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Health State Values of Deaf British Sign Language (BSL) Users in the UK: An Application of the BSL Version of the EQ-5D-5L



Deaf people experience health inequalities compared to hearing populations. The EQ-5D, a widely used, standardised, generic measure of health status, which is available in over 100 languages, was recently translated into British Sign Language (BSL) and initial validation conducted. Using data from this previous study of the EQ-5D-5L BSL we aimed to assess (1) whether responses to the EQ-5D differed between a sample of Deaf BSL users and the general population (2) whether socio-demographic characteristics and clinical measures were associated with EQ-5D index scores in Deaf BSL users and (3) the impact of psychological distress and depression on health status in Deaf BSL users.


Published population tariffs were applied to the EQ-5D-5L BSL, using the crosswalk methodology, to estimate health state values. Descriptive statistics (mean, SD, 95% CIs) compared Deaf BSL signer participants’ (n = 92) responses to data from the general population. Descriptive statistics and linear regression analyses were used to identify associations between Deaf participants’ EQ-5D index scores, socio-demographic characteristics, physical health and depression. Descriptive statistics compared the BSL index scores for people with psychological distress/depression to those from two cross-sectional, population-based surveys.


Using the EQ-5D, Deaf participants had lower mean health-state values (0.78; 95% CI 0.72–0.83; n = 89) than people participating in the 2017 Health Survey for England (0.84; 95% CI 0.83–0.84; n = 7169). Unlike larger studies, such as the Health Survey for England sample, there was insufficient evidence to assess whether Deaf participants’ EQ-5D health state values were associated with their demographic characteristics. Nevertheless, analysis of the BSL study data indicated long-standing physical illness was associated with lower health-state values (ordinary least squares coefficient = − 0.354; 95% CI − 0.484, − 0.224; p < 0.01; n = 82). Forty-three percent of our Deaf participants had depression. Participants with depression had reduced health status (0.67; 95% CI 0.58–0.77; n = 36) compared to those with no psychological distress or depression (0.87; 95% CI 0.61–0.67; n = 36).


The study highlights reduced health in the Deaf signing population, compared to the general population. Public health initiatives focused on BSL users, aiming to increase physical and mental health, are needed to address this gap.

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Author information




GES, KDR, LMD and AY planned the study; GES, LMD and KDR analysed the data. All authors contributed to the interpretation of the data; GES and SD conducted literature searching; GES and LMD drafted the first version of the manuscript and all authors contributed to subsequent versions. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gemma E. Shields.

Ethics declarations


This study was funded by the National Institute for Health Research (NIHR) Health Services Research and Delivery Programme, Grant Award Number: 12/136/79. This report/article presents independent research commissioned by the National Institute for Health Research (NIHR). The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Conflict of interest

AY declares funding from the National Deaf Children’s Society, as well as current and previous funding from the AHRC, MRC, GCRF, NIHR and NHS England within the last 3 years, related to research in the Deaf population. LMD declares funding from the MRC, ESRC, NIHR, Department of Health and Cancer Research UK, some of which relates to research in the Deaf population. KR declares current funding from the NIHR and National Deaf Children’s Society, as well as funding from the AHRC, Department for Education and NIHR in the last 3 years, related to research in the Deaf population. GES and SD declare that they have no conflict of interest.

Research Involving Human Participants and/or Animals

This study performed a secondary analysis of existing data and thus no participants were recruited. In the prior study, from which the data were taken, ethics approval was received from the University of Manchester Research Ethics Committee (REC) (reference number: 14183). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

In the prior study, all participants who completed the EQ5D-5L BSL gave individual informed consent and that they gave consent for secondary data analysis of anonymised results, ethics approval was received from the University of Manchester Research Ethics Committee (REC) (reference number: 14183).

Availability of Data and Material

The datasets analysed during the current study are available from the corresponding author on reasonable request.

Electronic supplementary material

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Shields, G.E., Rogers, K.D., Young, A. et al. Health State Values of Deaf British Sign Language (BSL) Users in the UK: An Application of the BSL Version of the EQ-5D-5L. Appl Health Econ Health Policy 18, 547–556 (2020).

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