FDA approval, clinical trial evidence, efficacy, epidemiology, and price for non-orphan and ultra-rare, rare, and common orphan cancer drug indications: cross sectional analysis

OBJECTIVE

To analyze the US Food and Drug Administration (FDA) approval, trials, unmet needs, benefit, and pricing of ultra-rare (<6600 affected US citizens), rare (6600-200 000 citizens), and common (>200 000 citizens) orphan cancer drug indications and non-orphan cancer drug indications.

DESIGN

Cross sectional analysis.

SETTING

Data from Drugs@FDA, FDA labels, Global Burden of Disease study, and Medicare and Medicaid.

POPULATION

170 FDA approved drugs across 455 cancer indications between 2000 and 2022.

MAIN OUTCOME MEASURES

Comparison of non-orphan and ultra-rare, rare, and common orphan indications regarding regulatory approval, trials, epidemiology, and price. Hazard ratios for overall survival and progression-free survival were meta-analyzed.

RESULTS

161 non-orphan and 294 orphan cancer drug indications were identified, of which 25 were approved for ultra-rare diseases, 205 for rare diseases, and 64 for common diseases. Drugs for ultra-rare orphan indications were more frequently first in class (76% v 48% v 38% v 42%; P<0.001), monotherapies (88% v 69% v 72% v 55%; P=0.001), for hematologic cancers (76% v 66% v 0% v 0%; P<0.001), and supported by smaller trials (median 85 v 199 v 286 v 521 patients; P<0.001), of single arm (84% v 44% v 28% v 21%; P<0.001) phase 1/2 design (88% v 45% v 45% v 27%; P<0.001) compared with rare and common orphan indications and non-orphan indications. Drugs for common orphan indications were more often biomarker directed (69% v 26% v 12%; P<0.001), first line (77% v 39% v 20%; P<0.001), small molecules (80% v 62% v 48%; P<0.001) benefiting from quicker time to first FDA approval (median 5.7 v 7.1 v 8.9 years; P=0.02) than those for rare and ultra-rare orphan indications. Drugs for ultra-rare, rare, and common orphan indications offered a significantly greater progression-free survival benefit (hazard ratio 0.53 v 0.51 v 0.49 v 0.64; P<0.001), but not overall survival benefit (0.50 v 0.73 v 0.71 v 0.74; P=0.06), than non-orphans. In single arm trials, tumor response rates were greater for drugs for ultra-rare orphan indications than for rare or common orphan indications and non-orphan indications (objective response rate 57% v 48% v 55% v 33%; P<0.001). Disease incidence/prevalence, five year survival, and the number of available treatments were lower, whereas disability adjusted life years per patient were higher, for ultra-rare orphan indications compared with rare or common indications and non-orphan indications. For 147 on-patent drugs with available data in 2023, monthly prices were higher for ultra-rare orphan indications than for rare or common orphan indications and non-orphan indications ($70 128 (£55 971; €63 370) v $33 313 v $16 484 v $14 508; P<0.001). For 48 on-patent drugs with available longitudinal data from 2005 to 2023, prices increased by 94% for drugs for orphan indications and 50% for drugs for non-orphan indications on average.

CONCLUSIONS

The Orphan Drug Act of 1983 incentivizes development of drugs not only for rare diseases but also for ultra-rare diseases and subsets of common diseases. These orphan indications fill significant unmet needs, yet their approval is based on small, non-robust trials that could overestimate efficacy outcomes. A distinct ultra-orphan designation with greater financial incentives could encourage and expedite drug development for ultra-rare diseases.

The Healthcare Cost Burden of Asthma in Children: A Longitudinal Population-Based Study

OBJECTIVES

This study aimed to investigate the extent of healthcare cost increase at population level due to childhood asthma. We aimed to investigate the cross-sectional relationship between asthma and healthcare costs among children aged 2 to 18 years and, in longitudinal analyses, whether costs increase with an increase in the duration of asthma prevalence.

METHODS

Study participants are 4175 and 4482 children of birth and kindergarten cohorts from the nationally representative Longitudinal Study of Australian Children for whom the linked Medicare cost data are available. The children were followed in all waves from the year 2004 to 2018. Generalized linear models were used to estimate the excess healthcare costs associated with asthma. The sum of Medicare Benefits Schedule and Pharmaceutical Benefits Scheme costs constitutes the total healthcare costs.

