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Galán I, Fontán J, Ortiz C, López-Cuadrado T, Téllez-Plaza M, García-Esquinas E. Volume of alcohol intake, heavy episodic drinking, and all-cause mortality in Spain: A longitudinal population-based study. Addict Behav 2024; 158:108108. [PMID: 39033565 DOI: 10.1016/j.addbeh.2024.108108] [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: 04/19/2024] [Revised: 06/13/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION The impact of alcohol consumption on health, particularly in low quantities, remains controversial. Our objective was to assess the association between alcohol volume and heavy episodic drinking (HED) with all-cause mortality, while minimizing many of the known methodological issues. METHODOLOGY This longitudinal study used data from the 2011-2012 National Health Survey and the 2014 European Health Survey in Spain. Data from 43,071 participants aged ≥ 15 years were linked to mortality records as of December 2021. Alcohol consumption categories were defined based on intake volume and frequency: never-drinkers, former drinkers, infrequent occasional drinkers (≤once/month), frequent occasional drinkers ( once /month). Regular drinkers (≥once/week) were further classified by volume: >0-10 g/day, >10-20 g/day, >20-40 g/day, and > 40 g/day. Heavy Episodic Drinking (HED) was defined as ≥ 6 and ≥ 5 standard drinks (10 g) within 4-6 h for men and women, respectively. Hazard ratios (HR) were calculated using Cox regression, adjusting for sociodemographic variables, lifestyle factors, health status, and alcohol volume or HED. RESULTS Compared to infrequent occasional drinkers, HRs for never-drinkers and former drinkers were 1.30 (95 %CI:1.14-1.47) and 1.32 (95 %CI:1.15-1.50), respectively. No differences in mortality risk were observed for intakes up to 20 g/day, but it increased for consumptions > 20-40 g/day and > 40 g/day (HR = 1.29; 95 %CI:1.05-1.58 and HR = 1.57; 95 %CI:1.14-2.17, respectively). The HR of weekly HED vs. never was 1.31 (95 %CI:0.98-1.75). CONCLUSIONS Compared to infrequent occasional drinking, consuming low amounts of alcohol had no impact on mortality risk. However, never-drinkers, former drinkers, individuals with regular consumption > 20 g/day, and those engaging in weekly HED, experienced higher mortality risk.
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Affiliation(s)
- Iñaki Galán
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain.
| | - Julia Fontán
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Cristina Ortiz
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.
| | - Teresa López-Cuadrado
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain.
| | - María Téllez-Plaza
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, Autonomous University of Madrid, Madrid, Spain.
| | - Esther García-Esquinas
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain.
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Pastor-Barriuso R, Galán I, Damián J. Additive interaction of disability with chronic conditions on mortality risk in middle-aged and older adults in Spain. Disabil Health J 2024:101672. [PMID: 39048486 DOI: 10.1016/j.dhjo.2024.101672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Disability and chronic diseases are prevalent conditions associated with mortality, but little information is available on their potential synergistic effects. OBJECTIVE This study aimed to describe additive interactions between disability and chronic diseases on mortality risk in middle-aged and older adults. METHODS A representative cohort of 22,800 community-dwelling Spanish people aged 50 years or older were interviewed for disability with the Global Activity Limitation Indicator and specific chronic diseases in the 2011-12 and 2014 National Health Surveys and subsequently followed up for mortality. Five-year all-cause mortality risks were standardized in each disability-by-comorbidity category through inverse probability weighting. We computed interaction contrasts as the departure of the standardized risk difference for people with both conditions from the sum of the standardized risk differences for those with any single condition. RESULTS The baseline prevalence of disability was 35.1 % (95 % confidence interval [CI] 34.4 %, 35.9 %). There was compelling evidence of synergistic effects of disability with chronic liver disease, heart diseases other than myocardial infarction, cancer, and cerebrovascular disease, with large positive interaction contrasts (95 % CIs) of 106.7 (-16.4, 229.9), 45.7 (6.9, 84.5), 45.1 (-15.0, 105.2), and 42.9 (-41.0, 126.9) excess deaths per 1000 persons. Less clear synergistic responses were observed for other comorbidities. We found some evidence of antagonism for osteoporosis, with a negative interaction contrast of -18.0 (95 % CI -82.2, 46.2) deaths per 1000 persons. CONCLUSION Given the high mortality risk in people with disability, the study of its synergistic effects with target comorbidities can provide relevant information regarding preventive measures.
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Affiliation(s)
- Roberto Pastor-Barriuso
- National Center for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Iñaki Galán
- National Center for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Javier Damián
- National Center for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Madrid, Spain
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Lahbib H, Carcaillon-Bentata L, Beltzer N, Delpierre C, Coste J. Trends and social inequalities in self-reported health and activity limitations in France between 2017 and 2021: results from four nationwide representative surveys. BMC Public Health 2024; 24:1916. [PMID: 39020354 PMCID: PMC11253369 DOI: 10.1186/s12889-024-19437-2] [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: 09/25/2023] [Accepted: 07/10/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Like other countries in Europe and around the world, France was hit by the COVID-19 pandemic in 2020, although it had also experienced several social crises since 2017. This study assessed the evolution of self-reported health and activity limitations and explored the dynamics of their socio-territorial inequalities among the French population aged 18-75 years between 2017 and 2021. METHODS Self-reported health (SRH) and global activity limitation indicator (GALI) were assessed in the same way in the four last editions of the French Health Barometer surveys conducted in the general population in 2017, 2019, 2020, and 2021, with between 9,200 and 24,500 subjects interviewed depending on the year. The prevalence of good or very good SRH and GALI (any limitation) and their evolution between 2017 and 2021 were studied according to sex, age, main socioeconomic positions (SEP), and regions. Poisson regression models were used to estimate adjusted prevalence ratios and potential modification effects of sociodemographic and geographic characteristics. RESULTS Between 2017 and 2021, SRH and GALI deteriorated in adults in France in a continuous way. Very good or good SRH decreased from 75.2% (CI95% [74.5-75.9]) of subjects in 2017 to 68.5% (CI95% [67.7-69.3]) in 2021. In parallel, GALI increased from 21.5% (CI95% [21.0-22.2) in 2017 to 25.2% (CI95% [24.5-26.0]) in 2021.The deterioration of indicators affected both sexes, all age classes (except 65-75 years), especially younger age classes (18-24 and 25-34 years), all geographical regions, and all SEP variables, with groups with a higher SEP deteriorating more than others. Negative variations exceeding 20% (8-10 percentage points on the absolute scale of indicators) were observed in several population groups from 2019 onwards. CONCLUSION The previously observed deterioration of the SRH and GALI continued in France between 2017 and 2021, with narrowing socio-territorial gradients of inequalities. The impact of successive social and health crises on the poor evolution of self-reported health and activity limitations warrants further investigation over time and across locations using complementary and possibly more detailed indicators.
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Affiliation(s)
- Hana Lahbib
- Santé Publique France (French National Public Health Agency), Direction Des Maladies Non Transmissibles, 12 Rue du Val d'Osne, Saint-Maurice, 94410, France
| | - Laure Carcaillon-Bentata
- Santé Publique France (French National Public Health Agency), Direction Des Maladies Non Transmissibles, 12 Rue du Val d'Osne, Saint-Maurice, 94410, France
| | - Nathalie Beltzer
- Santé Publique France (French National Public Health Agency), Direction Des Maladies Non Transmissibles, 12 Rue du Val d'Osne, Saint-Maurice, 94410, France
| | | | - Joël Coste
- Santé Publique France (French National Public Health Agency), Direction Des Maladies Non Transmissibles, 12 Rue du Val d'Osne, Saint-Maurice, 94410, France.
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Bramajo O, Zueras P, Rentería E, Permanyer I. Decomposition of life expectancy differentials with (and without) conditions by educational attainment for major groups of causes in contemporary Spain: where is the advantage? GENUS 2024; 80:11. [PMID: 39027674 PMCID: PMC11252180 DOI: 10.1186/s41118-024-00220-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/03/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Healthy life expectancy is higher among individuals with higher socioeconomic standing. However, it is unclear whether such advantage is attributable to longer (i.e., mortality advantage) or to healthier (morbidity advantage) lifespans across different health conditions. Objective Estimate the contribution of mortality and morbidity components in differences in condition-free life expectancies (CFLE) and life expectancy with conditions (LEWC) for five major groups of conditions by sex and educational attainment, instead of using a global indicator of morbidity. Methods Using the Sullivan Method, we computed remaining life expectancies at age 40 and 65, CFLE, and LEWC and applied a stepwise decomposition technique, using national health surveys along with mortality data, in a cross-sectional analysis. Results An educational gradient was present in almost all conditions, with different intensities. For females, morbidity was the main contributor to educational differences in health expectancies, but mainly in the older age groups. For males, the drivers behind higher health expectancies for high-educated males were evenly distributed across mortality and morbidity between ages 40 and 65, but after that, the mortality gradient vanished between high-educated and middle-educated individuals. Discussion The changing contribution of the mortality and morbidity gradient for different conditions across age-groups brings evidence to adequately plan health policies to mitigate health gaps and improve quality of life of the populations in a lower social standing.
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Affiliation(s)
- Octavio Bramajo
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Centre d’Estudis Demogràfics, Bellaterra, Spain
- University of Texas Medical Branch, Galveston, USA
| | - Pilar Zueras
- Centre d’Estudis Demogràfics, Bellaterra, Spain
- Institute for Social and Economic Research, University of Essex, Essex, UK
| | | | - Iñaki Permanyer
- Centre d’Estudis Demogràfics, Bellaterra, Spain
- ICREA-Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
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Casillas-Clot J, Pereyra-Zamora P, Nolasco A. Health conditions contribution to disability burden in Spain and the role of ethnicity and migrant status: A nation-wide study. PLoS One 2024; 19:e0306526. [PMID: 38995973 PMCID: PMC11244828 DOI: 10.1371/journal.pone.0306526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Disability is frequently associated with contextual or lifestyle factors. Some health conditions may affect the prevalence of disability differently, especially for some minority groups. This study aims to assess the impact and contribution of different health conditions to disability burden in Spain in Roma and immigrant populations, compared to the general population. METHODS This is a cross-sectional study. We have used data from the Spanish National Survey of 2017 and the National Health Survey of the Roma Population 2014. We have calculated frequencies of demographic variables and prevalence of health conditions grouped by body function. We also have fitted binomial additive hazard models, using the attribution method, to assess disabling impact and contribution of health conditions to disability burden. The software R was used for the computations. RESULTS Roma and immigrant populations had worse socioeconomic status than the general population, although the gap was more heavily marked among Roma. Roma population showed a higher prevalence in all health conditions, with a disability prevalence of 57.90%, contrary to the immigrant population, that showed a lower prevalence in all health conditions, including disability (30.79%), than the general population (40.00%). However, all health conditions were more disabling in the immigrant population. Neurological and cardiovascular diseases, and accidents among Roma, were the most disabling conditions. Nevertheless, musculoskeletal, chronic pain, and sensory diseases among Roma, had a greater contribution to disability burden, mainly due to a combination of a great prevalence and a great impact in functions of those health conditions. CONCLUSION Both ethnicity and migrant status have shown differences in the burden of disability. While in the general population, musculoskeletal problems have the greatest contribution to the disability burden, in immigrants it was chronic pain and in the Roma population it was sensory problems. Disparities by sex were also found, with the contribution of musculoskeletal diseases being more important in females.
