Table 3 - uploaded by Jean-Marie Robine
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The Euro-REVES 2 project, 'Setting up of a coherent set of health expectancies for the European Union', was begun in 1998 under the European Health Monitoring Programme with the aim of selecting a concise set of instruments to simultaneously monitor mortality and the different facets of health. An in-depth analysis of the current health survey inst...
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Citations
... The variables of sex (1 = female), age, children (1 = no children) and limitations on activities of daily living due to health problems were incorporated. The latter variable was evaluated using the Global Activity Limitation Indicator (GALI) [50]. The GALI consists of a single item ("For at least the last six months, have you been limited because of a health problem in activities people usually do?"), with three response categories (yes, strongly limited; yes, limited; no, not limited). ...
Background
The association between socioeconomic status and depression is weaker in older adults than in younger populations. Loneliness may play a significant role in this relationship, explaining (at least partially) the attenuation of the social gradient in depression. The current study examined the relationship between socioeconomic status and depression and whether the association was affected by loneliness.
Methods
A cross-sectional design involving dwelling and nursing homes residents was used. A total of 887 Spanish residents aged over 64 years took part in the study. Measures of Depression (GDS-5 Scale), Loneliness (De Jong-Gierveld Loneliness Scale), Socioeconomic Status (Education and Economic Hardship), and sociodemographic parameters were used. The study employed bivariate association tests (chi-square and Pearson’s r) and logistic regression analyses.
Results
The percentage of participants at risk of suffering depression was significantly higher among those who had not completed primary education (45.5%) and significantly lower among those with university qualifications (16.4%) (X² = 40.25;p <.001), and respondents who could not make ends meet in financial terms faced a higher risk of depression (X² = 23.62;p <.001). In terms of the respondents who experienced loneliness, 57.5% were at risk of depression, compared to 19% of those who did not report loneliness (X² = 120.04;p <.001). The logistic regression analyses showed that having university qualifications meant a 47% reduction in the risk of depression. This risk was 86% higher among respondents experiencing financial difficulties. However, when scores for the loneliness measure were incorporated, the coefficients relating to education and economic hardships ceased to be significant or were significantly reduced.
Conclusion
Loneliness can contribute to explaining the role played by socioeconomic inequalities in depression among older adults.
... die Einschätzung der Auswirkungen gesundheitlicher Einschränkungen auf die Fähigkeit einer Person zur Ausführung von Alltagsaktivitäten. Dieser Indikator ist eine Schlüsselkomponente der EU-SILC-Erhebung (European Union Statistics on Income and Living Conditions) und wurde von mehreren Ländern übernommen, um Daten über Behinderungen und Funktionseinschränkungen zu sammeln[23]. Bei den GALI-Analysen beschränken wir uns auf die von starken funktionellen Einschränkungen freie Lebenserwartung und damit auf den Aspekt der substanziellen Beeinträchtigung der gesundheitlichen Lebensqualität.Der Mobilität als spezifischem Bereich der funktionellen Gesundheit kommt im Alltag eine besondere Bedeutung zu. ...
Zusammenfassung
Einleitung
Der langfristige Anstieg der Lebenserwartung wirft die Frage auf, ob die gewonnene Lebenszeit mit einer Verlängerung der Jahre ohne gesundheitliche Einschränkungen einhergeht. Die Studie untersucht, wie sich die Lebenserwartung ohne funktionelle und Mobilitätseinschränkungen ab dem Alter 46 und 65 Jahre sowie ihre Anteile an der Restlebenserwartung seit 2008 verändert haben.
Methoden
Wir analysieren Daten des Deutschen Alterssurveys der Wellen 2008, 2014 und 2020/2021. Die Lebenserwartung ohne funktionelle Einschränkungen (Disability Free Life Expectancy – DFLE) wurde mit der Sullivan-Methode berechnet. Untersucht wurden starke funktionelle Einschränkungen mit dem „Global Activity Limitation Indicator“ (GALI) und Einschränkungen der Mobilität (Treppensteigen, mehr als 1 km Gehen).
Ergebnisse
Kompression der Morbidität beim GALI ist bei 46- und 65-jährigen Männern seit 2014 zu beobachten, bei gleichaltrigen Frauen dagegen nicht. Bei der Mobilität zeigen 46- und 65-jährige Männer Tendenzen zur Kompression beim Treppensteigen und 46-jährige Männer beim Gehen von mehr als 1 km seit 2014. Die Werte für Frauen stagnieren für die beiden erstgenannten Indikatoren, aber nicht für 46-jährige Frauen beim Gehen von mehr als 1 km seit 2014.