RESULTS

Total excess healthcare costs associated with asthma among the 2- to 18-year-old children were A$4316 per child. At the population level, the estimated total excess Medicare costs associated with current asthma treatment among 2- to 18-year-old children were, on average, A$190.6 million per year (2018 population and price). Compared with the non-asthmatic children, peers with persistent asthma morbidity and treatment requirements had excess costs up to A$20 727 for the B cohort children until 14 years of age, whereas excess costs for the K cohort children were A$19 571 until 18 years of age.

CONCLUSIONS

Asthma in children imposes a significant financial burden on the public health system. Higher excess healthcare costs of all asthmatic children than the costs of nonasthmatic children provide further economic justification for promoting preventive efforts at early ages.

Causal Effect of Tooth Loss on Cardiovascular Diseases

Many studies suggest associations between oral health and cardiovascular diseases, but there is a lack of causal evidence. Exploiting exogenous variation in tooth loss in US adults due to differential childhood exposure to fluoridated water, this study investigated the causal effect of tooth loss on cardiovascular diseases. A total of 722,519 participants in the Behavioral Risk Factor Surveillance System (BRFSS) waves 2006, 2008, or 2010 (birth years 1940-1978) were included in the analytical sample. To identify the effect of tooth loss on having a history of coronary heart disease (CHD) or stroke, instrumental variable analysis exploited childhood exposure to drinking water fluoride as an instrument. The weighted prevalence of CHD and stroke histories was 5.1% and 2.1%, respectively. First-stage regression indicated that childhood exposure to drinking water fluoride was a strong instrument for the number of lost teeth in adulthood (coefficient -0.61; 95% confidence interval [CI] -0.80, -0.41; F = 37.47). The probability of CHD was significantly higher by 1.04 percentage points (95% CI 0.57, 1.50) per lost tooth. The effect of tooth loss on stroke was significant only for people aged ≥60 y (coefficient 0.93 percentage points; 95% CI 0.14, 1.71). These findings are supportive of a causal effect of tooth loss on cardiovascular diseases among US adults, particularly in older age.

Does compulsory schooling affect health? Evidence from ambulatory claims data

Using claims data on more than 23 million statutorily insured, we investigate the causal effect of schooling on health in the largest and most comprehensive analysis for Germany to date. In a regression discontinuity approach, we exploit changes in compulsory schooling in West Germany to estimate the reduced form effect of the reforms on health, measured by doctor diagnoses in ICD-10 format covering physical as well as mental health conditions. To mitigate the problem that empirical results depend on subjective decisions made by the researcher, we perform specification curve analyses to assess the robustness of findings across various model specifications. We find that the reforms have, at best, very small impacts on the examined doctor diagnoses. In most of the specifications we estimate insignificant effects that are close to zero and often of the "wrong" sign. Therefore, our study questions the presence of the large positive effects of education on health that are found in the previous literature.

Causal Inference: Onward and Upward!

When announcing the Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel 2021, the Royal Swedish Academy emphasized how conclusions about cause and effect can be drawn from natural experiments. But what can dental research learn from this? The economist’s toolbox provides a number of methods for causal inference from observational data such as instrumental variables, regression discontinuity designs, or difference-in-differences analyses. Although the relevance of improving causal inference in dental research has repeatedly been highlighted in recent years, dental research still seems to reveal major room for improvement in the application of such methods. First, there seems to be an absence of causal literature on key essential research questions for oral health. Second, the diversity and diffusion of causal inferential methods in the dental literature seem very limited so far. Third, while dental research has widely been promoting the use of directed acyclic graphs (DAGs) to help conceptualize causal thinking, comparably little attention seems to have been paid to choosing and applying appropriate data-analytic approaches for causal inference. Fourth, similar to other fields of medicine, confusion seems to persist within the dental research community as to the use of causal language. If dental research is to secure a robust evidence base for promoting effective oral health interventions, we argue that dental research needs to move beyond its current methodological echo chamber and embrace a radically different approach to causal inference. We call for editors, reviewers, and authors to embrace a much more critically reflective approach to causal inference.

