Health-related Quality of Life (HRQOL): Variation across occupation groups

Posted on by Taylor M. Shockey, MPH

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.

Taylor M. Shockey, MPH, is a Title 42 Fellow in the NIOSH Division of Surveillance, Hazard Evaluations and Field Studies. 


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 and

Posted on by Taylor M. Shockey, MPH

8 comments on “Health-related Quality of Life (HRQOL): Variation across occupation groups”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Hi HRQOL Researchers,
    We need to do such research in Bangladesh as there is no single research for the worker groups. We are looking for collaborator. Any one interested can contact:

    It appears that additional insight may be gained by associating Hrqol with occupational subgroups and their work activities such as full time employment or contract jobs.

    in my opnion there is a lot of gap in 3rd world countries and they need more awareness about Health and Fitness Related Studies Based on Research to get maxiam output and giving them a good life standerd

    Interesting that ” … Farming, fishing, and forestry was the least likely of the 22 occupation groups to report negative HRQOL for all 5 measures.”

    But not surprising as we learn more about the benefits to human health of being outdoors in natural environments, particularly improved cognitive and emotional effects. Another example maybe of the need to understand and manage health using more holistic, interdisciplinary paradigms.

    We have the benefits of being outdoors in a natural environment. This improves the emotional and mental well being of the person.


    It appears that additional insight may be gained by associating Hrqol with occupational subgroups and their work activities such as full time employment or contract jobs.

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Page last reviewed: July 26, 2017
Page last updated: July 26, 2017