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Ayuso-Álvarez A, Ortiz C, Fontán J, Rodríguez-Blázquez C, Damián J, López-Cuadrado T, Galán I. Predictive value of the Global Activity Limitation Indicator (GALI) on all-cause mortality. Public Health 2024; 230:6-11. [PMID: 38460397 DOI: 10.1016/j.puhe.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVES The Global Activity Limitation Indicator (GALI) is an instrument that measures long-term overall disability. The objective of this study was to evaluate GALI's predictive value on mortality while examining variations according to sex, age, and educational level. STUDY DESIGN Longitudinal study. METHODS This longitudinal study was based on 42,991 individuals aged ≥15 years who participated in the 2011-2012 National Health Survey and the 2014 European Health Survey in Spain. These records were linked to mortality data up to December 2021. GALI assessed self-reported functional limitation in the past 6 months and classified individuals into three categories: severely limited, limited but not severely, and not limited. Incidence rate ratios (IRR) were calculated using Poisson regression models, adjusting for sociodemographic, lifestyle, and health status variables. RESULTS Compared to individuals with no limitations, those with non-severe limitations had an IRR for mortality of 1.27 (95% CI: 1.16-1.38), and 2.04 (95% CI: 1.81-2.31) in those with severe limitations. Women with severe limitations exhibited a higher IRR (2.32; 95% CI: 1.98-2.71) compared to men (1.73; 95% CI: 1.45-2.08) (P for interaction = 0.005). Individuals <65 years with severe limitations showed a greater association (2.22; 95% CI: 1.58-3.10) than those ≥65 (1.49; 95% CI: 1.32-1.69) (P for interaction <0.001). Among individuals with lower educational attainment, the IRR was 2.08 (95% CI: 1.83-2.37), and 1.87 (95% CI: 1.37-2.56) for the higher education group (P for interaction = 0.017). CONCLUSIONS GALI is a robust predictor of all-cause mortality in the general population and subgroups. The association is stronger in women, individuals <65 years, and those with lower educational levels.
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Affiliation(s)
- A Ayuso-Álvarez
- National Centre for Epidemiology, Institute of Health Carlos III, Spain; Department of Sociology, School of Economics, Universidad Autónoma de Madrid, Spain
| | - C Ortiz
- National Centre for Epidemiology, Institute of Health Carlos III, Spain
| | - J Fontán
- National Centre for Epidemiology, Institute of Health Carlos III, Spain
| | | | - J Damián
- National Centre for Epidemiology, Institute of Health Carlos III, Spain; Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Spain
| | - T López-Cuadrado
- National Centre for Epidemiology, Institute of Health Carlos III, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain
| | - I Galán
- National Centre for Epidemiology, Institute of Health Carlos III, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Spain.
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Ayala A, Ramallo-Fariña Y, Bilbao-Gonzalez A, Forjaz MJ. Mapping the EQ-5D-5L from the Spanish national health survey functional disability scale through Bayesian networks. Qual Life Res 2023; 32:1785-1794. [PMID: 36735174 DOI: 10.1007/s11136-023-03351-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Preference-based measures are valuable tools for evaluating therapeutic interventions and for cost-effectiveness studies. Mapping procedures are useful when it is not possible to collect these kind of measures. The objective of this study was to evaluate which mapping method is the most appropriate to estimate the EQ-5D-5L index from the Spanish National Health Survey functional disability scale. METHODS The sample, formed by 5708 older adults (aged 65 years or older), was drawn from the Spanish National Health Survey ("Encuesta Nacional de Salud en España," ENSE in Spanish 2011-2012). The predictions of EQ-5D-5L index were performed with response mapping using Bayesian network (BN), ordered logit (Ologit), and multinomial logistic (ML). The following direct methods were used: ordinary least squares (OLS) and Tobit regression. The intraclass correlation coefficient (ICC), absolute error (MAE), mean squared error (MSE), and root-mean squared error (RMSE) were calculated to compare all models. The predictions of response models were obtained through the expected value method. RESULTS BN model showed the highest ICC (0.756, 95% confidence interval, CI 0.733-0.777) and lowest MAE (0.110, 95% CI 0.104-0.115). OLS was the model with worse accuracy results with lowest ICC (0.621, 95% CI 0.553-0.681) and highest MAE (0.159, 95%CI: 0.145-0.173). CONCLUSION Indirect mapping methods (BN, Ologit, and ML) had a better accuracy than the direct methods. The response mapping approach provides a robust method to estimate EQ-5D-5L scores from the functional disability scale.
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Affiliation(s)
- Alba Ayala
- Department of Statistics, School of Law and Social Sciences, University Carlos III of Madrid, 126-28903, Getafe, Madrid, Spain. .,Health Service Research Network on Chronic Diseases (REDISSEC), Madrid, Spain. .,Research Network on Chronic Diseases, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain.