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Affiliation(s)
- Javier Casillas-Clot
- Department of Community Nursing, Preventive Medicine, Public Health, and History of Science, Research Unit for the Analysis of Mortality and Health Statistics, University of Alicante, San Vicente del Raspeig, Spain
| | - Pamela Pereyra-Zamora
- Department of Community Nursing, Preventive Medicine, Public Health, and History of Science, Research Unit for the Analysis of Mortality and Health Statistics, University of Alicante, San Vicente del Raspeig, Spain
| | - Andreu Nolasco
- Department of Community Nursing, Preventive Medicine, Public Health, and History of Science, Research Unit for the Analysis of Mortality and Health Statistics, University of Alicante, San Vicente del Raspeig, Spain
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Szenkurök V, Weber D, Bilger M. Informal and formal long-term care utilization and unmet needs in Europe: examining socioeconomic disparities and the role of social policies for older adults. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024:10.1007/s10754-024-09378-z. [PMID: 38772952 DOI: 10.1007/s10754-024-09378-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 05/12/2024] [Indexed: 05/23/2024]
Abstract
The rising number of older adults with limitations in their daily activities has major implications for the demands placed on long-term care (LTC) systems across Europe. Recognizing that demand can be both constrained and encouraged by individual and country-specific factors, this study explains the uptake of home-based long-term care in 18 European countries with LTC policies and pension generosity along with individual factors such as socioeconomic status. Using data from the Survey of Health, Ageing and Retirement in Europe conducted in 2019, we apply a two-part multilevel model to assess if disparities in use of LTC are driven by disparities in needs or disparities in use of care when in need. While individual characteristics largely affect the use of care through its association with disparities in need, country-level characteristics are important for the use of care when in need. In particular, the better health of wealthier and more educated individuals makes them less likely to use any type of home-based personal care. At the country level, results show that the absence of a means-tested benefit scheme and the availability of cash-for-care benefits (as opposed to in-kind) are strongly associated with the use of formal care, whether it is mixed (with informal care) or exclusive. LTC policies are, however, shown to be insufficient to significantly reduce unmet needs for personal care. Conversely, generous pensions are significantly associated with lower unmet needs, underscoring the importance of considering the likely adverse effects of future pension reforms.
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Affiliation(s)
- Viktoria Szenkurök
- Health Economics and Policy, Vienna University of Economics and Business, Vienna, Austria.
| | - Daniela Weber
- Health Economics and Policy, Vienna University of Economics and Business, Vienna, Austria
- Population and Just Societies Program, International Institute for Applied Systems Analysis (IIASA), Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, Univ. Vienna), Laxenburg, Austria
| | - Marcel Bilger
- Health Economics and Policy, Vienna University of Economics and Business, Vienna, Austria
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Moreno X, Moreno F. Attitudes towards seeking psychological help among community dwelling older adults enrolled in primary care in Chile. BMC Geriatr 2024; 24:386. [PMID: 38693485 PMCID: PMC11064339 DOI: 10.1186/s12877-024-04986-3] [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: 01/06/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Depression and anxiety are common mental disorders among older adults, but they are frequently underdiagnosed. Attitudes towards seeking professional mental health care is one of the barriers to access to treatment. This study was aimed at assessing the attitudes towards seeking psychological help among older adults who are enrolled in primary care in Chile, and to determine the associated factors. METHODS This cross-sectional study recruited 233 primary care users aged 65 or more years. The Attitudes Towards Seeking Professional Psychological Help was used. Reliability and factor analysis of this scale were carried out. The average scores of the scale and factors were calculated and compared, by selected variables. Multivariate linear regression was estimated to determine factors associated with attitudes towards seeking psychological help. RESULTS Three factors were identified in the attitudes towards seeking psychological help: confidence in psychologists, coping alone with emotional problems, and predisposition to seek psychological help. On average, participants had a favorable attitude towards seeking psychological help, compared with previous research. Lower level of education, and risk of social isolation were inversely associated with these attitudes. CONCLUSION Strategies to improve mental health literacy and social connection among older adults, could have an impact on factors that mediate the access to mental health care, such as attitudes towards seeking psychological help, among people who have a lower level of education or are at risk of social isolation.
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Affiliation(s)
- Ximena Moreno
- Facultad de Psicología y Humanidades, Universidad San Sebastián, Lota 2465 Providencia, Santiago, Chile.
| | - Francisco Moreno
- Department of Mathematics and Computer Science, University of Santiago, Las Sophoras 175, Oficina 420, Estación Central, Santiago, Chile
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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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Luy M, Di Giulio P, Minagawa Y. The impact of interpersonal reporting heterogeneity on cross-country differences in Healthy Life Years in Europe. Eur J Public Health 2023; 33:1060-1064. [PMID: 37608716 PMCID: PMC10710331 DOI: 10.1093/eurpub/ckad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND The European Union has used Healthy Life Years (HLY) as an indicator to monitor the health of its aging populations. Scholarly and popular interest in HLY across countries has grown, particularly regarding the ranking of countries. It is important to note that HLY is based on self-assessments of activity limitations, raising the possibility that it might be influenced by differences in health reporting behaviours between populations, a phenomenon known as differential item functioning (DIF). METHODS We estimated DIF-adjusted HLY at age 50 for Belgium, France, Germany, Greece, Italy, the Netherlands, Spain, and Sweden to determine the extent to which differences in HLY might be influenced by reporting heterogeneity across countries. We used anchoring vignettes, taken from the 2004 Survey of Health, Ageing and Retirement in Europe, to estimate DIF-adjusted prevalence rates of activity limitations measured by the Global Activity Limitations Indicator (GALI). The Sullivan method was used to calculate DIF-adjusted HLY. RESULTS Changes in HLY before and after adjustment ranged from a 1.20-year decrease for men in Italy to a 1.61-year increase for women in Spain. Adjustment for DIF produced changes in the rankings of the countries by HLY, with upward and downward movements of up to three positions. CONCLUSION Our results show that DIF is likely to affect HLY estimates, thereby posing a challenge to the validity of comparisons of HLY across European countries. The findings suggest that HLY should be used to monitor population health status within a country, rather than to make comparisons across countries.
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Affiliation(s)
- Marc Luy
- Vienna Institute of Demography (OeAW), Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna, Austria
| | - Paola Di Giulio
- Vienna Institute of Demography (OeAW), Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna, Austria
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Nissanholtz-Gannot R, Peretz-Dayan H. Equal Opportunities in Aging: Income Level Moderates the Relationship Between Infrequent Participation in Formal Social Activities and Loneliness Among Older Adults. J Appl Gerontol 2023; 42:1982-1992. [PMID: 37231706 PMCID: PMC10467004 DOI: 10.1177/07334648231175429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 04/03/2023] [Accepted: 04/09/2023] [Indexed: 05/27/2023] Open
Abstract
Infrequent participation in formal social activities among older adults increases the risk of loneliness. We examined whether a higher income level moderates the relationship between infrequent participation and loneliness. Utilizing data from wave #6 of the European Health, Aging, and Retirement Survey, we included participants aged 65+ (i.e., older adults), non-participants in the labor force (N = 24 819). Loneliness was measured by the R-UCLA loneliness questionnaire, formal social activity by participation frequency in volunteer/charity activities, educational course/training, sports/social/other clubs, and political/community organizations. Hierarchical multiple regression models examined relationships between variables, controlled by country. Infrequent participation in formal social activity associated with higher risk of loneliness. However, income moderated the association between participation and loneliness; infrequently participating older adults with low-to-moderate income were more vulnerable to loneliness than higher income older adults, for whom infrequent participation did not increase loneliness. This reinforces the need to encourage formal social activity with subsidy for low-to-moderate income older adults.
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Affiliation(s)
| | - Hagar Peretz-Dayan
- Department of Health System Management, Ariel University, Kiryat Hamada 3 Ariel, Israel 40700
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Beller J, Epping J, Sperlich S, Tetzlaff J. 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? SAGE Open Med 2023; 11:20503121231184012. [PMID: 37435099 PMCID: PMC10331346 DOI: 10.1177/20503121231184012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/07/2023] [Indexed: 07/13/2023] Open
Abstract
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.
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Hancharoenkul B, Joseph L, Khamwong P, Pirunsan U. An investigation of the prevalence of work-related musculoskeletal pain and related disability among poultry slaughterhouse workers: a cross-sectional study. Int Arch Occup Environ Health 2023; 96:463-472. [PMID: 36484843 DOI: 10.1007/s00420-022-01940-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The poultry slaughterhouse workers (PSW) are at substantial risk of developing work-related musculoskeletal pain (WMSP) at workplace due to their work. This study investigated the prevalence rate of WMSP and related disability among the PSW. METHODS A cross-sectional descriptive study was conducted among 78 PSW (40 women and 38 men) in the region of northern Thailand. The prevalence rate of WMSP was evaluated using the Standardized Nordic Musculoskeletal Questionnaire (SNMQ). The disability related to the MSP was evaluated using a series of disability questionnaires. Descriptive statistics were used to evaluate the WMSP. Data on the disability were summarized in frequency, mean (M), standard deviation (SD) and percentage. RESULTS The prevalence rate of WMSP in the past 7 days were higher in the shoulder region (61.5%, N = 48) followed by wrists/hands (60.3%, N = 47), and lower back region (35.9%, N = 28). The WMSP over the past 12 months was also high at the shoulder (61.5%, N = 48), wrists/hands (60.3%, N = 47), and neck region (37.1%, N = 29), respectively. The overall disability related to WMSP among PSW was found to be mild to moderate across different body regions. CONCLUSIONS PSW had a high prevalence rate of WMSP in the shoulders, wrists/hands, lower back, and neck regions. However, the PSW with WMSP reported only mild to moderate disability in the work.
