6 th Meeting of the Task Force on Health Expectancies 2 nd June 2008 Carol Jagger and Clare Gillies, University of Leicester Validating the GALI Question

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


.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)


Number of chronic conditions0

.2.4

.6.8

1

0 2 4 6 8Number of chronic conditions



Number of ADL limitations0

.2.4

.6.8

1

0 2 4 6Number of ADL limitations



Number of IADL limitations0

.2.4

.6.8

1

0 2 4 6 8Number of IADL limitations



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



European depression score0

.2.4

.6.8

1

0 2 4 6 8 10European depression score



Self-perceived health0

.2.4

.6.8

1

Very good Good Fair Bad Very badSelf-perceived health



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

Documents

6 th Meeting of the Task Force on Health Expectancies 2 nd June 2008 Carol Jagger and Clare Gillies, University of Leicester Validating the GALI Question