| | - Yolanda Ramallo-Fariña
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Tenerife, Spain.,Health Service Research Network on Chronic Diseases (REDISSEC), Madrid, Spain.,Research Network on Chronic Diseases, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
| | - Amaia Bilbao-Gonzalez
- Osakidetza Basque Health Service, Basurto University Hospital, Research and Innovation Unit, Bilbao, Spain.,Kronikgune Institute for Health Services Research, Barakaldo, Spain.,Health Service Research Network on Chronic Diseases (REDISSEC), Madrid, Spain.,Research Network on Chronic Diseases, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
| | - Maria João Forjaz
- National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain.,Health Service Research Network on Chronic Diseases (REDISSEC), Madrid, Spain.,Research Network on Chronic Diseases, Primary Care, and Health Promotion (RICAPPS), Madrid, Spain
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Cabrero-García J, Rico-Juan JR, Oliver-Roig A. Does the global activity limitation indicator measure participation restriction? Data from the European Health and Social Integration Survey in Spain. Qual Life Res 2022; 31:1335-1344. [PMID: 34882281 PMCID: PMC9023392 DOI: 10.1007/s11136-021-03057-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE The global activity limitation indicator (GALI) is the only internationally agreed and harmonised participation restriction measure. We examine if GALI, as intended, is a reflective measure of the domains of participation; furthermore, we determine the relative importance of these domains. Also, we investigated the consistency of response to GALI by age and gender and compared the performance of GALI with that of self-rated health (SRH). METHODS We used Spanish data from the European Health and Social Integration Survey and selected adults aged 18 and over (N = 13,568). Data analysis, based on logistic regression models and Shapley value decomposition, were also stratified by age. The predictors of the models were demographic variables and restrictions in participation domains: studies, work, mobility, leisure and social activities, domestic life, and self-care. The GALI and SRH were the response variables. RESULTS GALI was strongly associated with all participation domains (e.g. for domestic life, adjusted OR 24.34 (95% CI 18.53-31.97) in adult under 65) and performed differentially with age (e.g. for domestic life, adjusted OR 13.33 (95% CI 10.42-17.03) in adults over 64), but not with gender. The relative importance of domains varied with age (e.g. work was the most important domain for younger and domestic life for older adults). The results with SRH were parallel to those of GALI, but the association of SRH with participation domains was lowest. CONCLUSIONS GALI reflects well restrictions in multiple participation domains and performs differently with age, probably because older people lower their standard of good functioning.
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Affiliation(s)
- Julio Cabrero-García
- Department of Nursing, University of Alicante, Carretera San Vicente del Raspeig s/n, 03690 San Vicente del Raspeig-Alicante, Spain
| | - Juan Ramón Rico-Juan
- Department of Software and Computing Systems, University of Alicante, Carretera San Vicente del Raspeig s/n, 03690 San Vicente del Raspeig-Alicante, Spain
| | - Antonio Oliver-Roig
- Department of Nursing, University of Alicante, Carretera San Vicente del Raspeig s/n, 03690 San Vicente del Raspeig-Alicante, Spain
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Boon-Falleur M, Bouguen A, Charpentier A, Algan Y, Huillery É, Chevallier C. Simple questionnaires outperform behavioral tasks to measure socio-emotional skills in students. Sci Rep 2022; 12:442. [PMID: 35013410 PMCID: PMC8748826 DOI: 10.1038/s41598-021-04046-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 12/13/2021] [Indexed: 11/09/2022] Open
Abstract
Recent empirical research has shown that improving socio-emotional skills such as grit, conscientiousness and self-control leads to higher academic achievement and better life outcomes. However, both theoretical and empirical works have raised concerns about the reliability of the different methods used to measure socio-emotional skills. We compared the reliability and validity of the three leading measurements methods—a student-reported questionnaire, a teacher-reported questionnaire, and a behavioral task—in a sample of 3997 French students. Before analyzing the data, we polled 114 international researchers in cognitive development and education economics; most researchers in both fields predicted that the behavioral task would be the best method. We found instead that the teacher questionnaire was more predictive of students’ behavioral outcomes and of their grade progression, while the behavioral task was the least predictive. This work suggests that researchers may not be using optimal tools to measure socio-emotional skills in children.
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Affiliation(s)
- Mélusine Boon-Falleur
- Institut Jean Nicod, Département d'études Cognitives, Ecole Normale Supérieure, EHESS, Université PSL, 75005, Paris, France.
| | | | | | | | - Élise Huillery
- LEDa, Université Paris-Dauphine, Université PSL, IRD, CNRS, 75016, Paris, France
| | - Coralie Chevallier
- LNC², Département d'études cognitives, Ecole normale supérieure, Université PSL, INSERM, 75005, Paris, France
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Laborde C, Crouzet M, Carrère A, Cambois E. Contextual factors underpinning geographical inequalities in disability-free life expectancy in 100 French départements. Eur J Ageing 2021; 18:381-392. [PMID: 34483802 DOI: 10.1007/s10433-020-00589-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 01/16/2023] Open
Abstract
The objectives were to estimate disability-free life expectancy (DFLE) and life expectancy with disability (DLE) by gender for the 100 French départements (administrative geographical subdivisions) and to investigate associations with socioeconomic factors, supply of healthcare and services for older persons. DFLE and DLE at age 60 are estimated using the Sullivan method and based on the GALI indicator provided by the French cross-sectional survey Vie Quotidienne et Santé 2014. In 2014, DFLE for men and women aged 60 was 14.3 years and 15.6 years, respectively. Variations across départements were considerable (5.4 years for men, 6.7 years for women). Multivariate random effects meta-regression models indicated a negative association for men between DFLE and some of the socioeconomic contextual indicators (ratio of manual workers to higher-level occupations and unemployment rate); the level of in-home nursing services (HNS) was negatively associated with DFLE and density of nurses positively associated with DLE. Among women, ratio of manual workers to higher-level occupations, unemployment rate, proportion of the population living in large urban areas, density of nurses, and level of HNS were negatively associated with DFLE; density of physiotherapy supply was associated positively with DFLE and negatively with DLE. Our results suggest that geographical inequalities in health expectancies are significantly correlated with socioeconomic status and with healthcare supply, support for older persons, and urban environments, particularly among women. These results underline the importance of monitoring these indicators and disparities at infra-national-level, and of investigating their relations with local context, particularly the supply of healthcare and services.