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Affiliation(s)
- Benjamaporn Hancharoenkul
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Leonard Joseph
- School of Sports and Health Sciences, University of Brighton, Robert Dodd Building, 49 Darley Road, Eastbourne, BN20 7UR, East Sussex, UK.
| | - Peanchai Khamwong
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Ubon Pirunsan
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
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Streuli S, Garfein RS, Gaines T, Fielding-Miller R. COVID-19 disproportionately impacts access to basic needs among households with disabled members. Disabil Health J 2023; 16:101443. [PMID: 36764843 PMCID: PMC9851949 DOI: 10.1016/j.dhjo.2023.101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/19/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The COVID-19 pandemic has disproportionately impacted disabled people, especially those who are members of marginalized communities that were already denied access to the resources and opportunities necessary to ensure health equity before the pandemic. OBJECTIVE Compare COVID-19 impact on basic needs access among households with and without disabled adults. METHODS An online survey was distributed to households with children enrolled in one of 30 socially vulnerable elementary or middle schools in San Diego County, California. We measured disability using the single-item Global Activities Limitations Indicator. We measured pandemic impacts on basic needs access using the RADx-UP common data elements toolkit. We then assessed number of impact items reported by household disability using multivariable linear regression, adjusting for household income, household size, education, parent gender, and child's ethnicity. RESULTS Of 304 participants, 41% had at least one disabled household member. Participants reporting a disabled household member were more likely to report challenges accessing basic needs, such as food, housing, healthcare, transportation, medication, and stable income during the pandemic (all p < 0.05). Difficulty accessing basic needs was significantly associated with household income and parent gender in the final regression model. CONCLUSIONS Households with a disabled member were significantly more likely to experience difficulty accessing basic needs during the COVID-19 pandemic. This has important implications for the disproportionate impact of COVID-19 on disabled people, especially those from low-income communities that already face barriers to accessing resources. To improve COVID-19 outcomes for disabled people, we must focus on meeting their basic needs.
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Affiliation(s)
- Samantha Streuli
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego. 9500 Gilman Drive, La Jolla CA 92093, USA.
| | - Richard S Garfein
- Department of Medicine, Division of Global Public Health, University of California San Diego. 9500 Gilman Drive, La Jolla CA 92093, USA.
| | - Tommi Gaines
- Department of Medicine, Division of Global Public Health, University of California San Diego. 9500 Gilman Drive, La Jolla CA 92093, USA.
| | - Rebecca Fielding-Miller
- Herbert Wertheim School of Public Health & Human Longevity Science, University of California San Diego. 9500 Gilman Drive, La Jolla CA 92093, USA.
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14
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Kainiemi E, Saukkonen P, Virtanen L, Vehko T, Kyytsönen M, Aaltonen M, Heponiemi T. Perceived benefits of digital health and social services among older adults: A population-based cross-sectional survey. Digit Health 2023; 9:20552076231173559. [PMID: 37312955 PMCID: PMC10259144 DOI: 10.1177/20552076231173559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/17/2023] [Indexed: 06/15/2023] Open
Abstract
Objective The aim of this study was to describe the benefits of digital health and social services perceived by older adults and to examine factors associated with perceiving these benefits. Several factors related to (a) sociodemographic characteristics, (b) area of residence, (c) physical, cognitive, psychological, and social functioning, and (d) Internet use, were examined. Methods The present sample included 8019 respondents aged between 75 and 99 years. The inverse probability weighting method was used to correct for bias. Linear regression analyses were used to examine the associations. Results The ease of use of the services regardless of the time and location was perceived as the most beneficial. Convenient distance to local health or social services (parameter estimate = 0.15 [0.08-0.23]), good functional ability (PE = 0.08 [0.01-0.14]), good vision (PE = 0.15 [0.04-0.25]), ability to learn (PE = 0.05 [0.01-0.10]) and living with someone (PE = 0.08 [95% CI 0.04-0.13]) were associated with perceiving more benefits. In addition, access to the Internet (PE = 0.12 [0.06-0.19]) and independent use of the Internet (PE = 0.23 [0.17-0.29]) were associated with perceiving more benefits. Conclusions Older adults who are healthier, have a social relationship in their everyday life or have easier access to traditional services seem to perceive more benefits from digital health and social services. Digital services should be developed to correspond with special needs caused by disadvantages in health and the social environment. To facilitate the use of digital health and social services, more efforts should be made to enhance older adults' perceptions of their benefits.
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Affiliation(s)
- Emma Kainiemi
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Petra Saukkonen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Lotta Virtanen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tuulikki Vehko
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Maiju Kyytsönen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Mari Aaltonen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tarja Heponiemi
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
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15
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Scohy A, Charafeddine R, Van Wilder L, Van Oyen H, De Smedt D, Devleesschauwer B. Changes in quality-adjusted life expectancy in Belgium, 2013 and 2018. Arch Public Health 2022; 80:254. [PMID: 36527095 PMCID: PMC9758921 DOI: 10.1186/s13690-022-01011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION No information is available in Belgium on life expectancy adjusted for health-related quality of life (HRQoL). Quality-adjusted life expectancy (QALE) captures the multidimensionality of health by accounting for losses in mortality and HRQoL linked to physical, mental, and social impairments. The objective of this study is to estimate for Belgium QALE, the changes in QALE between 2013 and 2018 and the contribution of mortality, HRQoL and its dimensions to this trend. METHODS The Belgian Health Interview Survey (BHIS), a representative sample of the general population, included the EQ-5D-5L instrument in 2013 and 2018. The tool assesses HRQoL comprising five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) using a 5-level severity scoring to define a large variety of health states. The Sullivan method was used to compute at different ages QALE by gender using mortality data from the Belgian statistical office and average EQ-5D scores from the BHIS. QALE was calculated for 2013 and 2018, and changes in QALE over time were decomposed into mortality and ill-health effect. RESULTS In 2018, QALE at age 15 years (QALE15) was 56.3 years for women and 55.8 years for men, a decrease from 2013 by 0.7 year for women and a stagnation for men. In men, the decrease in mortality counterbalanced the decline in HRQoL. The decline in QALE in women is driven by a decrease in mortality rates that is too small to compensate for the substantial decline in HRQoL before the age of 50 years. In women at older ages, improvements in HRQoL are observed. In women, QALE15 is decreasing due to an increase in pain/discomfort, anxiety/depression and problems in usual activities. In men at age 15, the pain/discomfort and anxiety/depression domains contributed to the stagnation. QALE65 increased somewhat, due to an improvement in self-care and mobility for both genders, and usual activities and anxiety/depression in men only. CONCLUSION The strength of QALE as member of the family of composite indicators, the health expectancies, is the multidimensional structure of the underlying health component, including both ill-health with different health domains as levels of severity. The ability to decompose differences in the health expectancy not only into a mortality and health component but also into the different health dimensions allows to better inform on general population health trends. Next, compared to other health expectancy indicators, QALE is more sensitive to changes at younger ages.
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Affiliation(s)
- Aline Scohy
- grid.508031.fLifestyle and chronic diseases, Department of Epidemiology and Public Health, Sciensano, Rue J Wytsman 14, 1050 Brussels, Belgium
| | - Rana Charafeddine
- grid.508031.fLifestyle and chronic diseases, Department of Epidemiology and Public Health, Sciensano, Rue J Wytsman 14, 1050 Brussels, Belgium
| | - Lisa Van Wilder
- grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Herman Van Oyen
- grid.508031.fLifestyle and chronic diseases, Department of Epidemiology and Public Health, Sciensano, Rue J Wytsman 14, 1050 Brussels, Belgium ,grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Delphine De Smedt
- grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Brecht Devleesschauwer
- grid.508031.fLifestyle and chronic diseases, Department of Epidemiology and Public Health, Sciensano, Rue J Wytsman 14, 1050 Brussels, Belgium ,grid.5342.00000 0001 2069 7798Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
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16
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Caramenti M, Castiglioni I. Determinants of Self-Perceived Health: The Importance of Physical Well-Being but Also of Mental Health and Cognitive Functioning. Behav Sci (Basel) 2022; 12:bs12120498. [PMID: 36546981 PMCID: PMC9774654 DOI: 10.3390/bs12120498] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/01/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
With life expectancy increasing for the general population, public health promotion activities should be a priority to aim at a reduction of the burden and costs of hospitalization, disability, and lifelong treatment. This study aimed to explore the influence of parameters pertaining to different aspects of well-being, including physical and mental health and cognitive functioning, on self-perceived health, a predictor of chronic disease prevalence and mortality. We used data from the Survey of Health, Aging and Retirement in Europe (SHARE) project gathered between 2013 and 2017, obtaining a sample of 96,902 participants (63.23 ± 6.77 years). We found a strong association between the self-perceived health rating and not only physical health aspects but also mental health and cognitive functioning. In particular, BMI, chronic diseases and medications, muscle strength, and mobility issues had a strong effect on self-perceived health, as also did the quality of life, depression, and verbal fluency, while other aspects, such as individual characteristics, limitations in daily activities, and pain, among others only had a small effect. These results show that public health and prevention interventions should prioritize the targeting of all aspects of well-being and not only of physical health, acknowledging self-perceived health rating as a simple tool that could help provide a complete overview of psycho-physical well-being and functional status.