The effects of audits and fines on upcoding in neonatology

Upcoding is a common type of fraud in healthcare. However, how audit policies need to be designed to cope with upcoding is not well understood. We provide causal evidence on the effect of random audits with different probabilities and financial consequences. Using a controlled laboratory experiment, we mimic the decision situation of obstetrics staff members to report birth weights of neonatal infants. Subjects' payments in the experiment depend on their reported birth weights and follow the German non-linear diagnosis-related group remuneration for neonatal care. Our results show that audits with low detection probabilities only reduce fraudulent birth-weight reporting, when they are coupled with fines for fraudulent reporting. For audit policies with fines, increasing the probability of an audit only effectively enhances honest reporting, when switching from detectable to less gainful undetectable upcoding is not feasible. Implications for audit policies are discussed.

Causal effect of tooth loss on depression: evidence from a population-wide natural experiment in the USA

AIMS

Depression severely affects people's health and well-being. Oral diseases have been suggested to be associated with depression, but so far, there is no causal evidence. This study aimed to identify the causal effect of tooth loss on depression among US adults in a natural experiment study.

METHODS

Instrumental variable analysis was conducted using data from 169 061 respondents born in 1940-1978 who participated in the 2006, 2008 or 2010 waves of the Behavioral Risk Factor Surveillance System (BRFSS). Random variation in tooth loss due to differential childhood exposure to drinking water fluoride was exploited as an instrument.

RESULTS

US adults who were exposed to drinking water fluoride in childhood had more remaining teeth, therefore providing a robust instrument (F = 73.4). For each additional tooth loss, depressive symptoms according to the eight-item Patient Health Questionnaire depression (PHQ-8) score increased by 0.146 (95% CI 0.008-0.284), and the probability of having clinical depression (PHQ ⩾10) increased by 0.81 percentage points (95% CI -0.12 to 1.73).

CONCLUSIONS

Tooth loss causally increased depression among US adults. Losing ten or more teeth had an impact comparable to adults with major depressive disorder not receiving antidepressant drugs.

Causal Effect of Tooth Loss on Functional Capacity in Older Adults in England: A Natural Experiment

BACKGROUND/OBJECTIVES

Tooth loss is associated with reduced functional capacity, but so far, there is no relevant causal evidence reported. We investigated the causal effect of tooth loss on the instrumental activities of daily living (IADL) among older adults in England.

DESIGN

Natural experiment study with instrumental variable analysis.

SETTING

The English Longitudinal Study of Aging (ELSA) combined with the participants' childhood exposure to water fluoride due to the community water fluoridation.

PARTICIPANTS

Five thousand six hundred and thirty one adults in England born in 1945-1965 participated in the ELSA wave seven survey (conducted in 2014-2015; average age: 61.0 years, 44.6% men).

MEASUREMENTS

The number of natural teeth predicted by the exogenous geographical and historical variation in exposure to water fluoride from age 5 to 20 years old (instrumental variable) was used as an exposure variable. The outcome, having any limitations in IADL (preparing a hot meal, shopping for groceries, making telephone calls, taking medications, doing work around the house or garden, or managing money), was assessed by self-reported questionnaires.

RESULTS

Linear probability model with Two-Stage Least Squares estimation was fitted. Being exposed to fluoridated water was associated with having more natural teeth in later life (coefficient: 0.726; 95% confidence interval (CI) = 0.311, 1.142; F = 11.749). Retaining one more natural tooth reduced the probability of having a limitation in IADL by 3.1 percentage points (coefficient: -0.031; 95% CI = -0.060, -0.002).

CONCLUSION

Preventing tooth loss maintains functional capacity among older adults in England. Given the high prevalence of tooth loss, this effect is considerable. Further research on the mechanism of the observed causal relationship is needed.

Prenatal exposure to the German food crisis 1944-1948 and health after 65 years

Using data on 90% of the German population born 1930-1959, we investigate the long-term relationship between intra-uterine exposure to the German food crisis 1944-1948 and 16 doctor-diagnosed health conditions recorded in 2009 and 2015. Among the exposed, who are 60-70 years old in our data, we find elevated risks of being diagnosed with a wide range of conditions, including diabetes, depression, lung disease, and back pain. In terms of critical periods, malnutrition in the first trimester of pregnancy appears to have the strongest negative correlation with health at older ages.