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Affiliation(s)
- Caroline Laborde
- Inserm, CESP, Echappement aux anti-infectieux et pharmaco-épidémiologie, Université Paris-Saclay, UVSQ, 78180 Montigny-le-Bretonneux, France
- Observatoire régional de santé Île-de-France, Département de l'Institut Paris Région, Paris, France
| | - Maude Crouzet
- UMR7363 SAGE, Université de Strasbourg, Strasbourg, France
| | - Amélie Carrère
- Institut national d'études démographiques (Ined), Paris, France
- Université PSL Paris-Dauphine (LEDa-LEGOS), Paris, France
- Université Paris-Créteil (Erudite), Paris, France
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6
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Nusselder WJ, Rubio Valverde J, Bopp M, Brønnum-Hansen H, Deboosere P, Kalediene R, Kovács K, Leinsalu M, Martikainen P, Menvielle G, Regidor E, Wojtyniak B, Mackenbach JP. Determinants of inequalities in years with disability: an international-comparative study. Eur J Public Health 2021; 31:527-533. [PMID: 33221840 PMCID: PMC8277222 DOI: 10.1093/eurpub/ckaa194] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Persons with a lower socioeconomic position spend more years with disability, despite their shorter life expectancy, but it is unknown what the important determinants are. This study aimed to quantify the contribution to educational inequalities in years with disability of eight risk factors: father’s manual occupation, low income, few social contacts, smoking, high alcohol consumption, high body-weight, low physical exercise and low fruit and vegetable consumption. Methods We collected register-based mortality and survey-based disability and risk factor data from 15 European countries covering the period 2010–14 for most countries. We calculated years with disability between the ages of 35 and 80 by education and gender using the Sullivan method, and determined the hypothetical effect of changing the prevalence of each risk factor to the prevalence observed among high educated (‘upward levelling scenario’), using Population Attributable Fractions. Results Years with disability among low educated were higher than among high educated, with a difference of 4.9 years among men and 5.5 years among women for all countries combined. Most risk factors were more prevalent among low educated. We found the largest contributions to inequalities in years with disability for low income (men: 1.0 year; women: 1.4 year), high body-weight (men: 0.6 year; women: 1.2 year) and father’s manual occupation (men: 0.7 year; women: 0.9 year), but contributions differed by country. The contribution of smoking was relatively small. Conclusions Disadvantages in material circumstances (low income), circumstances during childhood (father’s manual occupation) and high body-weight contribute to inequalities in years with disability.
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Affiliation(s)
- Wilma J Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - José Rubio Valverde
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Henrik Brønnum-Hansen
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Patrick Deboosere
- Department of Sociology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ramune Kalediene
- Department of Health Management. Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Katalin Kovács
- Aging and health. Demographic Research Institute, Budapest, Hungary
| | - Mall Leinsalu
- Department of Sociology. Stockholm Centre for Health and Social Change, Södertörn University, Stockholm, Sweden.,Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Enrique Regidor
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.,CCIBER Epidemiología y Salud Pública, Instituto Salud Carlos III, Madrid, Spain
| | - Bodgan Wojtyniak
- Department of Population Health Monitoring and Analysis. National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Johan P Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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7
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Cabrero-García J, Juliá-Sanchis R, Richart-Martínez M. Association of the global activity limitation indicator with specific measures of disability in adults aged below 65. Eur J Public Health 2020; 30:1225-1230. [PMID: 32408346 DOI: 10.1093/eurpub/ckaa066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND health measures as the global activity limitation indicator (GALI) or self-rated health (SRH) allow to quantify and monitor the health of the population. The GALI is widely used in the European Union; however, evidence of its construct validity is still limited. We examine whether the GALI reflects disability in specific living contexts such as self-care, domestic life and work activity, whether it does so consistently across gender and age and its added value concerning SRH. METHODS We used the subsample of adults aged 16-64 years (N = 15 934) from the 2009 European Health Interview Survey in Spain and analyzed the data with logistic regression models using the GALI and SRH as response variables. RESULTS The GALI was strongly and significantly associated with the three measures of disability: self-care (OR = 22.8, 95% CI: 15.9-32.7), domestic life (OR = 16.3, 95% CI: 13.6-19.5) and work activity (e.g. impossibility to work: OR = 41.9, 95% CI: 30.3-57.8; prolonged sick leave: OR = 10.7, 95% CI: 9-12.7). There were significant interactions with age on all three disability measures and with the gender on one (domestic life), although they were small. SRH was also strongly associated with all three disability measures, but to a lesser extent than the GALI. CONCLUSIONS The GALI reflects well and better than SRH, disability in self-care, domestic life and work activity. It is unknown whether the GALI performs equally in other living contexts such as social relations and community life.
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Bao X, Borné Y, Yin S, Niu K, Orho-Melander M, Nilsson J, Melander O, Engström G. The associations of self-rated health with cardiovascular risk proteins: a proteomics approach. Clin Proteomics 2019; 16:40. [PMID: 31832026 PMCID: PMC6859604 DOI: 10.1186/s12014-019-9258-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/25/2019] [Indexed: 12/26/2022] Open
Abstract
Background Though subjective, poor self-rated health (SRH) has consistently been shown to predict cardiovascular disease (CVD). The underlying mechanism is unclear. This study evaluates the associations of SRH with biomarkers for CVD, aiming to explore potential pathways between poor SRH and CVD. Methods Based on the Malmö Diet and Cancer Cardiovascular Cohort study, a targeted proteomics approach was used to assess the associations of SRH with 88 cardiovascular risk proteins, measured in plasma from 4521 participants without CVD. The false discovery rate (FDR) was controlled using the Benjamini and Hochberg method. Covariates taken into consideration were age, sex, traditional CVD risk factors (low-density lipoprotein cholesterol, systolic blood pressure, anti-hypertensive medication, diabetes, body mass index, smoking), comorbidity, life-style and psycho-social factors (education level, living alone, alcohol consumption, low physical activity, psychiatric medication, sleep duration, and unemployment). Results Age and sex-adjusted associations with SRH was found for 34 plasma proteins. Nine of them remained significant after adjustments for traditional CVD risk factors. After further adjustment for comorbidity, life-style and psycho-social factors, only leptin (β = − 0.035, corrected p = 0.016) and C–C motif chemokine 20 (CCL20; β = − 0.054, corrected p = 0.016) were significantly associated with SRH. Conclusions Poor SRH was associated with raised concentrations of many plasma proteins. However, the relationships were largely attenuated by adjustments for CVD risk factors, comorbidity and psycho-social factors. Leptin and CCL20 were associated with poor SRH in the present study and could potentially be involved in the SRH–CVD link.