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Affiliation(s)
- Martina Caramenti
- Institute of Bioimaging and Molecular Physiology, National Research Council (IBFM-CNR), Via Gaetano Previati 1/e, 23900 Lecco, Italy
- Correspondence:
| | - Isabella Castiglioni
- Department of Physics “Giuseppe Occhialini”, University of Milan-Bicocca, Piazza della Scienza 3, 20126 Milan, Italy
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17
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Bakhtiari E. Diminished Returns in Europe: Socioeconomic Status and Ethno-Racial Health Disparities Across 30 Countries in the European Social Survey. J Racial Ethn Health Disparities 2022; 9:2412-2426. [PMID: 35094375 DOI: 10.1007/s40615-021-01178-2] [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: 08/13/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 12/29/2022]
Abstract
Ethnic and racial minorities in many countries experience worse relative health outcomes and earlier mortality compared to national averages or outcomes of the majority population. Although socioeconomic status often contributes to a portion of ethno-racial health disparities, there are many unanswered questions about the relationship between socioeconomic status and ethno-racial health disparities across contexts. Recent scholarship in the USA has found support for a "diminished returns" effect in which the socioeconomic health gradient is systematically smaller for marginalized groups, yet it is unclear whether this pattern exists in other national contexts. This study tests the interaction between socioeconomic status and ethno-racial minority status in 30 countries across six waves of the European Social Survey. The results include evidence of the diminished returns pattern, particularly for populations with origins in Sub-Saharan Africa and the Middle East. Multilevel mixed-effects models find variation across countries in the interaction between socioeconomic status and ethno-racial minority status. The findings suggest racism and socioeconomic status interact to affect health and health disparities in multiple contexts and highlight the importance of cross-national comparison to further understand variation across countries.
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Affiliation(s)
- Elyas Bakhtiari
- Department of Sociology, William & Mary, 100 Ukrop Way, Williamsburg, VA, 23185, USA.
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18
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Beller J, Luy M, Giarelli G, Regidor E, Lostao L, Tetzlaff J, Geyer S. Trends in Activity Limitations From an International Perspective: Differential Changes Between Age Groups Across 30 Countries. J Aging Health 2022:8982643221141123. [DOI: 10.1177/08982643221141123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
| | - Marc Luy
- Vienna Institute of Demography, Austrian Academy of Sciences, Austria
| | - Guido Giarelli
- Department of Health Sciences, University “MAGNA GRAECIA” Catanzaro, Italy
| | - Enrique Regidor
- Department of Public Health & Maternal and Child Health, Complutense University of Madrid, Spain
| | - Lourdes Lostao
- Department of Sociology, Public University of Navarre, Germany
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19
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Cohn-Schwartz E, Khalaila R. Accelerometer-Assessed Physical Activity and Cognitive Performance among European Adults Aged 50+: The Mediating Effects of Social Contacts and Depressive Symptoms. Healthcare (Basel) 2022; 10:2279. [PMID: 36421603 PMCID: PMC9690261 DOI: 10.3390/healthcare10112279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 08/18/2024] Open
Abstract
BACKGROUND Cognitive decline is a major public health concern worldwide and it is vital to identify and better understand effective population-based means to improve cognitive performance in old age. The current study set out to examine the links between accelerometer-based physical activity with cognitive performance in later life, as well the indirect pathways through one's social network contacts and depression. METHOD We used data from 855 participants aged 50 and above who took part in a cross-sectional accelerometer study as part of the Survey of Ageing, Retirement and Health (SHARE). Cognitive function was measured as an average score of fluency, immediate and delayed recall tests, social contacts were the average contact frequency with members of the social support network, and depression was the Euro-D summary score of depressive symptoms. A multiple mediation analysis was conducted to test the direct and indirect associations between total physical activity (intensity gradient) and cognitive function, as well as the mediation of this association by social contacts and depressive symptoms. RESULTS Intensity of physical activity was directly related to better cognitive performance (B = 0.170, p = 0.007). The association was partially mediated by social contacts (B = 0.022, 95% CI 0.005, 0.046) and depressive symptoms (B = 0.009, 95% CI 0.009, 0.025), such that total physical activity was linked to cognitive health via more frequent contacts with network members and low depressive symptoms. CONCLUSIONS Practitioners might consider encouraging a physically active lifestyle that involves social interactions to support better cognitive aging and mental health.
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Affiliation(s)
- Ella Cohn-Schwartz
- Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva 8410501, Israel
| | - Rabia Khalaila
- Zefat Academic College, 11 Jerusalem St., P.O.B. 169, Zefat 13206, Israel
- Global Brain Health Institute, University of California, San-Francisco, CA 94107, USA
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20
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Grabowska I, Antczak R, Zwierzchowski J, Panek T. How to measure multidimensional quality of life of persons with disabilities in public policies - a case of Poland. Arch Public Health 2022; 80:230. [DOI: 10.1186/s13690-022-00981-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 10/10/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
The aim of this paper is to construct a tool that can be used to measure multidimensional quality of life of persons with disabilities in comparison with population without disabilities for the purpose of monitoring of the UN Convention on the Rights of Persons with Disabilities (UNCRPD) in Poland.
Methods
The Sen’s capability approach was applied to conceptualize the quality of life in various life domains. We followed guidelines of The Quality of Life Framework developed within the European Statistical System on choosing the life domains in which the QoL should be measured. The QoL scores in each domain (covered by the UNCRPD) were constructed using multiply indicators and multiple causes model (MIMIC). All analysis were based on 2018 EU-SILC data for Poland. We constructed quality of life indicators for population with and without disabilities and compared the differences.
Results
Persons without disability experienced higher QoL as compared to population with disabilities, overall and in various domains. Lower average QoL of persons with disabilities is a result of a lower share of those who experience high QoL. The biggest difference is observed for health and for productive and main activity domains. For material conditions and economic security and physical safety there was a moderate difference recorded. For the leisure and social relations domain there is almost no difference observed. Additionally, we identified diversified associations between such factors as age, gender, household situation, education, partner status, urbanization, health on the QoL across domains and analysed populations.
Conclusions
A tool developed in this paper can be calibrated to enable cross-country and in time comparisons between different populations and support evidenced-based social policy.
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21
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Berete F, Demarest S, Charafeddine R, De Ridder K, Vanoverloop J, Van Oyen H, Bruyère O, Van der Heyden J. Predictors of nursing home admission in the older population in Belgium: a longitudinal follow-up of health interview survey participants. BMC Geriatr 2022; 22:807. [PMID: 36266620 PMCID: PMC9585772 DOI: 10.1186/s12877-022-03496-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 09/27/2022] [Indexed: 11/14/2022] Open
Abstract
Background This study examines predictors of nursing home admission (NHA) in Belgium in order to contribute to a better planning of the future demand for nursing home (NH) services and health care resources. Methods Data derived from the Belgian 2013 health interview survey were linked at individual level with health insurance data (2012 tot 2018). Only community dwelling participants, aged ≥65 years at the time of the survey were included in this study (n = 1930). Participants were followed until NHA, death or end of study period, i.e., December 31, 2018. The risk of NHA was calculated using a competing risk analysis. Results Over the follow-up period (median 5.29 years), 226 individuals were admitted to a NH and 268 died without admission to a NH. The overall cumulative risk of NHA was 1.4, 5.7 and 13.1% at respectively 1 year, 3 years and end of follow-up period. After multivariable adjustment, higher age, low educational attainment, living alone and use of home care services were significantly associated with a higher risk of NHA. A number of need factors (e.g., history of falls, suffering from urinary incontinence, depression or Alzheimer’s disease) were also significantly associated with a higher risk of NHA. On the contrary, being female, having multimorbidity and increased contacts with health care providers were significantly associated with a decreased risk of NHA. Perceived health and limitations were both significant determinants of NHA, but perceived health was an effect modifier on limitations and vice versa. Conclusions Our findings pinpoint important predictors of NHA in older adults, and offer possibilities of prevention to avoid or delay NHA for this population. Practical implications include prevention of falls, management of urinary incontinence at home and appropriate and timely management of limitations, depression and Alzheimer’s disease. Focus should also be on people living alone to provide more timely contacts with health care providers. Further investigation of predictors of NHA should include contextual factors such as the availability of nursing-home beds, hospital beds, physicians and waiting lists for NHA. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03496-4.
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Affiliation(s)
- Finaba Berete
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium. .,Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
| | - Stefaan Demarest
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Rana Charafeddine
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | - Karin De Ridder
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
| | | | - Herman Van Oyen
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Health aspects of musculoskeletal health and ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Johan Van der Heyden
- Department of Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, 1050, Brussels, Belgium
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22
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Telles Correia D. Values in mental and medical disorder concepts: Their presence is not the point, being aware of them is. J Eval Clin Pract 2022; 28:801-806. [PMID: 35445481 DOI: 10.1111/jep.13679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Both in medicine and in psychiatry, it's essential to find a general definition for medical and mental disorders. For this we have to analyze the concepts behind these definitions. In this article, we intend to review the proximity between the concepts of mental and medical disorders regarding the presence of values, and to propose a way to deal with the different kinds of values that might be present. METHODS The method used in this paper was a conceptual review/analysis. RESULTS Regarding the concept of medical disorder, it has resorted to different sub-concepts such as dysfunction and harm (distress disability). The concept of dysfunction, apparently being less value-laden, has been prioritized in relation to the harm component although several authors have already proved that implicitly and explicitly this concept is value laden. In medical-surgical disorder it is very unlikely to find any diagnostic information that includes moral values. In this type of disorder, the values in question are universally non-moral: pain, disability, distress (or risk for these) and risk of death. On the other hand, in several mental disorders, moral values have often been included in their diagnostic criteria. CONCLUSION It is concluded that values are present in the main concepts that have been used to define medical or mental disorder. What is essential is to understand what is descriptive and what is value and to try to avoid moral values in this context.
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Affiliation(s)
- Diogo Telles Correia
- Clínica Universitária de Psiquiatria e Psicologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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23
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Godeau D, Fadel M, Descatha A. Factors associated with limitations in daily life and at work in a population with shoulder pain. BMC Musculoskelet Disord 2022; 23:777. [PMID: 35971096 PMCID: PMC9377064 DOI: 10.1186/s12891-022-05638-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Shoulder pain, which is a widespread condition, can lead to participation restrictions in daily and professional life. However, there are few studies focusing on the differences between daily life limitations and work limitations. This study aims at identifying the factors associated with limitations in personal and professional life in a population of working age suffering from shoulder pain. Methods A sample of working age job seekers and workers with shoulder pain was drawn from the last general population cross-sectional French study on disability. Limitations were categorized depending on whether they related to daily life and/or work. The variables assessed were age, sex, state of health, activity restrictions, need for accommodation, and aggravating living conditions or aggravating working conditions. Separate Quasi-Poisson regressions were performed for each type of limitation. Results The sample consisted of 795 individuals of which 33.7% had no limitation, 21.7% were limited in daily life, 6.0% at work, and 38.6% in both. Factors significantly associated with daily life limitations and work limitations and their computed Prevalence Ratios (PR) were the need for accommodation (PR = 2.16), activity restrictions (PR = 2.28), perceived poor health (PR = 2.42) and low income (PR = 1.64). Aggravating living conditions and aggravating working conditions were associated with daily life limitations (PR of 1.69 and 0.63 respectively). Conclusions The present study identifies factors associated with disability in a population with shoulder pain. Further research should be carried out in order to study health-related periods of cessation of work.
