6 th meeting of the task force on health expectancies 2 nd june 2008 carol jagger and clare gillies,...
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6th Meeting of the Task Force on Health Expectancies2nd June 2008
Carol Jagger and Clare Gillies,
University of Leicester
Validating the GALI Question
Validating the GALI question
Carol Jagger and Clare Gillies
University of Leicester
6th meeting of Task Force on Health Expectancies June 2008
Validating the GALI
• HLY (based on the GALI) from SILC 2005 shows considerable differences between countries
• Are these differences ‘real’ or due to the GALI• Data from the Survey of Health and Retirement
in Europe (SHARE) study, was used to investigate
– How the GALI relates to other health measures– Does the GALI reflect similar levels of ill health in
different countries
SHARE data
• Data on a range of health expectancies – covering 11 European countries and over
12,569 individuals of 65 years of age or more. – GALI, ADL, IADL, self-perceived health,
European depression score, which can be converted into health expectancies and compared across countries.
GALI health expectancy at 65 years of age
7.0 7.4
9.9
7.4
9.2 9.0 9.5 9.2 9.710.9
6.0 5.6
8.2 7.89.1 8.5 8.6 8.4
9.48.6 8.6 8.0
8.9
11.5 7.0 11.66.9
10.8
6.7
10.6
7.0
8.6
10.7
14.68.7
12.5
7.9
12.5
8.8
12.2
7.8
12.5
8.6
13.4
0
5
10
15
20
25
M W M W M W M W M W M W M W M W M W M W M W
Denmark Greece Belgium Netherlands England Germany Austria Spain Sweden Italy France
Ex
pe
cte
d y
ea
rs o
f li
fe
Without activity limitation With activity limitaton
Other health measures in SHARE
• Self-reported– Number of chronic conditions– Number of symptoms– Euro-d (depression score)– Self-perceived health– ADL– IADL
• Objective?– Maximum grip strength– Walking speed
How do other health measures relate to the GALI?Odds ratio
(95% confidence interval)p-value
Objective measures
Maximum grip strength 0.96 (0.94, 0.97) <0.001
Walking speed (m/sec) 0.26 (0.18, 0.37) <0.001
Self-reported measures
Number of chronic conditions 1.79 (1.70, 1.89) <0.001
Number of symptoms 1.93 (1.80, 2.08) <0.001
Euro-d (depression score) 1.35 (1.31, 1.39) <0.001
Self-perceived health 2.95 (2.47, 3.50) <0.001
ADL 2.30 (2.07, 2.54) <0.001
IADL 5.24 (4.38, 6.26) <0.001
Adjusted for age and gender, and the clustering effect of country. The odds ratios are for a one unit increase in the health measure, except self-perceived health which was dichotomized to compare good or very good health to fair, bad or very bad.
Grip strength
*probabilities estimated by logistic regression and adjusted for age and gender
.2.4
.6.8
1 to 10 >10 to 20 >20 to 30 >30 to 40 >40 to 50 >50Maximum grip strength
Probability limited Probability not limited
Walking speed
*probabilities estimated by logistic regression and adjusted for age and gender
.3.4
.5.6
.7
0.0 to 0.5 >0.5 to 1.0 >1.0 to 1.5 >1.5 to 2.0 >2.0Walking speed (m/sec)
Probability limited Probability not limited
Number of chronic conditions0
.2.4
.6.8
1
0 2 4 6 8Number of chronic conditions
Probability limited Probability not limited
*probabilities estimated by logistic regression and adjusted for age and gender
Number of ADL limitations0
.2.4
.6.8
1
0 2 4 6Number of ADL limitations
Probability limited Probability not limited
*probabilities estimated by logistic regression and adjusted for age and gender
Number of IADL limitations0
.2.4
.6.8
1
0 2 4 6 8Number of IADL limitations
Probability limited Probability not limited
*probabilities estimated by logistic regression and adjusted for age and gender
Conclusions
• GALI appears to reflect self-reported functional limitation, chronic morbidity, depression and objectively measured physical function
• Does it do this similarly across countries?
For a given level of a health measure are countries equally likely to say
they are limited?