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Affiliation(s)
- Xue Bao
- 1Department of Cardiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.,2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden.,3Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yan Borné
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden
| | - Songjiang Yin
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden.,4Department of Orthopedics, Jiangsu Province Hospital of Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Kaijun Niu
- 3Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Marju Orho-Melander
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden
| | - Jan Nilsson
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden
| | - Olle Melander
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden
| | - Gunnar Engström
- 2Department of Clinical Sciences, Lund University, CRC 60:13, Jan Waldenströms gata 35, 20502 Malmö, Sweden
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Cambois E, Solé-Auró A, Robine JM. Gender Differences in Disability and Economic Hardship in Older Europeans. EUROPEAN JOURNAL OF POPULATION-REVUE EUROPEENNE DE DEMOGRAPHIE 2019; 35:777-793. [PMID: 31656461 DOI: 10.1007/s10680-018-9504-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/02/2018] [Indexed: 11/30/2022]
Abstract
European women live longer, but they experience more old age-related disability than men. Disability is related to social factors, among which is poverty, through various pathways. While women's poverty has been pointed up as a challenge for Europe, our study investigates to what extent and in which countries a greater exposure to economic hardship is associated with older women's disability disadvantage. We used the 2014 EU-SILC data in 30 European countries for men and women aged 50-79 years (N = [1179-17,474]). Disability was measured by self-reported activity limitation and economic hardship by difficulties in "making both ends meet" and "facing unexpected expenses". Country-specific nested logistic regressions measured the women's disability disadvantage and its association with economic hardship. We found that activity limitations and economic hardship varied substantially across Europe, being the lowest in Sweden and Norway. We found gender gaps in activity limitations in 23 countries, always to women's disadvantage. After adjusting for age, this disadvantage was significant in 19 countries. In 11 of these countries, women's excess disability is associated with excess economic hardship in women, especially in Iceland, France, Sweden, and Austria. Women's excess disability and social factors such as economic hardship are linked, even in protective countries. These situations of double disadvantage for women deserve attention when designing policies to reduce health inequalities and to promote healthy ageing.
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Affiliation(s)
- Emmanuelle Cambois
- 1Department of Mortality, Health and Epidemiology, Institut national d'études démographiques (INED), 133 Bd Davout, 75980 Paris Cedex 20, France
| | - Aïda Solé-Auró
- 2Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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Hsiao RL, Wu CH, Hsu CW, Saito Y, Lin YH. Validation of the global activity limitation indicator in Taiwan. BMC Med Res Methodol 2019; 19:52. [PMID: 30845914 PMCID: PMC6407180 DOI: 10.1186/s12874-019-0693-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background The Global Activity Limitation Indicator (GALI) is a single-item measure of functional decline, it is widely used in Europe but it has never been validated in an Asian population. The aim of this study was to validate the GALI in a sample of older Taiwanese people and to explore whether it captured not only physical but also psychological limitations. Methods Data for 4961 individuals (mean age, 62.4 ± 9.4 years; 47.2% men) were obtained from a national representative refresh cohort of the 8th wave of the Taiwan Longitudinal Survey on Aging. Logistic regression analysis was used to examine associations among the GALI, activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and to explore whether depressive symptoms (measured by the Center for Epidemiologic Studies Depression Scale, CES-D) could be an indicator of reporting limitations on the GALI. Results Responding to the GALI, 21.7% of the sample described themselves as ‘limited.’ In logistic regression, the GALI response was significantly associated with those who reported one or more ADL difficulties (odds ratio [OR] = 35.89, 95% confidence interval [CI] 21.10, 61.03) and IADL difficulties (OR = 13.37, 95%CI 10.09, 17.71), respectively. Furthermore, those with more depressive symptoms were more likely to report they were ‘limited’ on the GALI. Conclusions These findings provided evidence that the GALI is a valid tool to assess general limitations in an Asian population. Furthermore, it captured psychological limitations to some extent. There were variations between Taiwan and European countries (as has been previously reported between European countries). The reporting level in the GALI by the Taiwan population was comparatively lower than that in European countries, highlighting the need to embrace cultural differences and to use caution when comparing GALI results across countries.
