2%). Pain/discomfort and anxiety/depression were the most commonly reported problems. Mean EQ VAS and index scores were 74.2 ± 19.0 and 0.798 ± 0.276, respectively. The EQ-5D-5 L showed good convergent (93% hypotheses confirmed) and divergent validity (86% confirmed) with SF-12 and BDS-22 scores. Discriminative validity was supported for chronic conditions, psychological distress, and food insecurity, with large effect sizes observed for several clinical conditions. The EQ-5D-5 L can be implemented feasibly in fragile, resource-constrained settings and effectively captures the impact of humanitarian and economic shocks on population well-being. These data provide a foundation for future research on EQ-5D in crises and disaster recovery, support regional EuroQol collaborations in the Middle East, and inform potential valuation and system-level implementation work.