• Odds ratios calculated for each country, for a number of health indicators, adjusted for age using logistic regression
• Meta-analysis carried out to assess heterogeneity between countries in terms of the predicted odds ratios
Are the odds of being limited, by different health indicators, significantly different
between countriesHealth measure p-value
Objective measures
Maximum grip strength 0.121
Walking speed (m/sec) 0.573
Self-reported measures
Number of chronic conditions 0.001
Number of symptoms 0.002
Euro-d (depression score) 0.093
Self-perceived health 0.001
ADL 0.166
IADL 0.075
Odds ratio of being limited if have 2 or more chronic diseases compared to less
than 2
Odds ratio of being limited, by number of chronic conditions1 2 3 4 5 6
Combined
Netherlands
Greece
Germany
Spain
Austria
Italy
Denmark
Belgium
Switzerland
Sweden
France
P=0.001
Why do the odds ratios differ between countries?
France Netherlands
<2 2+ <2 2+
Not limited 82% 18% 71% 29%
Limited 48% 52% 40% 60%
Odds ratios
(adj. for age)
2.46
(95% CI:1.96, 3.09)
4.58
(95% CI: 3.56, 5.90)
Odds ratio of being limited if in the lowest third for maximum grip strength compared to others
Odds ratio of being limited, by maximum grip strength1 1.5 2 2.5 3
Combined
Italy
Netherlands
Belgium
Denmark
Spain
France
Switzerland
Germany
Sweden
Austria
Greece
P=0.121
Odds ratio of being limited if have a walking speed of <=0.4m/sec compared to >0.4m/sec
Odds ratio of being limited by walking speed-10 1 10 20 30
Combined
Switzerland
France
Germany
Belgium
Netherlands
Sweden
Spain
Greece
Austria
Italy
Denmark
P=0.573
Odds ratio of being limited, one or more ADLs compared to none
1 10 20 30 40
Combined
Austria
Spain
Italy
Sweden
Switzerland
Greece
Germany
Belgium
France
Netherlands
Denmark
P=0.166
Odds ratio of being limited if have 1 or more ADLs compared to none
Odds ratio of being limited if have 1 or more IADLs compared to none
Odds ratio of being limited, one or more IADLs compared to none1 5 10
Combined
Austria
Sweden
Denmark
Spain
France
Belgium
Switzerland
Germany
Italy
Netherlands
Greece
P=0.075
Conclusions 1• Odds ratios for number of chronic
conditions, number of symptoms and self-perceived health all showed significant heterogeneity between countries
• All countries showed a significant association between being limited and each of these three indicators (ORs>1) but for some countries the association was of a greater magnitude
Conclusions 2• Odds ratios for three significant subjective
health measures were additionally adjusted for walking speed and maximum grip strength, heterogeneity between countries was no longer significant.
• This suggests that the classification of individuals as limited or not limited by the GALI differed between countries in terms of individuals’ self-reporting of their health but not in terms of their actual (objectively measured) health.
Additional Slides
Number of symptoms0
.2.4
.6.8
1
0 2 4 6 8Number of symptoms
Probability limited Probability not limited
*probabilities estimated by logistic regression and adjusted for age and gender
European depression score0
.2.4
.6.8
1
0 2 4 6 8 10European depression score
Probability limited Probability not limited
*probabilities estimated by logistic regression and adjusted for age and gender
Self-perceived health0
.2.4
.6.8
1
Very good Good Fair Bad Very badSelf-perceived health
Probability limited Probability not limited
*probabilities estimated by logistic regression and adjusted for age and gender
Odds ratio of being limited if have 2 or more symptoms compared to less than 2
Odds ratio of being limited, by number of symptoms1 2 4 6 8 10
Combined
Netherlands
Spain
Belgium
Sweden
Germany
Denmark
Austria
Italy
France
Greece
Switzerland
P=0.002
Odds ratio of being limited, by Euro-d depression score
1 2 4 6 8 10
Combined
Austria
Germany
Netherlands
Denmark
Spain
Sweden
Belgium
France
Switzerland
Italy
Greece
Odds ratios of being limited if have a European depression score of >=4, compared to <4
P=0.093
Odds ratio of being limited if self-perceived health is less than good, compared to good or very good
Odds ratio of being limited, by self-perceived health1 5 10 15 20
Combined
Austria
Denmark
Italy
Switzerland
Germany
Netherlands
Spain
Belgium
France
Greece
Sweden
P=0.001
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