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Affiliation(s)
- Ru-Ling Hsiao
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chih-Hsun Wu
- Department of Psychology, National Chengchi University, No.64, Sec.2, ZhiNan Road, Taipei, Taiwan, 11605.
| | - Che-Wei Hsu
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Yasuhiko Saito
- Population Research Institute, Nihon University, Tokyo, Japan
| | - Yu-Hsuan Lin
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
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Nusselder WJ, Wapperom D, Looman CWN, Yokota RTC, van Oyen H, Jagger C, Robine JM, Cambois EM. Contribution of chronic conditions to disability in men and women in France. Eur J Public Health 2019; 29:99-104. [PMID: 30107556 DOI: 10.1093/eurpub/cky138] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Women report more disability than men perhaps due to gender differences in the prevalence of diseases and/or in their disabling impact. We compare the contribution of chronic diseases to disability in men and women in France, using a disability survey conducted in both private households and institutions, and we also examine the effect of excluding the institutionalized population. Methods Data comprised 17 549 individuals age 50+, who participated in the 2008-09 French Disability Health Survey including people living in institutions. Disability was defined by limitations in activities people usually do due to health problems (global activity limitation indicator). Additive regression models were fitted separately by gender to estimate the contribution of conditions to disability taking into account multi-morbidity. Results Musculoskeletal diseases caused most disability for both men (10.1%, CI: 8.1-12.0) and women (16.0%, CI 13.6-18.2). The second contributor for men was heart diseases (5.7%, CI: 4.5-6.9%), and for women anxiety-depression (4.0, CI 3.1-5.0%) closely followed by heart diseases (3.8%, CI 2.9-4.7%). Women's higher contribution of musculoskeletal diseases reflected their higher prevalence and disabling impact; women's higher contribution of anxiety-depression and lower contributions of heart diseases reflected gender differences in prevalence. Excluding the institutionalized population did not change the overall conclusions. Conclusions The largest contributors to the higher disability of women than men are moderately disabling conditions with a high prevalence. Whereas traditional disabling conditions such as musculoskeletal diseases are more prevalent and disabling in women, fatal diseases such as cardiovascular disease are also important contributors in women and men.
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Affiliation(s)
- Wilma J Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Dagmar Wapperom
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Caspar W N Looman
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Renata T C Yokota
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium.,Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
| | - Herman van Oyen
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium.,Department of Public Health, Ghent University, Ghent, Belgium
| | - Carol Jagger
- Institute of Health and Society, Newcastle University, Newcastle, UK.,Institute for Ageing, Newcastle University, Newcastle, UK
| | - Jean Marie Robine
- INSERM (National Institute of Health and Medical Research), Montpellier, France.,EPHE (École Pratique des Hautes Études), Paris, France
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Van Oyen H, Bogaert P, Yokota RTC, Berger N. Measuring disability: a systematic review of the validity and reliability of the Global Activity Limitations Indicator (GALI). ACTA ACUST UNITED AC 2018; 76:25. [PMID: 29881544 PMCID: PMC5985596 DOI: 10.1186/s13690-018-0270-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/09/2018] [Indexed: 12/03/2022]
Abstract
Background GALI or Global Activity Limitation Indicator is a global survey instrument measuring participation restriction. GALI is the measure underlying the European indicator Healthy Life Years (HLY). Gali has a substantial policy use within the EU and its Member States. The objective of current paper is to bring together what is known from published manuscripts on the validity and the reliability of GALI. Methods Following the PRISMA guidelines, two search strategies (PUBMED, Google Scholar) were combined to identify manuscripts published in English with publication date 2000 or beyond. Articles were classified as reliability studies, concurrent or predictive validity studies, in national or international populations. Results Four cross-sectional studies (of which 2 international) studied how GALI relates to other health measures (concurrent validity). A dose-response effect by GALI severity level on the association with the other health status measures was observed in the national studies. The 2 international studies (SHARE, EHIS) concluded that the odds of reporting participation restriction was higher in subjects with self-reported or observed functional limitations. In SHARE, the size of the Odds Ratio’s (ORs) in the different countries was homogeneous, while in EHIS the size of the ORs varied more strongly. For the predictive validity, subjects were followed over time (4 studies of which one international). GALI proved, both in national and international data, to be a consistent predictor of future health outcomes both in terms of mortality and health care expenditure. As predictors of mortality, the two distinct health concepts, self-rated health and GALI, acted independently and complementary of each other. The one reliability study identified reported a sufficient reliability of GALI. Conclusion GALI as inclusive one question instrument fits all conceptual characteristics specified for a global measure on participation restriction. In none of the studies, included in the review, there was evidence of a failing validity. The review shows that GALI has a good and sufficient concurrent and predictive validity, and reliability.
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Affiliation(s)
- Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium.,2Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Petronille Bogaert
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Renata T C Yokota
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium.,3Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Nicolas Berger
- 4Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
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Palmera-Suárez R, López-Cuadrado T, Fernández-Cuenca R, Alcalde-Cabero E, Galán I. Inequalities in the risk of disability due to traffic injuries in the Spanish adult population, 2009-2010. Injury 2018; 49:549-555. [PMID: 29433800 DOI: 10.1016/j.injury.2018.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/21/2017] [Accepted: 02/06/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although traffic injuries (TIs) are an important cause of disability the related factors are little known. We aimed to estimate the differences in risk of TI-related disability according to individual characteristics that might generate health inequalities. METHODS Cross-sectional study using a representative Spanish population sample drawn from the European Health Interview Survey 2009/2010. We calculated traffic crashes in the preceding year which resulted in injuries. Disability was measured using the Global Activity Limitation Indicator and four indicators of limitations (sensory, physical functional, self-care and domestic activities). Principal socio-demographic and behavioural/lifestyle variables were studied. We used multivariate logistic regression to estimate the risk (ORs) of TI-related disability in the sample as whole and disability-related factors in persons who had experienced TIs. RESULTS Persons with TIs had a higher risk of global disability (OR = 1.61; 95%CI:1.17-2.20), physical functional limitations (OR = 1.96; 95%CI:1.33-2.89) and self-care limitations (OR = 1.73; 95%CI:0.98-3.05). Among persons with TIs, GALI-related risk was higher in women (OR = 3.06, p = 0.002) and persons aged over 30 years (OR31-45years = 6.81, p < 0.001; OR46-64years = 5.96, p = 0.011; OR>64years = 4.54, p = 0.047). Lower risk was observed among persons with a higher educational level (OR = 0.22, p = 0.003). The risk of disability among persons with TIs who consumed illegal drugs was OR = 3.9 (p = 0.023). CONCLUSIONS Traffic injuries in the preceding year are associated with higher risk of disability, which is unevenly distributed. Individual (women and persons over 30 years), socio-economic (lower educational level) and behavioural (illegal drug use) factors are involved. Actions aimed at changing the unequal risk among vulnerable subgroups and providing health, social and protective services should be implemented.