Cognitive ability and teen smoking

We use data on 11-15-year-old boys in the West Bank to study the empirical link between cognitive ability and health behavior, specifically (teen) smoking. Adjusting for both age in months and grade level allows us to effectively shut down any simultaneous effect of maturation and schooling on cognitive ability and smoking. We find that those at the lower end of the cognitive ability distribution are more than twice as likely to smoke than those at the upper end (approximately 25 versus 10%) also after adjusting for parental background and peer composition in a generalized propensity score approach. Further, we find that the cognitive ability-smoking gradient is fairly flat at the lower end of the cognitive ability distribution and steep at the upper end.

Dishonesty in health care practice: A behavioral experiment on upcoding in neonatology

Dishonest behavior significantly increases the cost of medical care provision. Upcoding of patients is a common form of fraud to attract higher reimbursements. Imposing audit mechanisms including fines to curtail upcoding is widely discussed among health care policy-makers. How audits and fines affect individual health care providers' behavior is empirically not well understood. To provide new evidence on fraudulent behavior in health care, we analyze the effect of a random audit including fines on individuals' honesty by means of a novel controlled behavioral experiment framed in a neonatal care context. Prevalent dishonest behavior declines significantly when audits and fines are introduced. The effect is driven by a reduction in upcoding when being detectable. Yet upcoding increases when not being detectable as fraudulent. We find evidence that individual characteristics (gender, medical background, and integrity) are related to dishonest behavior. Policy implications are discussed.

The Causal Effect of Education on Tooth Loss: Evidence From United Kingdom Schooling Reforms

Associations between education and oral health have frequently been reported, but until now there has been no causal evidence. Exploiting exogenous variation in the duration of schooling due to 1947 and 1972 reforms in mandatory schooling in the United Kingdom, we examined the causal relationship between education and tooth loss in older age. We conducted a cross-sectional study using data from waves 3 (2006-2007), 5 (2010-2011), and 7 (2014-2015) of the English Longitudinal Study of Ageing. We used a 2-stage least squares instrumental variable approach and included 5,667 respondents (average age = 67.8 years; 44.4% were men) in the analyses, of whom 819 (14.5%) had no teeth. The schooling reforms increased the duration of education by an average of 0.624 years (95% confidence interval: 0.412, 0.835). For respondents born within ±6 years of the pivotal cohorts, a 1-year increment of education causally reduced the probability of edentulism by 9.1 (95% confidence interval: 1.5, 16.8) percentage points. The effects were stronger for the 1947 reform than for the 1972 reform. Results were robust to broadening of the cohort bandwidth and functional form of the cohort trend. The findings suggest that investment in education produces improved oral health later in life.

Gain a child, lose a tooth? Using natural experiments to distinguish between fact and fiction

Background

Dental diseases are among the most frequent diseases globally and tooth loss imposes a substantial burden on peoples' quality of life. Non-experimental evidence suggests that individuals with more children have more missing teeth than individuals with fewer children, but until now there is no causal evidence for or against this.

Methods

Using a Two-Stage Least Squares (2SLS) instrumental variables approach and large-scale cross-sectional data from the Survey of Health, Ageing, and Retirement in Europe (study sample: 34 843 non-institutionalised individuals aged 50+ from 14 European countries and Israel; data were collected in 2013), we investigated the causal relationship between the number of biological children and their parents’ number of missing natural teeth. Thereby, we exploited random natural variation in family size resulting from (i) the birth of multiples vs singletons, and (ii) the sex composition of the two first-born children (increased likelihood of a third child if the two first-born children have the same sex).

Results

2SLS regressions detected a strong causal relationship between the number of children and teeth for women but not for men when an additional birth occurred after the first two children had the same sex. Women then had an average of 4.27 (95% CI: 1.08 to 7.46) fewer teeth than women without an additional birth whose first two children had different sexes.

Conclusions

This study provides novel evidence for causal links between the number of children and the number of missing teeth. An additional birth might be detrimental to the mother’s but not the father’s oral health.

