Association of the global activity limitation indicator with specific measures of disability in adults aged below 65

[How has life expectancy without functional limitations developed in Germany? An analysis with data from the German Ageing Survey (DEAS)]

INTRODUCTION

The long-term increase in life expectancy raises the question of whether the increased life expectancy is accompanied by an extension of years without health limitations. The study analyzes how life expectancy without functional and mobility limitations from the ages of 46 and 65 and their proportions of remaining life expectancy have changed since 2008.

METHODS

We analyze data from the German Ageing Survey of the 2008, 2014, and 2020/21 waves. Life expectancy without functional limitations (disability-free life expectancy-DFLE) was calculated using the Sullivan method. Severe functional limitations (using the Global Activity Limitation Indicator-GALI) and mobility limitations (climbing stairs, walking more than 1 km) were examined.

RESULTS

Compression of morbidity in the GALI has been observed in 46- and 65-year-old men since 2014, but not in women of the same age. In terms of mobility, 46- and 65-year-old men show trends towards compression when climbing stairs and 46-year-old men when walking more than 1 km since 2014. The values for women have stagnated for the first two indicators mentioned, but not for 46-year-old women since 2014 when walking more than 1 km.

DISCUSSION

Our analyses show different trends in DFLE depending on the indicator, age, and gender and do not allow a clear answer to the question of morbidity compression or expansion. We tend to see morbidity compression in men, whereas trends of stagnation or expansion tend to be seen in women. These results signal challenges in maintaining functional health, especially in women, and point to the need for targeted interventions to improve quality of life and healthy life expectancy.

Trends in severe functional limitations among working and non-working adults in Germany: Towards an (un)-healthy working life?

We examined trends in severe functional limitations among working and non-working adults in Germany (ages 40-65). Four population-based samples of 11,615 participants were used, spanning the time periods 2002-2021. The overall prevalence of severe limitations was found to be 12.8% in the sample, but also varied from 10 to 20% according to occupational group. Over time, severe limitations were found to have increased, from 10.6% in 2002 to 13.2% in 2021. Logistic regression analysis showed that severe limitations increased significantly in certain subgroups, including working women with a low skilled white collar occupational group, working men with a low skilled blue collar occupational group and, particularly, among the whole non-working population, whereas limitations remained largely the same in the other groups, including most of the working population. In terms of expectancies, overall working life expectancy increased. Along with this increase, healthy (non-severely limited) working life expectancy increased, but this trend was accompanied by a clear increase in unhealthy working life expectancy (severely limited). Thus, although severe limitations have increased in some groups in the working-age adults, people today can expect to work more years free from severe limitations than before. In the future, potentials to increase working life expectancy may come to an end, as severe limitations increased strongly in the non-working population, which could limit the prospects for a further increase in the proportion of the population in employment. Further studies are needed to investigate the potential impact of the increasing prevalence of severe limitations on the population's ability to work.

Screening women in young adulthood for disabling dysmenorrhoea: a nationwide cross-sectional study from the CONSTANCES cohort

RESEARCH QUESTION

How do different warning indicators help to identify disabling dysmenorrhoea among women in young adulthood?

DESIGN

A nationwide cross-sectional study of women aged 18-25 years from the CONSTANCES cohort was constructed. Disability was assessed with the Global Activity Limitation Indicator question 'For the past 6 months, have you been limited in routine activities?Yes, severely limited/Yes, limited/ No, not limited'. Dysmenorrhoea pain intensity and other chronic pelvic pain symptoms (dyspareunia and non-menstrual pain) were evaluated according to questions from a specific questionnaire. Probability of disability was estimated using a logistic prediction model according to dysmenorrhoea intensity, other indicators of pelvic pain symptoms and other obvious covariates. The results of the predictive model of disabling dysmenorrhoea were presented on a nomogram.

RESULTS

Among 6377 women, the rate of disability was estimated at 7.5%. Increased intensity of dysmenorrhoea (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.04-1.13), increased frequency of dyspareunia (from OR 1.69, 95% CI 1.33-2.14 up to OR 3.41, 95% CI 2.16-5.38) non-menstrual chronic pelvic pain (OR 1.75, 95% CI 1.40-2.19), body mass index over 25 kg/m2 (OR 1.45, 95% CI 1.17-1.80) and non-use of the hormonal contraceptive pill (OR 1.29, 95% CI 1.05-1.59) were significantly associated with disability. According to the nomogram, a predicted probability of 15% or more could be chosen as a threshold. This represents almost 4.6% of young women in this sample being classified at risk of disabling dysmenorrhoea.

CONCLUSIONS

Dysmenorrhoea pain intensity and associated pelvic pain symptoms are warning indicators that can be measured to help screen young women who may suffer from disabling dysmenorrhoea.

Changes in disability over time among older working-age adults: Which global and specific limitations are increasing in Germany using the SHARE-data from 2004 to 2015?