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Affiliation(s)
- Rocío Palmera-Suárez
- Department of Epidemiological Analysis and Health Status, National Centre for Epidemiology, Carlos III Institute of Health, Calle Monforte de Lemos 5, Pabellón 12, PC 28029, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), National Centre for Epidemiology, Carlos III Institute of Health, Calle Monforte de Lemos 5, Pabellón 12, PC 28029, Madrid, Spain.
| | - Teresa López-Cuadrado
- Department of Epidemiological Analysis and Health Status, National Centre for Epidemiology, Carlos III Institute of Health, Calle Monforte de Lemos 5, Pabellón 12, PC 28029, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Autonomous University of Madrid/IdiPAZ (Instituto de Investigación del Hospital Universitario La Paz/La Paz University Teaching Hospital Research Institute), Calle del Arzobispo Morcillo 4, PC 28029, Madrid, Spain.
| | - Rafael Fernández-Cuenca
- Department of Epidemiological Analysis and Health Status, National Centre for Epidemiology, Carlos III Institute of Health, Calle Monforte de Lemos 5, Pabellón 12, PC 28029, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), National Centre for Epidemiology, Carlos III Institute of Health, Calle Monforte de Lemos 5, Pabellón 12, PC 28029, Madrid, Spain.
| | - Enrique Alcalde-Cabero
- Department of Applied Epidemiology, National Centre for Epidemiology, Carlos III Institute of Health, Calle Monforte de Lemos 5, Pabellón 12, PC 28029, Madrid, Spain.
| | - Iñaki Galán
- Department of Applied Epidemiology, National Centre for Epidemiology, Carlos III Institute of Health, Calle Monforte de Lemos 5, Pabellón 12, PC 28029, Madrid, Spain; Department of Preventive Medicine and Public Health, School of Medicine, Autonomous University of Madrid/IdiPAZ (Instituto de Investigación del Hospital Universitario La Paz/La Paz University Teaching Hospital Research Institute), Calle del Arzobispo Morcillo 4, PC 28029, Madrid, Spain.
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14
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Cambois E, Solé-Auró A, Robine JM. Economic Hardship and Educational Differentials in Disability in 26 European Countries. J Aging Health 2018; 28:1214-38. [PMID: 27590799 DOI: 10.1177/0898264316656503] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this article is to study to what extent European variations in differentials in disability by education level are associated to variation in poverty. METHOD Using the European Statistics on Income and Living Conditions (EU-SILC) for 26 countries, we measure the prevalence of activity limitation (AL) and the rate of economic hardship (EH) by level of education. We measure the increased AL prevalence (disadvantage) of the low-educated relative to the middle-educated and the reduced AL prevalence (advantage) of the high-educated groups, controlling or not for EH. RESULTS The rate of EH and the extent of the AL-advantage/disadvantage vary substantially across Europe. EH contributes to the AL-advantage/disadvantage but to different extent depending on its level across educational groups. DISCUSSION Associations between poverty, education, and disability are complex. In general, large EH goes along with increased disability differentials. Actions to reduce poverty are needed in Europe to reduce the levels and differentials in disability.
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Affiliation(s)
| | | | - Jean-Marie Robine
- Institut National de la Santé et de la Recherche Médicale (INSERM), Ecole Pratique des Hautes Etudes (EPHE) and Institut National d'Etudes Démographiques (INED), France
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15
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Cambois E, Grobon S, Van Oyen H, Robine JM. Impact of Question Wording on the Measurement of Activity Limitation: Evidence From a Randomized Test in France. J Aging Health 2018; 28:1315-38. [PMID: 27590804 DOI: 10.1177/0898264316656504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Global Activity Limitation Indicator (GALI), a single question measuring disability, had been introduced in various European surveys since 2004. The complexity of its wording has been questioned. Our study compares alternative variants aiming to simplify the wording. METHOD We used the Health-Related Opinion Survey run in 2014 in France (N = 3,009). Its split sample design allows testing four variants of the questions. We analyzed the prevalence of activity limitation (AL) resulting from the four different constructs of the GALI using multinomial logistic regressions, adjusted for background variables and functional limitations (FLs). RESULTS The alternative GALI variants result in significantly different prevalences compared with the original question, in particular for people with FL. The current variant is more inclusive than the routed variants. DISCUSSION Our study suggests limited benefits of changing the GALI construct which do not outweigh the costs of breaking the established chronological series of the current variant.