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Affiliation(s)
- Diane Godeau
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France. .,AP-HP ("Assistance Publique-Hôpitaux de Paris"), Unité des pathologies professionnelles et environnementales, Hôpitaux universitaires Paris Seine-Saint-Denis, Hôpital Avicenne, F-93009, Bobigny cedex, France. .,Université Sorbonne Paris Nord, F-93206, Saint-Denis, France. .,Godeau, Hôpital Avicenne, Unité fonctionnelle des pathologies professionnelles et environnementales, 125 rue de Stalingrad, 93009, Bobigny cedex, France.
| | - Marc Fadel
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000, Angers, France
| | - Alexis Descatha
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, Équipe d'Épidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France.,Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-49000, Angers, France.,CHU Angers, Poisoning Control Center- Clinical Data Center, F-49000, Angers, France
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24
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Brønnum-Hansen H, Davidsen M. Social differentials in the impact of risk factor exposures on life expectancy and health expectancy. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01724-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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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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26
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Fuchs J, Gaertner B, Prütz F. Limitations in activities of daily living and support needs - Analysis of GEDA 2019/2020-EHIS. JOURNAL OF HEALTH MONITORING 2022; 7:6-25. [PMID: 35434501 PMCID: PMC9009067 DOI: 10.25646/9570] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/04/2022] [Indexed: 11/16/2022]
Abstract
Being able to perform activities of daily living is an important component of a person's ability to function. If these activities are impaired, support is needed. Using data from GEDA 2019/2020-EHIS, we present how many people aged 55 and older living in private households in Germany experience limitations in activities of daily living. Severe limitations in basic (fundamental) activities (e.g. food intake) are reported by 5.8% of women and 3.7% of men. The proportion increases with age as 13.4% of women and 9.0% of men aged 80 and older experience limitations. Severe limitations of instrumental activities of daily living (e.g. grocery shopping) are rather rare in participants less than 80 years of age. But at age 80 and older the proportion rises to 35.9% of women and 21.0% of men. A total of 68.1% of afflicted women and 57.5% of men receive help and support related to limitations of basic activities. Women are also more likely to report a lack of support (48.8% vs. 43.2%). The situation is slightly better with regard to instrumental activities. The results of GEDA 2019/2020-EHIS show in which areas of daily life older and very old people are impaired, give an impression of who is affected particularly strongly and indicate where support services are insufficient. As such, these results provide clues as to where support can be provided to enable older people to keep living in their own homes for a long time.
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Affiliation(s)
- Judith Fuchs
- Corresponding author Dr Judith Fuchs, Robert Koch Institute, Department of Epidemiology and Health Monitoring, General-Pape-Str. 62–66, 12101 Berlin, Germany, E-mail:
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27
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Ortiz C, López-Cuadrado T, Rodríguez-Blázquez C, Pastor-Barriuso R, Galán I. Clustering of unhealthy lifestyle behaviors, self-rated health and disability. Prev Med 2022; 155:106911. [PMID: 34922996 DOI: 10.1016/j.ypmed.2021.106911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/20/2021] [Accepted: 12/12/2021] [Indexed: 11/18/2022]
Abstract
The main objective was to identify sociodemographic characteristics of the population at risk for a greater clustering of unhealthy behaviors and to evaluate the association of such clustering with self-rated health status and disability. Data come from the 2017 Spanish National Health Survey with a sample of 21,947 participants of 15 years of age or older. Based on tobacco consumption, risk drinking, unbalanced diet, sedentarism, and body mass index <18.5/≥25 we created two indicators of risk factor clustering: 1) Number of unhealthy behaviors (0-5); and 2) Unhealthy lifestyle index (score: 0-15). Self-rated health was dichotomized into "optimal" and "suboptimal," and disability was classified as "no disability," "mild," and "severe" based on the Global Activity Limitation Index (GALI). We estimated prevalence ratios (PR) adjusted for covariates using generalized linear models using the clustering count variable, and dose-response curves using the unhealthy lifestyle index. Most participants (77.4%) reported 2 or more risk factors, with men, middle-age individuals, and those with low socioeconomic status being more likely to do so. Compared to those with 0-1 risk factors, the PR for suboptimal health was 1.26 (95% CI:1.18-1.34) for those reporting 2-3 factors, reaching 1.43 (95% CI:1.31-1.55) for 4-5 factors. The PR for severe activity limitation was 1.66 (95% CI:1.35-2.03) for those reporting 2-3 factors and 2.06 (95% CI:1.59-2.67) for 4-5 factors. The prevalence of both health indicators increased in a non-linear fashion as the unhealthy lifestyle index score increased, increasing rapidly up to 5 points, slowing down between 5 and 10 points, and plateauing afterwards.
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Affiliation(s)
- Cristina Ortiz
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - Teresa López-Cuadrado
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, Autonomous University of Madrid/IdiPAZ, Madrid, Spain
| | | | - Roberto Pastor-Barriuso
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Iñaki Galán
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health, Autonomous University of Madrid/IdiPAZ, Madrid, Spain.
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Carcaillon-Bentata L, Soullier N, Beltzer N, Coste J. Alteration in perceived health status of those aged 55 to 65 between 2010 and 2017 in France: role of socioeconomic determinants. BMC Public Health 2021; 21:1804. [PMID: 34620145 PMCID: PMC8499534 DOI: 10.1186/s12889-021-11774-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While life expectancy increases, it is necessary to evaluate whether the additional years are lived in good health, particularly in order to adapt the health care provision and social measures available to support these individuals. Since the 1990s, improvements in perceived health and capacities have been observed among older people, however the changes appear to be far less favourable among the working-age population and, in particular, the generation of people approaching retirement age. The aim of this study was to examine the change in the perceived health status of those aged 55 to 65 in France and investigate the role of socioeconomic factors in this change. METHODS Self-reported health (SRH), chronic condition and activity limitation were assessed in 2010 and in 2017 in the French Health Barometer, a general population phone survey conducted on over 25,000 persons living in the community. The prevalence of all three indicators in 2017, and their evolution between 2010 and 2017 were studied according to the main socioeconomic determinants. RESULTS Between 2010 and 2017, there was a sharp increase in the proportion of individuals aged 55-65 reporting poor SRH, chronic condition or activity limitation. A much more marked deterioration was observed in the three indicators among those aged 55-65 than in older age groups, as well as different changes according to socioeconomic determinants. The category of workers with an average level of education was particularly affected by the deterioration. CONCLUSIONS This study confirms that the generation approaching retirement age presents a more significant deterioration in health status than those of previous generations. The question of how these trends will be reflected in terms of the burden of dependency at later ages remains open and should encourage increased monitoring of and prevention among this population in future years.
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Affiliation(s)
| | - Noémie Soullier
- Santé publique France, French national public health agency, F-94415, Saint-Maurice, France
| | - Nathalie Beltzer
- Santé publique France, French national public health agency, F-94415, Saint-Maurice, France
| | - Joël Coste
- Santé publique France, French national public health agency, F-94415, Saint-Maurice, France
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Altwicker-Hámori S. Disability insurance benefit application in Switzerland: an analysis of linked administrative and survey data. BMC Health Serv Res 2021; 21:982. [PMID: 34537032 PMCID: PMC8449436 DOI: 10.1186/s12913-021-06992-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/07/2021] [Indexed: 11/19/2022] Open
Abstract
Background The guiding principle of disability insurance in Switzerland is ‘rehabilitation before pension’. Access to rehabilitation measures to restore, maintain or improve the earning capacity of individuals with disabilities is essential. Gainful employment enables them to be an active part of society, improves their quality of life, and may mitigate the adverse health effects of disability pension receipt. The aim of this study was therefore to identify factors for disability insurance benefit application in Switzerland. Methods A novel dataset was created linking the 2010 Social Protection and Labour Market cross-section with administrative register data on disability insurance benefit application (2009–2018). Multiple logistic regression was employed to examine the associations between long-term health-related activity limitation, region of residence, demographic and socioeconomic characteristics and disability insurance benefit application in adults aged 18–55 (N = 18,448). Sensitivity analysis based on age was performed in individuals aged 18 to retirement age and aged 25 to 55. Results The regression results showed higher odds of disability insurance benefit application for individuals suffering from long-term health-related activity limitations (OR 2.88; 95% CI 1.29–6.44; p-value 0.010); born outside of Switzerland (OR 1.75; 95% CI 1.32–2.32; p-value 0.000); living without a working partner (OR 1.54; 95% CI 1.17–2.02; p-value 0.002); living without a child aged 0–14 years (OR 1.70; 95% CI 1.29–2.26; p-value 0.000); aged 18–39 (OR 1.41; 95% CI 1.09–1.83; p-value 0.009); with a learnt occupation in ‘Manufacturing’ (OR 2.75; 95% CI 1.68–4.50; p-value 0.000), ‘Construction and mining’ (OR 2.03; 95% CI 1.13–3.66; p-value 0.018), ‘Trade and transport’ (OR 2.12; 95% CI 1.30–3.45; p-value 0.003), ‘Business and administration’ (OR 1.68; 95% CI 1.03–2.72; p-value 0.036), and ‘Health, teaching, culture and science’ (OR 1.55; 95% CI 1.05–2.29; p-value 0.026); and renters (OR 1.44; 95% CI 1.00–1.94; p-value 0.016). The results were robust to alternative samples defined by age – albeit with some differences in regional and learnt occupational patterns. Conclusions The results suggested that disability insurance benefit application is more than a health-related phenomenon in Switzerland. However, the results provided a less consistent picture on the role of marginalization in application than in other European countries.
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Affiliation(s)
- Szilvia Altwicker-Hámori
- Institute of Health Sciences, School of Health Professions, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401, Winterthur, Switzerland.
