1
|
Kocot E, Denkowska S, Fijorek K. Are Measures of Health Status for the Total Population Good Proxies for the Health of the Older Population in International Comparison Studies? IJERPH 2022; 19:7559. [PMID: 35805218 PMCID: PMC9265627 DOI: 10.3390/ijerph19137559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Abstract
In the face of population aging, the health of older people is becoming especially important, impacting various areas of life, societies and countries’ economies. To provide the basis for effective decisions to achieve better health, comparative analyses can be used to find best practices to follow. The aim of the research was to check whether drawing conclusions about the older population’s health based on the health status of the total population is justified in international comparison analyses. An analysis was conducted for six population health indicators for European countries from 2010–2019. Rankings were created for the total population and the older subpopulation, and then ranks for these two populations were compared using statistical methods. The statistical analyses indicate that there is a strong, statistically significant relationship between the ranks for the total and the older population. However, looking at the descriptive analysis and visual presentation of data, differences in international rankings of indicator values for these two populations can be observed. As older people comprise a specific group of the population that is growing ever bigger and increasingly significant, it would be advisable to present the results of international comparisons not only for the total, but separately for the older population as well.
Collapse
|
2
|
Holm ME, Sainio P, Suvisaari J, Sääksjärvi K, Jääskeläinen T, Parikka S, Koskinen S. Differences in Unfavorable Lifestyle Changes during the COVID-19 Pandemic between People with and without Disabilities in Finland: Psychological Distress as a Mediator. Int J Environ Res Public Health 2022; 19:6971. [PMID: 35742223 DOI: 10.3390/ijerph19126971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 02/06/2023]
Abstract
We investigated whether people with disabilities—cognition, vision, hearing, mobility, or at least one of these disabilities—report more COVID-19-related negative lifestyle changes than those without disabilities, and whether psychological distress (MHI-5) mediates the association between disabilities and negative lifestyle changes. Information about COVID-related lifestyle changes among people with disabilities is scarce. We analyzed population-based data from the 2020 FinSote survey carried out between September 2020 and February 2021 in Finland (n = 22,165, aged 20+). Logistic regressions were applied to investigate the effect of the COVID-19 pandemic and related restrictions on negative lifestyle changes—sleeping problems or nightmares, daily exercise, vegetable consumption, and snacking. To test for a mediation effect of psychological distress, the Karlson–Holm–Breen method was used. People with all disability types reported increased sleeping problems or nightmares, and decreased vegetable consumption during the pandemic more frequently than those without. People with mobility and cognitive disabilities more frequently reported decreased daily exercise. People with cognitive disabilities more often reported increased snacking. Psychological distress mediated associations between disabilities and negative lifestyle changes, with the highest association between cognitive disabilities and increased sleeping problems or nightmares (B = 0.60), and the lowest between mobility disabilities and decreased daily exercise (B = 0.08). The results suggest that strategies to promote healthy lifestyles should consider people with disabilities. Alleviating their psychological distress during crisis situations could be one approach.
Collapse
|
3
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
4
|
Holm ME, Sainio P, Parikka S, Koskinen S. The effects of the COVID-19 pandemic on the psychosocial well-being of people with disabilities. Disabil Health J 2021; 15:101224. [PMID: 34690076 PMCID: PMC8542066 DOI: 10.1016/j.dhjo.2021.101224] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Abstract
Background Before the COVID-19 pandemic, people with mobility, vision, hearing, and cognitive disabilities were at a higher risk of lower psychosocial well-being than people without disabilities. It is, therefore, of great importance to investigate whether the pandemic has exacerbated this difference. Objective This study examines whether people with disabilities (categorized as mobility, vision, hearing, cognitive, and any disabilities) report more COVID-19-related negative effects on psychosocial well-being (loneliness, decreased social contact, decreased hope for the future, concerns about being infected) than people without disabilities. Methods We analyzed population-based data from the Finnish Health, Welfare, and Services (FinSote) survey carried out in 2020–2021 (N = 22 165, age 20+). Logistic regression models were applied, controlling for the effects of age, sex, partnership, living alone, and education. Results All disability groups, except those with vision disabilities, reported significantly more often that the pandemic increased loneliness than people without disabilities. There were no significant differences between the disability groups and people without disabilities in decreased social contacts. People with only mobility and cognitive disabilities reported significantly more often that the pandemic decreased their hope for the future than those without disabilities. All disability groups were more often concerned about being infected than people without disabilities, but this effect was not significant among people 75 or older. Conclusion The psychosocial well-being of people with specific types of disabilities should receive special attention during crises like the COVID-19 pandemic.
