Abstract
The below-poverty-line (BPL) population experiences challenges in accessing quality healthcare services due to their limited affordability and vulnerability to illness. This paper assessed their health-related quality of life (HRQoL) and its associated determinants. A cross-sectional survey was conducted among 803 BPL individuals aged 18 and above in Tangail district from July to September 2018. To measure HRQoL, we employed a Bengali version of the EuroQol-5 dimensions (EQ-5D) questionnaire and the Visual Analogue Scale (VAS). Tobit regression models were applied to determine the association between HRQoL scores and sociodemographic characteristics, multimorbidity, and healthcare utilization in the last three months. The BPL population had an average EQ-5D score of 0.738 (SD = 0.192) and an EQ-VAS score of 0.750 (SD = 0.149). Among the five EQ-5D domains, 68% of the respondents reported experiencing some or extreme problems in the anxiety/depression dimension, and 55% reported pain/discomfort. The EQ-5D and EQ-VAS scores were significantly lower among individuals aged 35 years and above compared to those aged 18-34 years. Individuals with multimorbidity had significantly lower EQ-5D and EQ-VAS scores, by 0.250 and 0.158 (p < 0.001), respectively, compared to those without any health problems. Respondents in the richest asset quintile had significantly higher EQ-5D scores than those in the poorest quintile. The findings shed light on the keydeterminants of HRQoL among the BPL population in Bangladesh, such as age, multimorbidity, marital status, and wealth status. These determinants may help policymakers in developing interventions for improving the health and well-being of the BPL population. Tailored interventions are needed to address their specific needs for improving HRQoL, such as community-based programs for the older adults, provision of integrated healthcare for addressing multimorbidity, effective implementation of the current health protection scheme for the poor and other vulnerable groups, including widowed/separated individuals.