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Affiliation(s)
| | - Sébastien Grobon
- Direction de la recherche de l'évaluation, des études et des statistiques, Ministry of health (DREES), France
| | - Herman Van Oyen
- Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Jean-Marie Robine
- Institut National de la Santé et de la Recherche Médicale (INSERM), Ecole Pratique des Hautes Etudes (EPHE) and Institut National d'Etudes Démographiques (INED), France
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16
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Nettle D, Bateson M. Childhood and adult socioeconomic position interact to predict health in mid life in a cohort of British women. PeerJ 2017; 5:e3528. [PMID: 28674669 PMCID: PMC5493971 DOI: 10.7717/peerj.3528] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/10/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Low childhood socioeconomic position (cSEP) is associated with poorer adult health, even after adult socioeconomic position (aSEP) is adjusted for. However, whether cSEP and aSEP combine additively or non-additively in predicting adult health is less well studied. Some evidence suggests that the combination of low cSEP and low aSEP is associated with worse health than would be predicted from the sum of their individual effects. METHODS Using data from female members of the British National Child Development Study cohort, we developed continuous quantitative measures of aSEP and cSEP, and used these to predict self-rated health at ages 23, 33, and 42. RESULTS Lower aSEP predicted poorer heath at all ages. Lower cSEP predicted poorer health at all ages, even after adjustment for aSEP, but the direct effects of cSEP were substantially weaker than those of aSEP. At age 23, the effects of cSEP and aSEP were additive. At ages 33 and 42, cSEP and aSEP interacted, such that the effects of low aSEP on health were more negative if cSEP had also been low. CONCLUSIONS As women age, aSEP and cSEP may affect their health interactively. High cSEP, by providing a good start in life, may be partially protective against later negative impacts of low aSEP. We relate this to the extended 'silver spoon' principle recently documented in a non-human species.
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Affiliation(s)
- Daniel Nettle
- Centre for Behaviour and Evolution & Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Melissa Bateson
- Centre for Behaviour and Evolution & Institute of Neuroscience, Newcastle University, Newcastle, UK
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Berger N, Robine JM, Ojima T, Madans J, Van Oyen H. Harmonising summary measures of population health using global survey instruments. J Epidemiol Community Health 2016; 70:1039-44. [PMID: 27165845 PMCID: PMC5036208 DOI: 10.1136/jech-2015-206870] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 04/13/2016] [Indexed: 11/12/2022]
Abstract
Summary measures of population health—health expectancies in particular—have become a standard for quantifying and monitoring population health. To date, cross-national comparability of health expectancies is limited, except within the European Union (EU). To advance international comparability, the European Joint Action on Healthy Life Years (JA: EHLEIS) set up an international working group. The working group discussed the conceptual basis of summary measures of population health and made suggestions for the development of comparable health expectancies to be used across the EU and Organisation for Economic Co-operation and Development (OECD) members. In this paper, which summarises the main results, we argue that harmonised health data needed for health expectancy calculation can best be obtained from ‘global’ survey measures, which provide a snapshot of the health situation using 1 or a few survey questions. We claim that 2 global measures of health should be pursued for their high policy relevance: a global measure of participation restriction and a global measure of functional limitation. We finally provide a blueprint for the future development and implementation of the 2 global measures. The blueprint sets the basis for subsequent international collaboration, having as a core group Member States of the EU, the USA and Japan. Other countries, in particular OECD members, are invited to join the initiative.
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Affiliation(s)
- Nicolas Berger
- Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jean-Marie Robine
- French Institute of Health and Medical Research (INSERM), Montpellier, France École Pratique des Hautes Études, Paris, France
| | | | | | - Herman Van Oyen
- Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
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18
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Cambois E, Solé-Auró A, Brønnum-Hansen H, Egidi V, Jagger C, Jeune B, Nusselder WJ, Van Oyen H, White C, Robine JM. Educational differentials in disability vary across and within welfare regimes: a comparison of 26 European countries in 2009. J Epidemiol Community Health 2015; 70:331-8. [PMID: 26546286 DOI: 10.1136/jech-2015-205978] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/09/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Social differentials in disability prevalence exist in all European countries, but their scale varies markedly. To improve understanding of this variation, the article focuses on each end of the social gradient. It compares the extent of the higher disability prevalence in low social groups (referred to as disability disadvantage) and of the lower prevalence in high social groups (disability advantage); country-specific advantages/disadvantages are discussed regarding the possible influence of welfare regimes. METHODS Cross-sectional disability prevalence is measured by longstanding health-related activity limitation (AL) in the 2009 European Statistics on Income and Living Conditions (EU-SILC) across 26 countries classified into four welfare regime groups. Logistic models adjusted by country, age and sex (in all 30-79 years and in three age-bands) measured the country-specific ORs across education, representing the AL-disadvantage of low-educated and AL-advantage of high-educated groups relative to middle-educated groups. RESULTS The relative AL-disadvantage of the low-educated groups was small in Sweden (eg, 1.2 (1.0-1.4)), Finland, Romania, Bulgaria and Spain (youngest age-band), but was large in the Czech Republic (eg, 1.9 (1.7-2.2)), Denmark, Belgium, Italy and Hungary. The high-educated groups had a small relative AL-advantage in Denmark (eg, 0.9 (0.8-1.1)), but a large AL-advantage in Lithuania (eg, 0.5 (0.4-0.6)), half of the Baltic and Eastern European countries, Norway and Germany (youngest age-band). There were notable differences within welfare regime groups. CONCLUSIONS The country-specific disability advantages/disadvantages across educational groups identified here could help to identify determining factors and the efficiency of national policies implemented to tackle social differentials in health.