Diskussion
Unsere Analysen zeigen je nach Indikator, Alter und Geschlecht unterschiedliche Trends der DFLE und lassen keine eindeutige Antwort auf die Frage nach Morbiditätskompression oder -expansion zu. Kompression der Morbidität sehen wir eher bei Männern, Tendenzen der Stagnation oder Expansion dagegen eher bei Frauen. Diese Resultate signalisieren Herausforderungen in der Erhaltung der funktionellen Gesundheit vor allem bei Frauen und weisen auf die Notwendigkeit gezielter Interventionen hin, um die Lebensqualität und die gesunde Lebenserwartung zu verbessern.
... Among these contextually dependent factors, characteristics that attract discrimination, features of relationships, and time-dependent relationships have been highlighted (33). In this study, we assessed characteristics that attract discrimination through the Global Activity Limitations Indicator (GALI) and age (34). The GALI self-reported measure is conceived by assessing the degree of limitation experienced in the last 6 months, with the possible answers being severely limited, mildly limited, or not limited. ...
Background
Breast cancer is a critical public health concern in Spain, and organized screening programs have been in place since the 1990s to reduce its incidence. However, despite the bi-annual invitation for breast cancer screening (BCS) for women aged 45–69, significant attendance inequalities persist among different population groups. This study employs a quantitative intersectional perspective to identify intersectional positions at risk of not undergoing breast cancer screening in Spain.
Methods
Women were selected from the 2020 European Health Interview Survey in Spain, which surveyed the adult population (> 15 years old) living in private households (N = 22,072; 59% response rate). Inequality indicators based on the PROGRESS-Plus framework were used to disentangle existing social intersections. To identify intersectional groups, decision tree models, including classification and regression trees (CARTs), chi-squared automatic interaction detector (CHAID), conditional inference rees (CITs), and C5.0, along with an ensemble algorithm, extreme gradient boosting (XGBoost), were applied.
Results
XGBoost (AUC 78.8%) identified regional differences (Autonomous Community) as the most important factor for classifying BCS attendance, followed by education, age, and marital status. The C5.0 model (balanced accuracy 81.1%) highlighted that the relative importance of individual characteristics, such as education, marital status, or age, for attendance differs based on women’s place of residence and their degree of interaction. The highest risk of not attending BCS was observed among illiterate older women in lower social classes who were born in Spain, were residing in Asturias, Cantabria, Basque Country, Castile and León, Extremadura, Galicia, Madrid, Murcia, La Rioja, or Valencian Community, and were married, divorced, or widowed. Subsequently, the risk of not attending BCS extends to three other groups of women: women living in Ceuta and Melilla; single or legally separated women living in the rest of Spain; and women not born in Spain who were married, divorced, or widowed and not residing in Ceuta or Melilla.
Conclusion
The combined use of decision trees and ensemble algorithms can be a valuable tool in identifying intersectional positions at a higher risk of not utilizing public resources and, thus, can aid substantially in developing targeted interventions to increase BCS attendance.
... Longstanding activity limitation was measured with the two items Global Activity Limitation Indicator (GALI) which is a comprehensive survey instrument measuring physical restrictions [29,30]. The first part of the question was "Are you limited because of a health problem in activities people usually do? ...
Objectives: To examine with a population-based longitudinal survey design whether poor health, longstanding activity limitation, impaired cognitive functioning, mental distress, or loneliness predict poor access to healthcare and whether digital competence mediates these associations.
Methods: The data were from the longitudinal FinHealth -survey gathered in Finland in 2017 and 2020 including 3,771 respondents (57.1% women). Linear regression analyses were used to examine the associations of factors affecting healthcare utilization with access to care adjusted for age, sex, and education. Counterfactual causal mediation framework was used to examine the mediating role of digital competence in the relationships among these factors and access to healthcare.
Results: Factors affecting healthcare utilization were associated with poor access to care and these associations were partly mediated by low digital competence. Low digital competence mediated 12%, 9% and 8%, of the associations of impaired cognitive functioning, longstanding activity limitation, and loneliness with poor access to care, respectively.
Conclusion: According to our results, one way to improve the access to healthcare among vulnerable groups could be to improve their digital competence.
... The variables addressing physical limitations and coded as binary consisted in (1) having one or more activity daily limitations (ADL) (Katz 1963), (2) having one or more instrumental activity daily limitations (IADL) (Lawton and Brody 1969), (3) being limited according to the global activity limitation index (GALI) (Robine et al. 2003) and (4) having two or more mobility, arm function and fine motor limitations. Self-perceived health (Ware and Gandek 1998) was also included as a binary variable, coding for a "poor," "fair" or "good" self-reported health against the "very good" and "excellent" categories. ...