Collapse
Affiliation(s)
- Marja Eliisa Holm
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
| | - Päivi Sainio
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
| | - Suvi Parikka
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
| | - Seppo Koskinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland.
| |
Collapse
|
5
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
6
|
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: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
7
|
Casillas-Clot J, Pereyra-Zamora P, Nolasco A. Determinants of Disability in Minority Populations in Spain: A Nationwide Study. Int J Environ Res Public Health 2021; 18:3537. [PMID: 33805538 DOI: 10.3390/ijerph18073537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [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.
Collapse
|
8
|
Rueda-Salazar S, Spijker J, Devolder D, Albala C. The contribution of social participation to differences in life expectancy and healthy years among the older population: A comparison between Chile, Costa Rica and Spain. PLoS One 2021; 16:e0248179. [PMID: 33711063 PMCID: PMC7954322 DOI: 10.1371/journal.pone.0248179] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 02/19/2021] [Indexed: 11/18/2022] Open
Abstract
We study the health trajectories of the population aged over 60, comparing between one European and two Latin American countries (Spain, Chile and Costa Rica) which have similar longevity patterns. Our focus is on functional limitation and mortality risks, considering differences by gender, education and social participation. Data come from national panel surveys (EPS, CRELES, SHARE). Multistate modelling is used to estimate transition probabilities between two health states: healthy to unhealthy, unhealthy to healthy as well as the transition to death from healthy or unhealthy states, to estimate the duration of stay in a specific state (computing healthy and unhealthy life expectancies) and the effect of the selected covariates. Results show that older Costa Ricans have the smallest gender gap in life expectancy but women have a lower healthy life expectancy compared to those in Chile and Spain. Participation in social activities leads to higher healthy life expectancy among the elderly in Costa Rica and Spain, whilst there were no relevant educational differences observed in longevity in the analysed countries. To conclude: despite the different patterns observed in health transitions and survival across the three countries, social participation is associated with greater health and longevity among people of old age, with little effect coming from educational attainment. Public policies should therefore be aimed at reducing unhealthy life years and dependency at advanced ages by promoting more engagement in social activities, especially among vulnerable groups who are more likely to experience impairment from a younger age.
Collapse
Affiliation(s)
- Sarahí Rueda-Salazar
- Centre d’Estudis Demogràfics (CED), Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Jeroen Spijker
- Centre d’Estudis Demogràfics (CED), Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Daniel Devolder
- Centre d’Estudis Demogràfics (CED), Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Cecilia Albala
- Unidad de Nutrición Pública, Instituto de la Nutrición y Tecnología de los Alimentos (INTA), Universidad de Chile, Santiago, Chile
| |
Collapse
|
9
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
10
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
|
11
|
Sauerberg M, Guillot M, Luy M. The cross-sectional average length of healthy life (HCAL): a measure that summarizes the history of cohort health and mortality. Popul Health Metr 2020; 18:21. [PMID: 32867786 PMCID: PMC7457804 DOI: 10.1186/s12963-020-00220-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 07/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Healthy life years have superseded life expectancy (LE) as the most important indicator for population health. The most common approach to separate the total number of life years into those spent in good and poor health is the Sullivan method which incorporates the health dimension to the classic period life table, thus transforming the LE indicator into the health expectancy (HE) indicator. However, life years derived from a period life table and health prevalence derived from survey data are based on different conceptual frameworks. Method We modify the Sullivan method by combining the health prevalence data with the conceptually better fitting cross-sectional average length of life (CAL). We refer to this alternative HE indicator as the “cross-sectional average length of healthy life” (HCAL). We compare results from this alternative indicator with the conventional Sullivan approach for nine European countries. The analyses are based on EU-SILC data in three empirical applications, including the absolute and relative level of healthy life years, changes between 2008 and 2014, and the extent of the gender gap. Results HCAL and conventional HE differ in each of these empirical applications. In general, HCAL provides larger gains in healthy life years in recent years, but at the same time greater declines in the proportion of healthy life years. Regarding the gender gap, HCAL provides a more favourable picture for women compared to conventional HE. Nonetheless, the extent of these differences between the indicators is only of minor extent. Conclusions Albeit the differences between HE and HCAL are small, we found some empirical examples in which the two indicators led to different conclusions. It is important to note, however, that the measurement of health and the data quality are much more important for the healthy life years indicator than the choice of the variant of the Sullivan method. Nonetheless, we suggest to use HCAL in addition to HE whenever possible because it widens the spectrum of empirical analyses and serves for verification of results based on the highly sensitive HE indicator.