Childhood socioeconomic conditions and teeth in older adulthood: Evidence from SHARE wave 5

OBJECTIVES

Dental diseases are the most common chronic diseases worldwide. Healthy teeth are vital for quality of life, particularly diet and nutrition. However, little information exists to inform health policymakers about potentially long-lasting influences of early-life conditions. The purpose of this study was to investigate the relation between early-life socioeconomic conditions and number of natural teeth at age 50 and above.

METHODS

Analyses were conducted on cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE wave 5), which includes information on 41 560 respondents aged 50 years or older from 14 European countries and Israel. Using SHARE life history information, a series of regression models (OLS, Tobit) were estimated to analyse the relationship between socioeconomic conditions in earlier life and the number of teeth at age 50+.

RESULTS

Childhood socioeconomic background was associated with the number of natural teeth at age 50 and above, even after controlling for current determinants of oral health. Respondents who had had more than 25 books in their childhood household had a mean 1.4 (95% CI: 1.2-1.5) more teeth than respondents with fewer books. Respondents who reported poor financial conditions during childhood had a mean 0.6 (95% CI: 0.3-0.9) fewer teeth than respondents who reported better financial conditions in childhood.

CONCLUSION

These findings substantiate the association between socioeconomic conditions in the early years of life and tooth retention to older adulthood and highlight the long-lasting relation between childhood living conditions and oral health through the lifecourse.

Financial incentives, timing of births, and infant health: a closer look into the delivery room

As a result of strong financial incentives created by the German parental leave reform on January 1, 2007, some 1000 births have been shifted from the last days of 2006 to the first days of 2007, especially by working mothers. This fact is already described in the literature, yet there is no evidence as to the mechanisms and only scarce evidence regarding the effects on newborn health. I use new data to study the timing of C-sections and the induction of births around the day the reform took effect. I estimate that postponed C-sections and inductions account for nearly 80 % of the pre-reform shortfall and nearly 90 % of the post-reform excess number of births. Despite concerns voiced by doctors before the reform, hardly any evidence can be found for detrimental health effects of those shifts, as measured by changes in gestational age, birth weight, APGAR scores, neonatal mortality, or hospitalization.

A comparison of tooth retention and replacement across 15 countries in the over-50s

OBJECTIVES

Oral diseases are still among the most common chronic diseases globally with substantial detrimental impact especially on elderly people's health and well-being. However, limited evidence exists on international variation in the oral health status of the older population. We aimed to examine international variation in tooth loss and tooth replacement in the general population aged between 50 and 90 years.

METHODS

A cross-sectional analysis of data from the fifth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) was conducted. The data cover 14 European countries (Austria, Belgium, Czech Republic, Denmark, Estonia, France, Germany, Italy, Luxembourg, the Netherlands, Slovenia, Spain, Sweden, and Switzerland) and Israel, and they were collected during the year 2013. Age-specific percentages of the population having all natural teeth, the age-specific numbers of natural (and artificial) teeth, and the age-specific percentages of full, partial, or no replacement of missing teeth were assessed with stratification by country. It was further evaluated to which extent proposed oral health goals concerning tooth loss at higher ages had been achieved.

RESULTS

In total, 62,763 individuals were included in the study. Age-standardized mean numbers of natural teeth exhibited substantial variation, ranging from 14.3 (Estonia) to 24.5 (Sweden). The oral health goal of retaining at least 20 teeth at age 80 years was achieved by 25% of the population or less in most countries. A target concerning edentulism (≤15% in population aged 65-74 years) was reached in Sweden, Switzerland, Denmark, France, and Germany. Tooth replacement practices varied especially for a number of up to five missing teeth which were more likely to be replaced in Austria, Germany, Luxembourg, and Switzerland than in Israel, Denmark, Estonia, Spain, and Sweden.

CONCLUSIONS

This study suggests that the age-specific number of natural teeth and the practice of tooth replacement in the over 50s differ substantially among the included countries. The present results may be helpful in the formulation and evaluation of oral health goals in the older population.