Multimorbidity, the concurrence of several chronic conditions, is a rising concern that increases the years lived with disability and poses a burden on healthcare systems. Little is known on how it interacts with socioeconomic deprivation, previously associated with poor health-related outcomes. We aimed to characterize the association between multimorbidity and these outcomes and how this relationship may change with socioeconomic development of regions. 55,915 individuals interviewed in 2017 were drawn from the Survey of Health, Ageing and Retirement in Europe, a population-based study. A Latent Class Analysis was conducted to fit multimorbidity patterns based on 16 self-reported conditions. Physical limitation, quality-of-life and healthcare utilization outcomes were regressed on those patterns adjusting for additional covariates. Those analyses were then extended to assess whether such associations varied with the region socioeconomic status. We identified six different patterns, labelled according to their more predominant chronic conditions. After the “healthy” class, the “metabolic” and the “osteoarticular” classes had the best outcomes involving limitations and the lowest healthcare utilization. The “neuro-affective-ulcer” and the “several conditions” classes yielded the highest probabilities of physical limitation, whereas the “cardiovascular” group had the highest probability of hospitalization. The association of multimorbidity over physical limitations appeared to be stronger when living in a deprived region, especially for metabolic and osteoarticular conditions, whereas no major effect differences were found for healthcare use. Multimorbidity groups do differentiate in terms of limitation and healthcare utilization. Such differences are exacerbated with socioeconomic inequities between regions even within Europe.
Supplementary Information
The online version contains supplementary material available at 10.1007/s10433-023-00795-6.
... The conceptual translational method relies on detailed explanations of the terms used in each survey question, as well as the underlying concepts that the questions were intended to measure. This approach differs from the forward-backward method in the 'backward' step, during which rather than translating the question back into the original language, a checker determines whether each question was properly translated such that the intended concepts were actually captured (Robine andJagger, 2002, 2003). ...
... Mental Health Inventory-5 (MHI-5): The MHI-5 is part of the 36-item Short-Form Health Survey (SF-36) questionnaire and represents the subscale for emotional wellbeing [22]. It can be used to detect emotional wellbeing as well as depression in the general population and chronically ill patients, and is recommended for the measurement of psychological distress in the European context [20,23,24]. The MHI-5 was originally coded with a 6-point Likert scale. ...
... In a study of the Mental Component scale, a larger subscale of the SF-36 from which the MHI-5 was derived, Sweden, Denmark and the Netherlands had higher scores whereas France had lower scores than the overall cohort mean, a pattern which is consistent with our findings [40]. Despite the variations between countries, the MHI-5 is recommend for use in European cohorts [20,23,24]. ...
... Continued assessment of mental health during pregnancy, the NICU stay and after discharge could help further clarify the needs of these groups. Interventions during the NICU stay and subsequently that are focused on strengthening the social context of the family could be beneficial for parents to cope with very preterm birth [11,17,24,46,53]. ...
(1) Background: Mothers of very preterm (VPT) infants may experience psychological symptoms compromising long-term emotional wellbeing. This study describes the emotional wellbeing of mothers of five-year-old children born VPT. We assess the association between sociodemographic, perinatal and neonatal characteristics, and the child’s health and development at five years old and maternal emotional wellbeing. (2) Methods: Data are from the prospective European “Effective Perinatal Intensive Care in Europe” (EPICE) and subsequent “Screening for Health In very Preterm infantS in Europe” (SHIPS) projects including births <32 weeks’ gestational age in 11 countries in 2011/12. Data were abstracted from obstetric and neonatal records. At five years old, 2605 mothers answered a parental questionnaire including the Mental Health Inventory-5 (MHI-5). Associations between sociodemographic and health characteristics and the mother’s MHI-5 score were investigated using multilevel multivariate linear regression analysis with the country modelled as a random effect and inverse probability weighting to correct for attrition bias. (3) Results: The mean MHI-5 score was 71.3 (SD 16.7) out of 100 (highest emotional wellbeing) with a variation among countries from 63.5 (SD 16.8; Poland) to 82.3 (SD 15.8; the Netherlands). MHI-5 scores were significantly lower for mothers whose child had a severe health problem, developmental, or speech delay, for multiparous and single mothers, and when at least one of the parents was unemployed. (4) Conclusions: The emotional wellbeing of mothers of VPT infants differs between European countries. Identifying sociodemographic characteristics and child’s health and developmental conditions that affect maternal emotional wellbeing may help to identify groups of mothers who need special assistance to cope with consequences of the delivery of a VPT child.
