Associations of Participation in Community Assets with Health-Related Quality of Life and Health Care Utilisation: a cross-sectional study of older people in the community

Background: Community assets are promoted as a way to improve quality of life and reduce healthcare utilisation. However, the quantitative impact of participation in community assets on these outcomes is not known.
Methods: We examined the association between participation in community assets and health-related quality of life (EuroQol-5D-5L) and healthcare utilisation in 3686 individuals aged ≥65 years. We estimated the unadjusted differences in EuroQol-5D-5L scores and healthcare utilisation between participants and non-participants in community assets and then used multivariate regression to examine scores adjusted for socio-demographic and limiting long-term health conditions. We derived the net benefits of participation using a range of threshold values for a Quality-Adjusted Life Year.
Results: 50% of individuals reported participation in community assets. Their EuroQol-5D-5L scores were 0.094 (95% CI 0.077 to 0.111) points higher than non-participants. Controlling for socio-demographic characteristics reduced this differential to 0.081 (95% CI 0.064 to 0.098). Further controlling for limiting long-term conditions reduced this effect to 0.039 (95% CI 0.025 to 0.052). Once we adjusted for socio-demographic and limiting long-term conditions, the reductions in healthcare utilisation and costs associated with community asset participation were not statistically significant. Based on a threshold value of £20,000 per Quality-Adjusted Life Year, the net-benefits of participation in community assets were £763 (95% CI £478 to £1048) per participant per year.
Conclusion: Participation in community assets is associated with substantially higher health-related quality of life but is not associated with lower healthcare costs. The social value of developing community assets is potentially substantial.