Health-related quality of life (HRQOL) is an individual’s or group’s self-perception of their physical and mental health over time. HRQOL goes beyond the traditionally diagnosable health outcomes to provide a measure of well-being, it has become an important part of health surveillance. HRQOL is used outside of public health by fields such as psychology, social work, economics, and urban planning. HRQOL is used to determine disease burden, to monitor progress in achieving the Healthy People Goals, to guide policy and legislation, to develop interventions, and to allocate resources where they are most needed.

Earlier this month, the National Institute for Occupational Safety and Health (NIOSH) published an article in the American Journal of Public Health on HRQOL by occupation group among 17 states using data from the 2013 and 2014 Behavioral Risk Factor Surveillance System (BRFSS).

In this study, HRQOL is determined from the BRFSS “Healthy Days Measures” which are comprised of a set of four questions, three of which address health over the past 30 days (i.e., overtime):

  1. “Would you say that in general your health is excellent, very good, good, fair, or poor?”
  2. “Now thinking about your physical health, which includes physical illness and injury, how many days during the past 30 days was your physical health not good?”
  3. “Now thinking about your mental health, which includes stress, depression, and problems with emotions, how many days during the past 30 days was your mental health not good?”
  4. “During the past 30 days, approximately how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?”

An overall unhealthy days measure is calculated by summing responses to questions 2 and 3 (physical and mental unhealthy days) with a maximum of 30 days. Based on clinical guidelines, we separated the responses to questions 2, 3, 4 and the overall unhealthy days measure into two categories: 14 days or more and 13 days or less: If the respondent falls into the category of 14 days or more than they are characterized as having frequent physical distress, mental distress, activity limitation, and unhealthy days. The study used the 14 day cut point and also separated question 1 (self-rated health) into two categories: “excellent/very good/good” and “fair/poor”.

In terms of adjusted prevalence, the study found variabilities in HRQOL exist among workers from different occupation groups. Among the 22 occupation groups, the arts, design, entertainment, sports, and media occupation group most commonly reported the negative HRQOL measures of frequent physical distress, frequent mental distress, frequent activity limitation, and frequent overall unhealthy days. Both the personal care and service occupation group and the community and social services occupation group were among the top 3 in most commonly reporting 3 of the 5 negative HRQOL measures. Farming, fishing, and forestry was the least likely of the 22 occupation groups to report negative HRQOL for all 5 measures.

This study suggests that workers’ jobs are associated with their HRQOL. Further research is needed to understand how work exposures or characteristics influence HRQOL and what work exposures or characteristics have the largest impact on HRQOL. We would like to hear from you. What problems do you think are raised by the study’s results? How do you think these problems could be addressed? Please share your thoughts in the comment section below.

Additional Resources for Employers and Employees

  • CDC maintains a list of publications on the topic of HRQOL.
  • The NIOSH Total Worker Health program published an article examining the economic reasons for supporting HRQOL.
  • NIOSH has published a booklet entitled “Stress…at Work” which discusses the causes of stress at work as well as offering methods for preventing or reducing job stress.
  • NIOSH leads an initiative known as Prevention through Design (PTD)  which seeks, “…to prevent or reduce occupational injuries, illnesses, and fatalities through the inclusion of prevention considerations in all designs that impact workers.”
  • Additionally, NIOSH offers resources tailored to certain occupations, such as outdoor workers and healthcare workers, which describe the types of hazards specific to their jobs.
  • For more information on the Healthy Days measures, visit

Click here to visit the NIOSH Science Blog post.