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30
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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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Tarazona B, González-Enríquez J, Almazán-Isla J, Alcalde-Cabero E, de Pedro-Cuesta J, Galán I. Validity of the Global Activity Limitation Indicator (GALI) to evaluate severity of disability. Eur J Public Health 2021; 31:539-540. [PMID: 33313738 DOI: 10.1093/eurpub/ckaa214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Our aim was to estimate the validity of the Global Activity Limitation Indicator (GALI) when measuring the severity level of disability. Data came from 153 residents of Spain, who requested an evaluation of their degree of disability. We compared disability classifications (severe vs. non-severe) from GALI against those from the 36-item questionnaire WHODAS 2.0, the current gold standard measure of disability. The sensitivity of GALI to detect severe disability was 58.3% [95% confidence interval (CI):43.2-72.4], and the specificity was 84.8% (95% CI: 76.4-91.0). Thus, the validity of GALI to accurately categorize the degree of severity of an individual's disability is not high, this in great part due to its limited sensitivity.
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Affiliation(s)
- Belisa Tarazona
- Department of Preventive Medicine and Public Health, University Hospital Infanta Elena, Madrid, Spain.,National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | | | - Javier Almazán-Isla
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Institute of Health Carlos III, Madrid, Spain
| | - Enrique Alcalde-Cabero
- Health Technology Assessment Agency, Institute of Health Carlos III, Madrid, Spain.,Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Institute of Health Carlos III, Madrid, Spain
| | - Jesús de Pedro-Cuesta
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Institute of Health Carlos III, Madrid, Spain
| | - Iñaki Galán
- National Centre for Epidemiology, Institute of Health Carlos III, Madrid, Spain.,Autonomous University of Madrid/IdiPAZ, Madrid, Spain
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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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Pasanen TP, Tamminen N, Martelin T, Solin P. Positive Mental Health of Finnish People Living Alone: The Role of Circumstantial Factors and Leisure-Time Activities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136735. [PMID: 34201445 PMCID: PMC8268311 DOI: 10.3390/ijerph18136735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/20/2022]
Abstract
Living alone has become more common across Europe. Past research has consistently identified living alone as a risk factor for poor mental health while evidence on the positive dimension(s) of mental health has been scarce. Positive mental health has been associated with rather stable circumstantial factors, such as socio-economic characteristics and social relationships, and day-to-day activities in the form of leisure participation, in general populations. In this study, our objective was to assess these relationships among people living alone. We specified a structural equation model in a random sample of Finnish people living alone (n = 884), with the circumstantial factors as (exogenous) explanatory variables, participation in various leisure activities as mediators, and positive mental health as the outcome. In the model, more frequent engagement in several leisure-time activities, including being in contact with family/friends and physical activity in nature, were positively associated with positive mental health. The circumstantial factors that most strongly explained both leisure participation and positive mental health were the number of friends, being in a relationship, and having no limiting illnesses. In conclusion, among Finnish people living alone, social and functional factors appear to be more strongly associated with leisure participation and positive mental health than socio-economic factors.
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Affiliation(s)
- Tytti P. Pasanen
- Finnish Institute for Health and Welfare, Equality, Mental Health, FI-00271 Helsinki, Finland; (N.T.); (P.S.)
- Correspondence:
| | - Nina Tamminen
- Finnish Institute for Health and Welfare, Equality, Mental Health, FI-00271 Helsinki, Finland; (N.T.); (P.S.)
| | - Tuija Martelin
- Non-Discrimination and Gender Equality, Finnish Institute for Health and Welfare, Equality, FI-00271 Helsinki, Finland;
| | - Pia Solin
- Finnish Institute for Health and Welfare, Equality, Mental Health, FI-00271 Helsinki, Finland; (N.T.); (P.S.)
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Economic Evaluation of Emotional and Personal Support in the Health Care of Women with Disabilities. Healthcare (Basel) 2021; 9:healthcare9040438. [PMID: 33917941 PMCID: PMC8068370 DOI: 10.3390/healthcare9040438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/31/2021] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
It is generally accepted that people with disabilities make greater use of health services. Moreover, certain social circumstances alter the intensity of such use. This manuscript seeks to analyze the existing differences in the use of healthcare among women with and without disabilities, to study the impact of emotional and personal support (EPS) on such use and to assess the reduction of the economic cost that this factor entails. Data from the Spanish National Health Survey (SNHS-2017) and updated unit costs of health services have been used to estimate the differences in use attributable to disability and the economic impact of emotional and personal support. The empirical results show an association between disability and perceived EPS, the latter being less common among Spanish women with disabilities. In addition, within this group, EPS significantly influences the levels of use of health services. Finally, the net effect of a perceived EPS increase would translate into a reduction in the economic costs of health care for women with disabilities.
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Casillas-Clot J, Pereyra-Zamora P, Nolasco A. Determinants of Disability in Minority Populations in Spain: A Nationwide Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3537. [PMID: 33805538 PMCID: PMC8037545 DOI: 10.3390/ijerph18073537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/20/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022]
Abstract
Some population groups could be especially vulnerable to the effects of population ageing. The Global Activity Limitation Indicator (GALI) has been proposed as a measure of disability, but it has not been used in minority groups. The aim of this study is to estimate the prevalence of disability using the GALI and to analyse its determinants in immigrant and Roma populations. Data from the Spanish National Health Survey 2017 and the National Health Survey of the Roma Population 2014 were used, including adults aged 50 and above. Prevalence of disability was estimated, and odds ratios were calculated using logistic regression models to assess the association between disability and demographic, socioeconomic, and health variables. The prevalence of disability was estimated at 39.4%, 30.6%, and 58.7% in the native, immigrant, and Roma populations, respectively. Gender was a common determinant for the native and Roma populations. On the other hand, among immigrants, the risk of disability increased over the time residing in Spain. There were significant interactions with age and gender in the native population. Disability has different determinants in the three population groups. Public health measures to protect the Roma population and immigrants' health should be considered.
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Affiliation(s)
| | - Pamela Pereyra-Zamora
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, 03080 Alicante, Spain; (J.C.-C.); (A.N.)
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Rubio Valverde JR, Mackenbach JP, Nusselder WJ. Trends in inequalities in disability in Europe between 2002 and 2017. J Epidemiol Community Health 2021; 75:712-720. [PMID: 33674458 PMCID: PMC8292565 DOI: 10.1136/jech-2020-216141] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/18/2021] [Accepted: 02/26/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Monitoring socioeconomic inequalities in population health is important in order to reduce them. We aim to determine if educational inequalities in Global Activity Limitation Indicator (GALI) disability have changed between 2002 and 2017 in Europe (26 countries). METHODS We used logistic regression to quantify the annual change in disability prevalence by education, as well as the annual change in prevalence difference and ratio, both for the pooled sample and each country, as reported in the European Union Statistics on Income and Living Conditions (EU-SILC) and the European Social Survey (ESS) for individuals aged 30-79 years. RESULTS In EU-SILC, disability prevalence tended to decrease among the high educated. As a result, both the prevalence difference and the prevalence ratio between the low and high educated increased over time. There were no discernible trends in the ESS. However, there was substantial heterogeneity between countries in the magnitude and direction of these changes, but without clear geographical patterns and without consistency between surveys. CONCLUSIONS Socioeconomic inequalities in disability appear to have increased over time in Europe between 2002 and 2017 as per EU-SILC, and have persisted as measured by the ESS. Efforts to further harmonise disability instruments in international surveys are important, and so are studies to better understand international differences in disability trends and inequalities.
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Affiliation(s)
- Jose R Rubio Valverde
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wilma J Nusselder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Estimating disability prevalence and disability-related inequalities: Does the choice of measure matter? Soc Sci Med 2021; 272:113740. [PMID: 33571943 DOI: 10.1016/j.socscimed.2021.113740] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/26/2021] [Accepted: 01/30/2021] [Indexed: 11/24/2022]
Abstract
RATIONALE Different measures for quantifying the percentage of people with a disability in surveys result in diverging estimates of prevalence and disability-related inequalities. Thus understanding the implications of using different disability measures is of vital policy importance. This study is the first to investigate the within-survey variation in disability prevalence based on two internationally recognized measures: the Washington Group Short Set (WGSS) and the Global Activity Limitation Indicator (GALI). It is also the first to examine the disability-related inequality in voter turnout, based on official validated voter records. METHODS We use data on 11,308 25-54-year-old respondents from the 2016 wave of the Survey of Health, Impairment and Living Conditions in Denmark (SHILD) to estimate the disability prevalence based on the WGSS and the GALI. Moreover, we investigate health characteristics of individuals with a disability according to the two measures and inequalities in two central social policy success parameters: voter turnout and employment. RESULTS The WGSS estimates higher disability prevalence (10.6%) than the GALI (5.5%). Only 2.5% of the sample are in both groups, implying that largely, different individuals are defined as having a disability depending on which measure is used. The health profiles of the two groups also differ, as people with a GALI-defined disability are significantly more likely to report a severe mental illness or a major physical health problem. The GALI estimates indicate larger inequalities between people with and without a disability than the WGSS for the probability of being employed, whereas there are no significant differences for voter turnout. CONCLUSION The choice of disability measure strongly influences within-survey estimates of disability prevalence, the health profile of the defined groups, and inequalities in outcomes. The WGSS underrepresents the number of people suffering from severe mental illness. Estimated inequalities in employment are larger for the GALI than for the WGSS.
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Valverde JR, Mackenbach J, Bopp M, Brønnum-Hansen H, Deboosere P, Kalediene R, Kovács K, Leinsalu M, Martikainen P, Regidor E, Strand BH, Nusselder W. Determinants of educational inequalities in disability-free life expectancy between ages 35 and 80 in Europe. SSM Popul Health 2021; 13:100740. [PMID: 33598526 PMCID: PMC7868628 DOI: 10.1016/j.ssmph.2021.100740] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/31/2020] [Accepted: 01/16/2021] [Indexed: 01/01/2023] Open
Abstract
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. Disability-free life expectancy is lower among low than the high educated in Europe. Over-all, the risk factor contributing most to the inequality was low income. Other important contributors are high body-weight, smoking and father's manual occupation. Size of inequality and contribution of risk factors vary importantly between countries.