Collapse
Affiliation(s)
- Markus Sauerberg
- Vienna Institute of Demography, Austrian Academy of Sciences, Vienna, Austria. .,Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna, Austria.
| | - Michel Guillot
- Population Studies Center, University of Pennsylvania, Philadelphia, PA, USA.,French Institute for Demographic Studies (INED), Paris, France
| | - Marc Luy
- Vienna Institute of Demography, Austrian Academy of Sciences, Vienna, Austria.,Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, University of Vienna), Vienna, Austria
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Di Lego V, Di Giulio P, Luy M. Gender Differences in Healthy and Unhealthy Life Expectancy. International Handbook of Health Expectancies 2020. [DOI: 10.1007/978-3-030-37668-0_11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
14
|
De Carvalho Yokota RT, Van Oyen H. 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] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
15
|
Hsiao RL, Wu CH, Hsu CW, Saito Y, Lin YH. Validation of the global activity limitation indicator in Taiwan. BMC Med Res Methodol 2019; 19:52. [PMID: 30845914 PMCID: PMC6407180 DOI: 10.1186/s12874-019-0693-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background The Global Activity Limitation Indicator (GALI) is a single-item measure of functional decline, it is widely used in Europe but it has never been validated in an Asian population. The aim of this study was to validate the GALI in a sample of older Taiwanese people and to explore whether it captured not only physical but also psychological limitations. Methods Data for 4961 individuals (mean age, 62.4 ± 9.4 years; 47.2% men) were obtained from a national representative refresh cohort of the 8th wave of the Taiwan Longitudinal Survey on Aging. Logistic regression analysis was used to examine associations among the GALI, activities of daily living (ADLs) and instrumental activities of daily living (IADLs) and to explore whether depressive symptoms (measured by the Center for Epidemiologic Studies Depression Scale, CES-D) could be an indicator of reporting limitations on the GALI. Results Responding to the GALI, 21.7% of the sample described themselves as ‘limited.’ In logistic regression, the GALI response was significantly associated with those who reported one or more ADL difficulties (odds ratio [OR] = 35.89, 95% confidence interval [CI] 21.10, 61.03) and IADL difficulties (OR = 13.37, 95%CI 10.09, 17.71), respectively. Furthermore, those with more depressive symptoms were more likely to report they were ‘limited’ on the GALI. Conclusions These findings provided evidence that the GALI is a valid tool to assess general limitations in an Asian population. Furthermore, it captured psychological limitations to some extent. There were variations between Taiwan and European countries (as has been previously reported between European countries). The reporting level in the GALI by the Taiwan population was comparatively lower than that in European countries, highlighting the need to embrace cultural differences and to use caution when comparing GALI results across countries.
Collapse
Affiliation(s)
- Ru-Ling Hsiao
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chih-Hsun Wu
- Department of Psychology, National Chengchi University, No.64, Sec.2, ZhiNan Road, Taipei, Taiwan, 11605.
| | - Che-Wei Hsu
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Yasuhiko Saito
- Population Research Institute, Nihon University, Tokyo, Japan
| | - Yu-Hsuan Lin
- Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| |
Collapse
|
16
|
Nusselder WJ, Wapperom D, Looman CWN, Yokota RTC, van Oyen H, Jagger C, Robine JM, Cambois EM. Contribution of chronic conditions to disability in men and women in France. Eur J Public Health 2019; 29:99-104. [PMID: 30107556 DOI: 10.1093/eurpub/cky138] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Women report more disability than men perhaps due to gender differences in the prevalence of diseases and/or in their disabling impact. We compare the contribution of chronic diseases to disability in men and women in France, using a disability survey conducted in both private households and institutions, and we also examine the effect of excluding the institutionalized population. Methods Data comprised 17 549 individuals age 50+, who participated in the 2008-09 French Disability Health Survey including people living in institutions. Disability was defined by limitations in activities people usually do due to health problems (global activity limitation indicator). Additive regression models were fitted separately by gender to estimate the contribution of conditions to disability taking into account multi-morbidity. Results Musculoskeletal diseases caused most disability for both men (10.1%, CI: 8.1-12.0) and women (16.0%, CI 13.6-18.2). The second contributor for men was heart diseases (5.7%, CI: 4.5-6.9%), and for women anxiety-depression (4.0, CI 3.1-5.0%) closely followed by heart diseases (3.8%, CI 2.9-4.7%). Women's higher contribution of musculoskeletal diseases reflected their higher prevalence and disabling impact; women's higher contribution of anxiety-depression and lower contributions of heart diseases reflected gender differences in prevalence. Excluding the institutionalized population did not change the overall conclusions. Conclusions The largest contributors to the higher disability of women than men are moderately disabling conditions with a high prevalence. Whereas traditional disabling conditions such as musculoskeletal diseases are more prevalent and disabling in women, fatal diseases such as cardiovascular disease are also important contributors in women and men.