What explains DRG upcoding in neonatology? The roles of financial incentives and infant health

We use the introduction of diagnosis related groups (DRGs) in German neonatology to study the determinants of upcoding. Since 2003, reimbursement is based inter alia on birth weight, with substantial discontinuities at eight thresholds. These discontinuities create incentives to upcode preterm infants into classes of lower birth weight. Using data from the German birth statistics 1996-2010 and German hospital data from 2006 to 2011, we show that (1) since the introduction of DRGs, hospitals have upcoded at least 12,000 preterm infants and gained additional reimbursement in excess of 100 million Euro; (2) upcoding rates are systematically higher at thresholds with larger reimbursement hikes and in hospitals that subsequently treat preterm infants, i.e. where the gains accrue; (3) upcoding is systematically linked with newborn health conditional on birth weight. Doctors and midwives respond to financial incentives by not upcoding newborns with low survival probabilities, and by upcoding infants with higher expected treatment costs.

Are anchoring vignettes ratings sensitive to vignette age and sex?

Anchoring vignettes are commonly used to study and correct for differential item functioning and response bias in subjective survey questions. Self-assessed health status is a leading example. A crucial assumption of the vignette methodology is 'vignette equivalence': The health status of the person described in the vignette must be perceived by all respondents in the same way. We use data from a survey experiment conducted with a sample of almost 5000 older Americans to validate this assumption. We find weak evidence that respondents' vignette ratings may be sensitive to the sex and, for older respondents, also to the age (implied by the first name) of the person described in the vignette. Our findings suggest that vignette equivalence may not hold, at least if the potentially subtle connotations of vignette persons' names are not fully controlled.

Collateral damage: the German food crisis, educational attainment and labor market outcomes of German post-war cohorts

Using the German 1970 census to study educational and labor market outcomes of cohorts born during the German food crisis after World War II, I document that those born between November 1945 and May 1946 have significantly lower educational attainment and occupational status than cohorts born shortly before or after. Several alternative explanations for this finding are tested. Most likely, a short spell of severe undernutrition around the end of the war has impaired intrauterine conditions in early pregnancies and resulted in long-term detriments among the affected cohorts. This conjecture is corroborated by evidence from Austria.

Medical guidelines, physician density, and quality of care: evidence from German SHARE data

We use German SHARE data to study the relationship between district general practitioner density and the quality of preventive care provided to older adults. We measure physician quality of care as the degree of adherence to medical guidelines (for the management of risk factors for cardiovascular disease and the prevention of falls) as reported by patients. Contrary to theoretical expectations, we find only weak and insignificant effects of physician density on quality of care. Our results shed doubt on the notion that increasing physician supply will increase the quality of care provided in Germany's present health care system.

Parental income and child health in Germany

Using newly available data from Germany, we study the relationship between parental income and child health. We find a strong gradient between parental income and subjective child health as has been documented earlier in the United States, Canada, and the United Kingdom. The relationship in Germany is about as strong as in the United States and stronger than in the United Kingdom. However, in contrast to US results, we do not find consistent evidence that the disadvantages associated with low parental income accumulate as the child ages, nor that children from low socioeconomic background are more likely to suffer from doctor-diagnosed conditions. There is some evidence, however, that high-income children are better able to cope with the adverse consequences of chronic conditions. Investigating potential diagnosis bias, we find only weak evidence for health disadvantages for low-income children when using objective health measures, but some evidence for under-utilization of health services among low-income families.

Changes in compulsory schooling and the causal effect of education on health: evidence from Germany

In this paper we investigate the causal effect of years of schooling on health and health-related behavior in West Germany. We apply an instrumental variables approach using as natural experiments several changes in compulsory schooling laws between 1949 and 1969. These law changes generate exogenous variation in years of schooling both across states and over time. We find evidence for a strong and significant causal effect of years of schooling on long-term illness for men but not for women. Moreover, we provide somewhat weaker evidence of a causal effect of education on the likelihood of having weight problems for both sexes. On the other hand, we find little evidence for a causal effect of education on smoking behavior. Overall, our estimates suggest significant non-monetary returns to education with respect to health outcomes but not necessarily with respect to health-related behavior.

Secondary school fees and the causal effect of schooling on health behavior

Using German census data, we estimate the causal effect of education on smoking and overweight/obesity using the abolition of secondary school fees as instrumental variable. The West German federal states enacted this reform at different dates after World War II, generating exogenous variation in the access to secondary education. While we find a strong association between schooling and health behaviors using OLS, we do not find support for the notion that education causes better health behavior.