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Affiliation(s)
| | - Johan Mackenbach
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Matthias Bopp
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, 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
| | | | - Katalin Kovács
- Hungarian Demographic Research Institute, Budapest, Hungary
| | - Mall Leinsalu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | | | - Enrique Regidor
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid y CIBER Epidemiologia y Salud Publica, Madrid, Spain
| | | | - Wilma Nusselder
- Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
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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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Stephan AJ, Schwettmann L, Meisinger C, Ladwig KH, Linkohr B, Thorand B, Schulz H, Peters A, Grill E. Living longer but less healthy: The female disadvantage in health expectancy. Results from the KORA-Age study. Exp Gerontol 2020; 145:111196. [PMID: 33310150 DOI: 10.1016/j.exger.2020.111196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/26/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES We explored the male-female health-survival paradox in the context of health expectancy (HE) at age 65 and thereafter, using three different morbidity measures and different severity cut-offs with and without adjustments for the share of nursing home residents. METHODS HE at ages 65, 70, 75, 80, and 85 was estimated with the Sullivan method, linking morbidity prevalence from the KORA (Cooperative Health Research in the Region of Augsburg)-Age study to 2016 Bavarian mortality data. Morbidity measures comprised deficit accumulation (Frailty Index, FI, cut-offs 0.08 and 0.25), disability (Health Assessment Questionnaire-Disability Index, HAQ-DI, cut-off >0) and participation (Global Activity Limitation Indicator, GALI, "limited" vs "not limited"). RESULTS Morbidity data were available for 4083 participants (52.7% female). HE was lower in women than in men at all ages. Differences in morbidity prevalence, absolute HE, and health proportions of life expectancy (relative HE) increased with age for FI ≥ 0.25 and GALI, but not for HAQ-DI > 0 and FI > 0.08. Accounting for the share of nursing home residents resulted in a slight reduction of HE estimates but had no impact on estimated sex differences. CONCLUSIONS In HE at age 65 and thereafter, women's health disadvantage was larger than their life expectancy advantage over men.
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Affiliation(s)
- Anna-Janina Stephan
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Department of Economics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Christa Meisinger
- Independent Research Group Clinical Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Chair of Epidemiology, Ludwig-Maximilians-Universität München at UNIKA-T Augsburg, Augsburg, Germany
| | - Karl-Heinz Ladwig
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Department for Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Birgit Linkohr
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Holger Schulz
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany; Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany
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Weber D, Loichinger E. Live longer, retire later? Developments of healthy life expectancies and working life expectancies between age 50–59 and age 60–69 in Europe. Eur J Ageing 2020; 19:75-93. [PMID: 35241999 PMCID: PMC8881563 DOI: 10.1007/s10433-020-00592-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/30/2022] Open
Abstract
AbstractEurope’s population is ageing. Statutory retirement ages are commonly raised to account for continuous increases in life expectancy. In order to estimate the potential to increase statutory and consequently effective retirement ages further, in this study, we investigate the relationship between partial working life expectancy (WLE) and three health expectancies that represent health aspects important for work ability and employability between ages 50 and 59 as well as 60 and 69 for women and men in Europe. We also explore the association between these four indicators and the highest level of educational attainment. We apply Sullivan’s method to estimate WLE and three selected measures that capture general, physical, and cognitive health status of older adults for 26 European countries since 2004. Over time, WLEs increased significantly in the younger age group for women and in the older age group for both sexes. The expected number of years in good physical health have continuously been higher than any of the other three indicators, while the expected number of years in good cognitive health have shown a noticeable increase over time. The investigation of the relationship between education and each life expectancy confirms the well-established positive correlation between education and economic activity as well as good health. Our results indicate potential to extend working lives beyond current levels. However, significant differences in the expected number of years in good health between persons with different levels of education require policies that account for this heterogeneity.
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Affiliation(s)
- Daniela Weber
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OEAW, WU), International Institute for Applied Systems Analysis (IIASA), 2361 Laxenburg, Austria
- Health Economics and Policy Division, Vienna University of Economics and Business, Welthandelsplatz 1, 1020 Vienna, Austria
| | - Elke Loichinger
- Federal Institute for Population Research, 65185 Wiesbaden, Germany
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Nusselder WJ, Cambois EM, Wapperom D, Meslé F, Looman CWN, Yokota RTC, Van Oyen H, Jagger C, Robine JM. Women's excess unhealthy life years: disentangling the unhealthy life years gap. Eur J Public Health 2020; 29:914-919. [PMID: 31280299 PMCID: PMC6761840 DOI: 10.1093/eurpub/ckz114] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Compared to men, women live longer but have more years with disability. We assessed the contribution of gender differences in mortality and disability, total and by cause, to women’s excess unhealthy life years (ULYs). Methods We used mortality data for France 2008 from Eurostat, causes of death from the CépiDc-INSERM-database; and disability and chronic conditions data from the French Disability Health Survey 2008–09. ULYs were calculated by the Sullivan method. The contributions of mortality and disability differences to gender differences in ULY were based on decomposition analyses. Results Life expectancy of French women aged 50 was 36.3 years of which 19.0 were ULYs; life expectancy of men was 30.4 years of which 14.2 were ULYs. Of the 4.8 excess ULYs in women, 4.0 years were due to lower mortality. Of these 4.0 ULYs, 1.8 ULY originated from women’s lower mortality from cancer, 0.8 ULY from heart disease and 0.3 ULY from accidents. The remaining 0.8 excess ULY in women were from higher disability prevalence, including higher disability from musculoskeletal diseases (+1.8 ULY) and anxiety-depression (+0.6 ULY) partly offset by lower disability from heart diseases (−0.8 ULY) and accidents (−0.3 ULY). Conclusion Lower mortality and higher disability prevalence contributed to women’s longer life expectancy with disability. Women’s higher disability prevalence due to non-fatal disabling conditions was partly offset by lower disability from heart disease and accidents. Conditions differentially impact gender differences in ULY, depending on whether they are mainly life-threatening or disabling. The conclusions confirm the health-survival paradox.
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Affiliation(s)
- Wilma J Nusselder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Emmanuelle M Cambois
- INED (French Institute for Demographic Studies), Mortality, Health, Epidemiology Research Unit, Paris, France
| | - Dagmar Wapperom
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - France Meslé
- INED (French Institute for Demographic Studies), Mortality, Health, Epidemiology Research Unit, Paris, France
| | - Caspar W N Looman
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Renata T C Yokota
- SD Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
| | - Herman Van Oyen
- SD Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Carrol Jagger
- Instiute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.,Newcastle University Institute for Ageing, Newcastle upon Tyne, UK
| | - Jean Marie Robine
- Inserm (French Institute of Health and Medical Research), CERMES3 Research Unit, Paris, France.,EPHE (École Pratique des Hautes Études), MMDN Research Unit, Univ., Montpellier, France
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Giacomozzi C, Palmieri L, Gargiulo L, Lo Noce C, Iannucci L, Di Lonardo A, Vannucchi S, Onder G, Colivicchi F, Giampaoli S, Donfrancesco C. The Perceived Health Status from Young Adults to Elderly: Results of the MEHM Questionnaire within the CUORE Project Survey 2008-2012. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176160. [PMID: 32854268 PMCID: PMC7503627 DOI: 10.3390/ijerph17176160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/21/2020] [Accepted: 08/21/2020] [Indexed: 11/16/2022]
Abstract
Improving healthy life years requires an effective understanding and management of the process of healthy ageing. Assessing the perceived health status and its determinants is a relevant step in this process. This study explored the potentialities of the Minimum European Health Module (MEHM) to cope with this critical issue. Investigation was conducted on 4798 Italian residents (49.7% women, aged 35-79 years), participating in the CUORE Project Health Examination Survey 2008-2012. The three MEHM questions-perceived health status, chronic morbidity and activity limitations-were examined also in association with living context, seasonality, marital status and level of education. A higher prevalence of health status negative perception was associated with older age (9% and 24% respectively in men and women aged 35-44 years; 46% and 61% respectively in men and women aged 75-79 years). In women, this negative perception was higher than in men in any age group, and reached 50% in the 65-69 age group, 10 years earlier than in men. For both sexes, the level of education had a strong impact on this negative perception (odds ratio 2.32 and 2.72 in men and women respectively), while "living alone" played a greater impact in women than in men. MEHM activity limitations subscale was as much as 30% higher for questionnaires answered during the hottest months. This study identified potential predictors of perceived health status in adults aged 35-79 years, which can be used to target interventions aimed at improving self-perceived health status.
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Affiliation(s)
- Claudia Giacomozzi
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, National Institute of Health, 00161 Rome, Italy; (L.P.); (C.L.N.); (A.D.L.); (S.V.); (G.O.); (S.G.); (C.D.)
- Correspondence: ; Tel.: +39-06-4990-2864
| | - Luigi Palmieri
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, National Institute of Health, 00161 Rome, Italy; (L.P.); (C.L.N.); (A.D.L.); (S.V.); (G.O.); (S.G.); (C.D.)
| | - Lidia Gargiulo
- Department for Statistical Production—Directorate for Social Statistics and Welfare, Italian National Statistical Institute, 00100 Rome, Italy; (L.G.); (L.I.)
| | - Cinzia Lo Noce
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, National Institute of Health, 00161 Rome, Italy; (L.P.); (C.L.N.); (A.D.L.); (S.V.); (G.O.); (S.G.); (C.D.)
| | - Laura Iannucci
- Department for Statistical Production—Directorate for Social Statistics and Welfare, Italian National Statistical Institute, 00100 Rome, Italy; (L.G.); (L.I.)
| | - Anna Di Lonardo
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, National Institute of Health, 00161 Rome, Italy; (L.P.); (C.L.N.); (A.D.L.); (S.V.); (G.O.); (S.G.); (C.D.)
| | - Serena Vannucchi
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, National Institute of Health, 00161 Rome, Italy; (L.P.); (C.L.N.); (A.D.L.); (S.V.); (G.O.); (S.G.); (C.D.)
| | - Graziano Onder
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, National Institute of Health, 00161 Rome, Italy; (L.P.); (C.L.N.); (A.D.L.); (S.V.); (G.O.); (S.G.); (C.D.)
| | - Furio Colivicchi
- National Association Hospital Cardiologists—Health Care Foundation, 50121 Florence, Italy;
- U.O.C. Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—ASL Roma 1, 00135 Rome, Italy
| | - Simona Giampaoli
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, National Institute of Health, 00161 Rome, Italy; (L.P.); (C.L.N.); (A.D.L.); (S.V.); (G.O.); (S.G.); (C.D.)
| | - Chiara Donfrancesco
- Department of Cardiovascular and Endocrine-Metabolic Diseases and Aging, National Institute of Health, 00161 Rome, Italy; (L.P.); (C.L.N.); (A.D.L.); (S.V.); (G.O.); (S.G.); (C.D.)