Objectives

Previous studies have observed increasing limitations among the middle-aged, including those aged 40-64, raising the question how healthy work participation has changed. Helping answer this question, we ask: How have general and specific limitations changed in working and non-working adults in Germany?

Methods

We used population-based data of older working-age adults, aged 50-64 years old, from Germany provided by the Survey of Health Aging and Retirement (SHARE) study from 2004 to 2014 (N = 3522). Multiple logistic regression analyses were used to study changes in limitations over time.

Results

We found that employment rates generally increased over time, whereas limitation rates mostly increased among participants aged 50-54 and mostly decreased among participants aged 60-64 in both the working and non-working population. Regarding type of disability, increases were more pronounced with movement-related and general activity-related limitations.

Conclusion

Therefore, if the comparatively younger more-limited cohorts age and replace the older less-limited cohorts, a larger part of the working and non-working life might be expected to be spent with limitations in the future, and it seems questionable whether further substantial increases in healthy work participation can be achieved. Further prevention efforts and assistance should be directed at current middle-aged cohorts to improve and maintain their health, including adapting current working conditions to a work force with more limitations.

Trends in Activity Limitations From an International Perspective: Differential Changes Between Age Groups Across 30 Countries

Objectives: Examine trends in limitations among young (15–39), middle-aged (40–64) and older age-groups (>=65) and their socioeconomic differences. Methods: Population-based European Social Survey data ( N = 396,853) were used, covering 30 mostly European countries and spanning the time-period 2002–2018. Limitations were measured using a global activity limitations indicator. Results: Age-differential trends in limitations were found. Activity limitations generally decreased in older adults, whereas trends varied among younger and middle-aged participants, with decreasing limitations in some countries but increasing limitations in others. These age-differential trends were replicated across limitation severity and socioeconomic groups; however, stronger limitation increases occurred regarding less-severe limitations. Discussion: Functional health has improved in older adults. Contrarily, the increasing limitations in younger and middle-aged individuals seem concerning, which were mostly observed in Western and Northern European countries. Given its public health importance, future studies should investigate the reasons for this declining functional health in the young and middle-aged.

Does the global activity limitation indicator measure participation restriction? Data from the European Health and Social Integration Survey in Spain

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.

Projecting years in good health between age 50-69 by education in the Netherlands until 2030 using several health indicators - an application in the context of a changing pension age

Objective

We investigate whether there are changes over time in years in good health people can expect to live above (surplus) or below (deficit) the pension age, by level of attained education, for the past (2006), present (2018) and future (2030) in the Netherlands.

Methods

We used regression analysis to estimate linear trends in prevalence of four health indicators: self-assessed health (SAH), the Organization for Economic Co-operation and Development (OECD) functional limitation indicator, the OECD indicator without hearing and seeing, and the activities-of-daily-living (ADL) disability indicator, for individuals between 50 and 69 years of age, by age category, gender and education using the Dutch National Health Survey (1989–2018). We combined these prevalence estimates with past and projected mortality data to obtain estimates of years lived in good health. We calculated how many years individuals are expected to live in good health above (surplus) or below (deficit) the pension age for the three points in time. The pension ages used were 65 years for 2006, 66 years for 2018 and 67.25 years for 2030.

Results

Both for low educated men and women, our analyses show an increasing deficit of years in good health relative to the pension age for most outcomes, particularly for the SAH and OECD indicator. For high educated we find a decreasing surplus of years lived in good health for all indicators with the exception of SAH. For women, absolute inequalities in the deficit or surplus of years in good health between low and high educated appear to be increasing over time.

Conclusions

Socio-economic inequalities in trends of mortality and the prevalence of ill-health, combined with increasing statutory pension age, impact the low educated more adversely than the high educated. Policies are needed to mitigate the increasing deficit of years in good health relative to the pension age, particularly among the low educated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13223-8.

Determinants of inequalities in years with disability: an international-comparative study

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.

Determinants of educational inequalities in disability-free life expectancy between ages 35 and 80 in Europe

Socioeconomic inequalities in disability-free life expectancy (DFLE) exist across all European countries, yet the driving determinants of these differences are not completely known. We calculated the impact on educational inequalities in DFLE of equalizing the distribution of eight risk factors for mortality and disability using register-based mortality data and survey data from 15 European countries for individuals between 35 and 80 years old. From the selected risk factors, the ones that contribute the most to the educational inequalities in DFLE are low income, high body-weight, smoking (for men), and manual occupation of the father. Potentially large reductions in inequalities can be achieved in Eastern European countries, where educational inequalities in DFLE are also the largest.

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Disability-free life expectancy is lower among low than the high educated in Europe.

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Over-all, the risk factor contributing most to the inequality was low income.

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Other important contributors are high body-weight, smoking and father's manual occupation.

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Size of inequality and contribution of risk factors vary importantly between countries.