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Affiliation(s)
- Emmanuelle Cambois
- Department of Mortality, Health and Epidemiology, Institut National d'Etudes Démographiques (INED), Paris, France
| | - Aïda Solé-Auró
- Department of Political and Social Science, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Henrik Brønnum-Hansen
- Department of Public Health, University of Copenhagen, Faculty of Health Sciences, Copenhagen, Denmark
| | - Viviana Egidi
- Department of Statistical Science, Sapienza University of Rome, Roma, Italy
| | - Carol Jagger
- Newcastle University Institute for Ageing and Institute of Health & Society, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Bernard Jeune
- Department of Epidemiology, Institute of Public Health, and Danish Ageing Research Center, University of Southern Denmark, Odense, Denmark
| | - Wilma J Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Herman Van Oyen
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium
| | - Chris White
- Government Statistical Service, Office for National Statistics, Government Buildings, Newport, UK
| | - Jean-Marie Robine
- Institut National de la Santé et de la Recherche Médicale (INSERM), Ecole Pratique des Hautes Etudes (EPHE) and Institut National d'Etudes Démographiques (INED), Montpellier, France
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Berger N, Van der Heyden J, Van Oyen H. The global activity limitation indicator and self-rated health: two complementary predictors of mortality. ACTA ACUST UNITED AC 2015; 73:25. [PMID: 25964852 PMCID: PMC4426645 DOI: 10.1186/s13690-015-0073-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/05/2015] [Indexed: 12/02/2022]
Abstract
Background The purpose of this study is to compare the ability of the Global Activity Limitation Indicator (GALI) and self-rated health (SRH) to predict all-cause mortality in the general adult population. Methods We linked the 2001 Belgian Health Interview Survey with mortality and migration registers 2001–2010. The baseline sample included 8,583 individuals aged 15 years and older. Poisson regression models were used to estimate the effect of the GALI and SRH on mortality rate during follow-up. We investigated the impact of gender, age, education and follow-up period on the association between the GALI/SRH and mortality. Results The GALI and SRH were strong and complementary predictors of mortality in the Belgian adult population. Although the two global instruments shared some traits, they predicted mortality concurrently, with some indication of a somewhat stronger effect for SRH. We found neither significant differences between men and women, nor between education groups. The predictive effect of the GALI and SRH slightly decreased over time and the predictive effect of SRH slightly decreased with age. Conclusions Our findings suggest that the GALI and SRH are useful and complementary measures for assessing the health and functional status of adults in population surveys.
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Affiliation(s)
- Nicolas Berger
- Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK ; Public Health and Surveillance, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Johan Van der Heyden
- Public Health and Surveillance, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium ; Department of Public Health, Ghent University, Ghent, Belgium
| | - Herman Van Oyen
- Public Health and Surveillance, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium ; Department of Public Health, Ghent University, Ghent, Belgium
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Van der Heyden J, Van Oyen H, Berger N, De Bacquer D, Van Herck K. Activity limitations predict health care expenditures in the general population in Belgium. BMC Public Health 2015; 15:267. [PMID: 25885249 PMCID: PMC4409706 DOI: 10.1186/s12889-015-1607-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/04/2015] [Indexed: 12/29/2022] Open
Abstract
Background Disability and chronic conditions both have an impact on health expenditures and although they are conceptually related, they present different dimensions of ill-health. Recent concepts of disability combine a biological understanding of impairment with the social dimension of activity limitation and resulted in the development of the Global Activity Limitation Indicator (GALI). This paper reports on the predictive value of the GALI on health care expenditures in relation to the presence of chronic conditions. Methods Data from the Belgian Health Interview Survey 2008 were linked with data from the compulsory national health insurance (n = 7,286). The effect of activity limitation on health care expenditures was assessed via cost ratios from multivariate linear regression models. To study the factors contributing to the difference in health expenditure between persons with and without activity limitations, the Blinder-Oaxaca decomposition method was used. Results Activity limitations are a strong determinant of health care expenditures. People with severe activity limitations (5.1%) accounted for 16.9% of the total health expenditure, whereas those without activity limitations (79.0%), were responsible for 51.5% of the total health expenditure. These observed differences in health care expenditures can to some extent be explained by chronic conditions, but activity limitations also contribute substantially to higher health care expenditures in the absence of chronic conditions (cost ratio 2.46; 95% CI 1.74-3.48 for moderate and 4.45; 95% CI 2.47-8.02 for severe activity limitations). The association between activity limitation and health care expenditures is stronger for reimbursed health care costs than for out-of-pocket payments. Conclusion In the absence of chronic conditions, activity limitations appear to be an important determinant of health care expenditures. To make projections on health care expenditures, routine data on activity limitations are essential and complementary to data on chronic conditions. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1607-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johan Van der Heyden
- Department of Public Health and Surveillance, Scientific Institute of Public Health, 14, Juliette Wytsmanstraat, 1050, Brussels, Belgium. .,Department of Public Health, Ghent University, Ghent, Belgium.
| | - Herman Van Oyen
- Department of Public Health and Surveillance, Scientific Institute of Public Health, 14, Juliette Wytsmanstraat, 1050, Brussels, Belgium. .,Department of Public Health, Ghent University, Ghent, Belgium.
| | - Nicolas Berger
- Department of Public Health and Surveillance, Scientific Institute of Public Health, 14, Juliette Wytsmanstraat, 1050, Brussels, Belgium. .,Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - Dirk De Bacquer
- Department of Public Health, Ghent University, Ghent, Belgium.
| | - Koen Van Herck
- Department of Public Health, Ghent University, Ghent, Belgium.
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Van der Heyden J, Berger N, Van Oyen H. Comparison of self-rated health and activity limitation as predictors of short term mortality in the older population. Public Health 2015; 129:283-5. [DOI: 10.1016/j.puhe.2014.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 12/02/2014] [Accepted: 12/05/2014] [Indexed: 11/26/2022]
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22
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Nettle D. What the future held: childhood psychosocial adversity is associated with health deterioration through adulthood in a cohort of British women. EVOL HUM BEHAV 2014. [DOI: 10.1016/j.evolhumbehav.2014.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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