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Abstract
Objective: To examine whether we live healthier as we live longer in Hong Kong, which has one of the highest life expectancies in the world. Methods: Sullivan's method was used to evaluate the chronic disease-free life expectancy (CDFLE), life expectancy in good self-perceived health (GPHLE), and impairment-free life expectancy (IFLE) among population aged 50 years and older in Hong Kong in 2007-2016. Results: In spite of the marked improvement in life expectancy in Hong Kong, the increase in GPHLE was much smaller, while CDFLE and IFLE even declined for both genders. The situation was more severe among older population. Discussion: People in Hong Kong live longer but with worsening health. The expansion of chronic diseases, self-perceived poor health, and impairments among older adults calls for more fiscal investments, government attention, and public health policies.
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Affiliation(s)
- Yan Zheng
- Department of Social Work and Social Administration, Faculty of Social Sciences, 25809The University of Hong Kong, Hong Kong
| | - Karen Siu Lan Cheung
- Mindlink Research Centre, Hong Kong.,Sau Po Centre on Ageing, 25809The University of Hong Kong, Hong Kong
| | - Paul S F Yip
- Department of Social Work and Social Administration, Faculty of Social Sciences, 25809The University of Hong Kong, Hong Kong.,Hong Kong Jockey Club Centre for Suicide Research and Prevention, 25809The University of Hong Kong, Hong Kong
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Weber D, Scherbov S. Prospects of activity limitations among older adults in 23 low and middle income countries. Sci Rep 2020; 10:10442. [PMID: 32591610 PMCID: PMC7319965 DOI: 10.1038/s41598-020-67166-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 05/31/2020] [Indexed: 11/28/2022] Open
Abstract
Increasing life expectancy and a growing share of older people around the world spotlight the issue of health during additional years of life. Research on trends of proportions of older people with activity limitations for low and middle income countries is sparse. We use data from the World Health Survey and the UN World Population Prospects to predict prevalence of activity limitations for 23 low and middle income countries for the upcoming 30 years. Our projections highlight huge variation in the proportion of older adults with limitations across investigated countries and this variation is not expected to diminish. However, these countries are facing considerable demographic changes and even though prevalence rates appear almost constant, absolute numbers are changing which require policy interventions. Furthermore, variations across countries reflect not only disparities in health conditions, but also differences in cultural peculiarities of reporting and historical perception of health.
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Affiliation(s)
- Daniela Weber
- Wittgenstein Centre (IIASA, VID/ÖAW, WU), International Institute for Applied Systems Analysis (IIASA), Schlossplatz 1, 2361, Laxenburg, Austria. .,Health Economics and Policy Division, Vienna University of Economics and Business, Welthandelsplatz 1, 1020, Vienna, Austria.
| | - Sergei Scherbov
- Wittgenstein Centre (IIASA, VID/ÖAW, WU), International Institute for Applied Systems Analysis (IIASA), Schlossplatz 1, 2361, Laxenburg, Austria.,International Laboratory on Demography and Human Capital, Russian Presidential Academy of National Economy and Public Administration, Prospekt Vernadskogo, 84, 119571, Moscow, Russian Federation.,Vienna Institute of Demography, Austrian Academy of Science, Welthandelsplatz 2, 1020, Vienna, Austria
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Beller J, Epping J. Disability trends in Europe by age-period-cohort analysis: Increasing disability in younger cohorts. Disabil Health J 2020; 14:100948. [PMID: 32690322 DOI: 10.1016/j.dhjo.2020.100948] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/12/2020] [Accepted: 05/31/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Several studies have examined trends in disability, but only few have explicitly considered possible age, time period and birth cohort differences simultaneously. OBJECTIVE We examined disability trends in Europe according to age, time period, and birth cohort. METHODS We used population-based data of Europeans (European Social Survey, N = 228159), aged 15-90 years, covering 15 countries (Belgium, Finland, France, Germany, Great Britain, Hungary, Ireland, Netherlands, Norway, Poland, Portugal, Slovenia, Spain, Sweden, Switzerland) and spanning a time period from 2002 to 2016. RESULTS We found that there were only small overall changes in disability over time periods. However, there were strong U-shaped birth cohort effects, such that younger cohorts born after 1960 experienced higher levels of disability. This U-shaped cohort trend appeared strongest for non-severe disability and was most pronounced in Germany. CONCLUSIONS Therefore, disability in Europe seemed to generally increase in more recent cohorts, who might thus be at risk to experience more morbidity in the future than previous generations. Future studies should investigate the mechanisms that contribute to these trends, the generalizability of the observed birth cohort effects, and the cross-national differences in time period trends.
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Affiliation(s)
- Johannes Beller
- Hanover Medical School, Medical Sociology, Hannover, Germany.
| | - Jelena Epping
- Hanover Medical School, Medical Sociology, Hannover, Germany
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Self-Perceived Health, Objective Health, and Quality of Life among People Aged 50 and Over: Interrelationship among Health Indicators in Italy, Spain, and Greece. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072414. [PMID: 32252321 PMCID: PMC7178192 DOI: 10.3390/ijerph17072414] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/23/2020] [Accepted: 03/30/2020] [Indexed: 11/17/2022]
Abstract
It is well known that self-perceived health (SPH), even if it is a subjective health indicator, is significantly associated with objective health and quality of life (QoL) in the general population. Whether it can be considered an indicator of cognitive functioning and quality of life in the elderly is still an open issue. This study used a data-driven approach to investigate the interrelationship among SPH, non-communicable diseases (NCDs), QoL, and cognitive functioning to answer this question. The study sample included information about 12,831 people living in Italy, Spain, and Greece, extracted from the Survey on Health, Aging, and Retirement in Europe, in the year 2015. The additive Bayesian networks methodology was used to identify the best directed acyclic graphs (DAG) for SPH, QoL, and NCDs. Results were given as posterior estimates of generalized linear models (GLM) coefficients, with 95% credibility intervals. Good SPH was associated with a decreasing number of chronic diseases in Italy (coeff = −0.52, 95%CI: [−0.59, −0.44]), Spain (coeff = −0.53, 95%CI: [−0.60, −0.46]) and Greece (coeff = −0.57, 95%CI: [−0.64, −0.50]). Age and Body Mass Index were determinants of NCDs in all countries. QoL of elderly was associated with SPH in Italy (coeff = 0.12, 95%CI: [0.10, 0.14]), Spain (coeff = 0.16, 95%CI: [0.15, 0.18]), and Greece (coeff = 0.18, 95%CI: [0.16, 0.20]). The number of NCDs was higher for people who were not employed in Spain (coeff = 0.45, 95%CI: [0.37, 0.53]) and was decreasing for a unitary increase in years of education in Greece (coeff = −0.12, 95%CI: [−0.14, −0.09]). As a general rule, the framework of the interrelationship among NCDs, SPH, and QoL was similar for Italy, Spain, and Greece. The connections found among indicators could be proposed to identify strategies for health promotion and healthy aging among people aged 50 and above, which are viable in general and at a country level. Reinforcing strategies targeted at some health indicators could have relevant effects on other related indicators.
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Formal social participation protects physical health through enhanced mental health: A longitudinal mediation analysis using three consecutive waves of the Survey of Health, Ageing and Retirement in Europe (SHARE). Soc Sci Med 2020; 251:112906. [DOI: 10.1016/j.socscimed.2020.112906] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 02/13/2020] [Accepted: 02/29/2020] [Indexed: 11/21/2022]
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Operationalization of Concepts of Health and Disability. INTERNATIONAL HANDBOOK OF HEALTH EXPECTANCIES 2020. [DOI: 10.1007/978-3-030-37668-0_1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Otavova M, Van Oyen H, Yokota RTC, Charafeddine R, Joossens L, Molenberghs G, Nusselder WJ, Boshuizen HC, Devleesschauwer B. Potential impact of reduced tobacco use on life and health expectancies in Belgium. Int J Public Health 2019; 65:129-138. [PMID: 31781804 PMCID: PMC7049546 DOI: 10.1007/s00038-019-01315-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/30/2019] [Accepted: 11/19/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We investigated the potential impact of reduced tobacco use scenarios on total life expectancy and health expectancies, i.e., healthy life years and unhealthy life years. METHODS Data from the Belgian Health Interview Survey 2013 were used to estimate smoking and disability prevalence. Disability was based on the Global Activity Limitation Indicator. We used DYNAMO-HIA to quantify the impacts of risk factor changes and to compare the "business-as-usual" with alternative scenarios. RESULTS The "business-as-usual" scenario estimated that in 2028 the 15-year-old men/women would live additional 50/52 years without disability and 14/17 years with disability. The "smoking-free population" scenario added 3.4/2.8 healthy life years and reduced unhealthy life years by 0.79/1.9. Scenarios combining the prevention of smoking initiation with smoking cessation programs are the most effective, yielding the largest increase in healthy life years (1.9/1.7) and the largest decrease in unhealthy life years (- 0.80/- 1.47). CONCLUSIONS Health impact assessment tools provide different scenarios for evidence-informed public health actions. New anti-smoking strategies or stricter enforcement of existing policies potentially gain more healthy life years and reduce unhealthy life years in Belgium.
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Affiliation(s)
- Martina Otavova
- Unit of Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark.,Interdisciplinary Center on Population Dynamics, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark
| | - Herman Van Oyen
- Department of Epidemiology and public health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, Ghent University, Ghent, Belgium
| | - Renata T C Yokota
- Department of Epidemiology and public health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium
| | - Rana Charafeddine
- Department of Epidemiology and public health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium
| | - Luk Joossens
- Association of European Cancer Leagues, Brussels, Belgium
| | | | - Wilma J Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hendriek C Boshuizen
- Department of Statistics, Informatics and Mathematical Modeling, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Brecht Devleesschauwer
- Department of Epidemiology and public health, Sciensano, Rue J Wytsman 14, 1050, Brussels, Belgium. .,Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
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