[Isometric grip strength and social gerontological research: results and analytic potentials of SHARE and SOEP]

This paper shows that the measurement of hand grip strength provides a non-invasive and reliable objective health indicator for social science research and is easy to collect in general population surveys. Grip strength is not only a useful complement of self-reported indicators of health, but it also exhibits a considerable predictive power with regard to a number of further relevant variables for social gerontological research, such as mortality risks. New data from the 2004 Survey of Health, Ageing and Retirement in Europe (SHARE) and the 2006 wave of the German Socio-Economic Panel Study (SOEP) allow insightful methodological and very first substantive cross-sectional analyses of grip strength in Germany. The focus of the present study is on the analysis of individuals aged 50 or older. The experience of both surveys when measuring grip strength is consistently positive, particularly with regard to the respondents' feedback. Major determinants of isometric grip strength are - beyond the individual's gender - age, body size and weight. A multivariate analysis also provides evidence for a clear positive association between various health indicators and grip strength.

True health vs response styles: exploring cross-country differences in self-reported health

The aim of this paper is to decompose cross-national differences in self-reported general health into parts explained by differences in 'true' health, measured by diagnosed conditions and measurements, and parts explained by cross-cultural differences in response styles. The data used were drawn from the Survey of Health, Ageing and Retirement in Europe 2004 (SHARE), using information from 22 731 individuals aged 50 and over from 10 European countries. Self-rated general health shows large cross-country variations. According to their self-reports, the healthiest respondents live in the Scandinavian countries and the least healthy live in Southern Europe. Counterfactual self-reported health distributions that assume identical response styles in each country show much less variation in self-reports than factual self-reports. Danish and Swedish respondents tend to largely over-rate their health (relative to the average) whereas Germans tend to under-rate their health. If differences in reporting styles are taken into account, cross-country variations in general health are reduced but not eliminated. Failing to account for differences in reporting styles may yield misleading results.

Quality of work, well-being, and intended early retirement of older employees--baseline results from the SHARE Study

BACKGROUND

Given the challenge of a high proportion of older employees who retire early from work we analyse associations of indicators of a poor psychosocial quality of work with intended premature departure from work in a large sample of older male and female employees in 10 European countries.

METHODS

Baseline data from the 'Survey of Health, Ageing and Retirement in Europe' (SHARE) were obtained from 3523 men and 3318 women in 10 European countries. Data on intended early retirement, four measures of well-being (self-rated health, depressive symptoms, general symptom load, and quality of life), and quality of work (effort-reward imbalance; low control at work) were obtained from structured interviews and questionnaires. Country-specific and total samples are analysed, using logistic regression analysis.

RESULTS

Poor quality of work is significantly associated with intended early retirement. After adjustment for well-being odds ratios (OR) of effort-reward imbalance [OR 1.72 (1.43-2.08)] and low control at work [OR 1.51 (1.27-1.80)] on intended early retirement are observed. Poor quality of work and reduced well-being are independently associated with the intention to retire from work.

CONCLUSION

The consistent association of a poor psychosocial quality of work with intended early retirement among older employees across all European countries under study calls for improved investments into better quality of work, in particular increased control and an appropriate balance between efforts spent and rewards received at work.

A new comprehensive and international view on ageing: introducing the 'Survey of Health, Ageing and Retirement in Europe'

This paper introduces the 'Survey of Health, Ageing and Retirement in Europe' (SHARE) to researchers on ageing. SHARE provides an infrastructure to help researchers better understand the individual and population ageing process: where we are, where we are heading to, and how we can influence the quality of life as we age, both as individuals and as societies. The baseline wave in 2004 provides data on the life circumstances of some 27,000 persons aged 50 and over in 11 European countries, ranging from Scandinavia across Western and Central Europe to the Mediterranean. SHARE has made great efforts to deliver truly comparable data, so we can reliably study how differences in cultures, living conditions and policy approaches shape the life of Europeans just before and after retirement. The paper first describes the SHARE data. In order to demonstrate its value, it then presents highlights from the three main research areas covered by SHARE, namely economics, sociology, and health.