Collapse
Affiliation(s)
- Wilma J Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Dagmar Wapperom
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Caspar W N Looman
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Renata T C Yokota
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium.,Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium
| | - Herman van Oyen
- Department of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium.,Department of Public Health, Ghent University, Ghent, Belgium
| | - Carol Jagger
- Institute of Health and Society, Newcastle University, Newcastle, UK.,Institute for Ageing, Newcastle University, Newcastle, UK
| | - Jean Marie Robine
- INSERM (National Institute of Health and Medical Research), Montpellier, France.,EPHE (École Pratique des Hautes Études), Paris, France
| | | |
Collapse
|
17
|
Van Oyen H, Bogaert P, Yokota RTC, Berger N. Measuring disability: a systematic review of the validity and reliability of the Global Activity Limitations Indicator (GALI). ACTA ACUST UNITED AC 2018; 76:25. [PMID: 29881544 PMCID: PMC5985596 DOI: 10.1186/s13690-018-0270-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/09/2018] [Indexed: 12/03/2022]
Abstract
Background GALI or Global Activity Limitation Indicator is a global survey instrument measuring participation restriction. GALI is the measure underlying the European indicator Healthy Life Years (HLY). Gali has a substantial policy use within the EU and its Member States. The objective of current paper is to bring together what is known from published manuscripts on the validity and the reliability of GALI. Methods Following the PRISMA guidelines, two search strategies (PUBMED, Google Scholar) were combined to identify manuscripts published in English with publication date 2000 or beyond. Articles were classified as reliability studies, concurrent or predictive validity studies, in national or international populations. Results Four cross-sectional studies (of which 2 international) studied how GALI relates to other health measures (concurrent validity). A dose-response effect by GALI severity level on the association with the other health status measures was observed in the national studies. The 2 international studies (SHARE, EHIS) concluded that the odds of reporting participation restriction was higher in subjects with self-reported or observed functional limitations. In SHARE, the size of the Odds Ratio’s (ORs) in the different countries was homogeneous, while in EHIS the size of the ORs varied more strongly. For the predictive validity, subjects were followed over time (4 studies of which one international). GALI proved, both in national and international data, to be a consistent predictor of future health outcomes both in terms of mortality and health care expenditure. As predictors of mortality, the two distinct health concepts, self-rated health and GALI, acted independently and complementary of each other. The one reliability study identified reported a sufficient reliability of GALI. Conclusion GALI as inclusive one question instrument fits all conceptual characteristics specified for a global measure on participation restriction. In none of the studies, included in the review, there was evidence of a failing validity. The review shows that GALI has a good and sufficient concurrent and predictive validity, and reliability.
Collapse
Affiliation(s)
- Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium.,2Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Petronille Bogaert
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Renata T C Yokota
- Department of Epidemiology and Public Health, Sciensano, J. Wytsmanstraat 14, 1050 Brussels, Belgium.,3Department of Sociology, Interface Demography, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
| | - Nicolas Berger
- 4Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| |
Collapse
|
18
|
Abstract
OBJECTIVE To project the proportion of population 65+ years with severe long-term activity limitations from 2017 to 2047. DESIGN Large population study. SETTING Population living in private households of the European Union (EU) and neighbouring countries. PARTICIPANTS Participants from the EU Statistics on Income and Living Conditions aged 55 years and older and living in one of 26 EU and neighbouring countries, who answered the health section of the questionnaire. OUTCOME MEASURES Prevalence of severe long-term activity limitations of particular subpopulations (ie, 55+, 65+, 75+ and 85+ years) by sex and country. RESULTS We find a huge variation in the prevalence of self-reported severe long-term limitations across Europe for both sexes. However, in 2017, about 20% of the female population aged 65 years and above and about 16% of their male counterparts are expected to report severe long-term activity limitations after accounting for differences in reporting. Accounting for cultural differences in reporting, we expect that European countries will have about 21% (decile 1: 19.5%; decile 9: 22.9%) of female and about 16.8% (decile 1: 15.4%; decile 9: 18.1%) of male 65+ years population with severe long-term activity limitations by 2047. CONCLUSIONS Overall, despite the expected increase of life expectancy in European countries, our results suggest almost constant shares of older adults with severe long-term activity limitations within the next 30 years.
Collapse
Affiliation(s)
- Sergei Scherbov
- Wittgenstein Centre (IIASA, VID/ÖAW, WU), International Institute for Applied Systems Analysis, Laxenburg, Austria
- Russian Presidential Academy of National Economyand Public Administration (RANEPA), Moscow, Russian Federation
- Vienna Institute of Demography, Austrian Academy of Science, Vienna, Austria
| | - Daniela Weber
- Wittgenstein Centre (IIASA, VID/ÖAW, WU), International Institute for Applied Systems Analysis, Laxenburg, Austria
- Health Economics and Policy Division, Vienna University of Economics and Business, Vienna, Austria
| |
Collapse
|