... The response options are 'severely limited', 'limited but not severely', and 'not limited at all'. The ICF was used as the conceptual framework for the development of GALI (Robine et al, 2003) and the indicator satisfies the six conceptual criteria of a single-question measure of participation restriction (Berger et al, 2016;Van Oyen et al, 2018). In the analyses, the moderately limited and severely limited cases are merged into one category labelled 'disabled'. ...
... Moreover, the GALI question for persons aged 16 and over is not perfectly harmonised in the EU-SILC countries (EHLEIS, 2018) and variations in the question wording imply different prevalence rates (Finger et al, 2014;Cambois et al, 2016a). GALI was designed to be usable for all ages (Robine et al, 2003), although it has never been applied to study disability among children. So far, it is not known whether it is an appropriate measure of childhood disability in European countries and whether the cultural context affects the interpretation and reporting of GALI for children. ...
... Fourth, even though GALI was designed to be usable for all ages (Robine et al, 2003), it is still to be examined whether it is an appropriate measure of disability among children in European countries. This can be done by cross-validating GALI with other functioning and disability measures in an international context, as done by Berger et al (2015) and Jagger et al (2010). ...
By ratifying the United Nations Convention on the Rights of Persons with Disabilities, states committed themselves to ensure an adequate standard of living and social protection to all persons with disabilities, including children. Yet, prior studies showed that children with disabilities are more likely to grow up poor. Existing research has mainly focused on single-country case studies or comparative analyses for low- and middle-income countries. Due to the lack of good quality data, comparative studies on poverty outcomes, its determinants and the poverty-reducing role of social transfers among children with disabilities in high-income countries are largely missing. This article addresses these gaps using the 2017 EU-SILC cross-sectional survey. The results show great differences across Europe in the prevalence of childhood disability, the poverty outcomes of children with disabilities and the poverty-reducing effectiveness of social transfers for them. In only a third of European countries are children with disabilities more likely to live in poor households than children without disabilities. Countries that perform weakly for children without disabilities also perform weakly for children with disabilities. Moreover, social transfers achieve more for children with disabilities in more than half of European countries. The family’s employment participation and social background have the expected poverty-reducing effects for children with disabilities and children without disabilities, though the strength of some effects differs between the two groups within certain geographical regions. However, the income-based poverty indicator disregards the higher costs families with children with disabilities face which underestimates their poverty risk. More research is needed on which poverty indicator accurately reflects the real living standards of children with disabilities.
... the Global Activity limitation indicator (GAli) is a self-report measure of participation restriction [96], which does not specifically ask about disability. Since 2000, the GAli has been part of the suite of questions used in major european health and non-health surveys [97] including the Survey of Health, Ageing and Retirement in europe (SHARe) [98,99], the european Health interview Survey (eHiS) [100], the Survey on income and living conditions (Silc) [101]. it is one standard question, which is: 'For at least the past six months, to what extent have you been limited in activities people usually do?'; response options are: severe, moderate, limited (including severe and moderate) or none, or severely limited, limited but not severely, or not limited at all. ...
Purpose:
There are several ways to include "disability" in research studies, which can be confusing or overwhelming for researchers, community members, and students. The aim of this paper is to share conceptualizations of disability and how to ask about "disability" in research studies. The paper provides a general introduction and brief analysis of the methodological approaches which can be used.
Methods:
We used reviews of the literature and extensive discussions to identify key articles, books, websites, and reports that provide guidance and examples of asking about disability in research.
Results:
Four primary approaches to asking study participants about disability were identified. For each of these, we provide background information, key points about the ways to use the approach including tools that have been developed, and example studies. A comparison table provides a high-level overview of similarities and differences in approaches. Other approaches and tools were also identified and are briefly described.
Conclusion:
Researchers involved in disability and rehabilitation research should be aware that there is not one best or singular way to ask about disability when conducting research. The approach or approaches chosen for a particular study need to match the purpose of the study. It is important that researchers take time to carefully consider their options and choose the best fit for their study.
... Self-rated health was measured by a validated single-item question: "How do you rate your health?" The response options were 1 = poor, 2 = fairly poor, 3 = average, 4 = fairly good, 5 = good (Robine et al., 2003). This single-item question of self-rated health is a widely used measure, which has been shown to be a robust predictor for many health-related outcomes (Berglund et al., 2016;Cullati et al., 2020). ...
