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The Global Activity Limitation Indicator (GALI) is an instrument that measures long-term overall disability. The objective of this study was to evaluate GALI's predictive value on mortality while examining variations according to sex, age, and educational level. Longitudinal study. This longitudinal study was based on 42,991 individuals aged ≥15 years who participated in the 2011–2012 National Health Survey and the 2014 European Health Survey in Spain. These records were linked to mortality data up to December 2021. GALI assessed self-reported functional limitation in the past 6 months and classified individuals into three categories: severely limited, limited but not severely, and not limited. Incidence rate ratios (IRR) were calculated using Poisson regression models, adjusting for sociodemographic, lifestyle, and health status variables. Compared to individuals with no limitations, those with non-severe limitations had an IRR for mortality of 1.27 (95% CI: 1.16–1.38), and 2.04 (95% CI: 1.81–2.31) in those with severe limitations. Women with severe limitations exhibited a higher IRR (2.32; 95% CI: 1.98–2.71) compared to men (1.73; 95% CI: 1.45–2.08) (P for interaction = 0.005). Individuals <65 years with severe limitations showed a greater association (2.22; 95% CI: 1.58–3.10) than those ≥65 (1.49; 95% CI: 1.32–1.69) (P for interaction <0.001). Among individuals with lower educational attainment, the IRR was 2.08 (95% CI: 1.83–2.37), and 1.87 (95% CI: 1.37–2.56) for the higher education group (P for interaction = 0.017). GALI is a robust predictor of all-cause mortality in the general population and subgroups. The association is stronger in women, individuals <65 years, and those with lower educational levels. [ABSTRACT FROM AUTHOR]

The Healthy Life Years (HLY) indicator is the official European Union indicator and a cornerstone of many health policies used in over 15 countries in the EU region to set national health plans and monitor targets. It is also used to investigate trends over time in the proportion of total life years spent in good or poor health, socioeconomic inequalities in health and mortality and the male-female health survival paradox. Based on the Global Activity Limitation Indicator (GALI) included in the European Union Statistics on Income and Living Conditions (EU-SILC), a great amount of effort has been directed at harmonising and making HLY comparable across countries. Nonetheless, the characteristics of the age-specific prevalence distribution are still rarely accounted for, regardless of the fact that patterns of prevalence often fluctuate considerably by age. In addition, the impact of assumptions used at very young ages on HLY estimates are seldom discussed, despite the fact that the majority of policies and initiatives at the EU level use HLY at birth, while data on health is only available after age 16. In this paper, we assess whether smoothing the age-specific prevalence distributions by different methods, extrapolating to older ages and changing assumptions at younger ages affect HLY estimates. Overall, assumptions made before age 15 are the most important and affect women and men differently, thus affecting HLY at birth for some countries. Estimates at age 65 are very slightly impacted. Generalised linear models (GAMs) seem promising for harmonising and extrapolating to older ages, while using polynomials or aggregating into 5-year age groups seem best for younger ages. As most EU policies use HLY at birth and by sex for developing and monitoring health policies, caution is needed when estimating HLY at birth. * This article belongs to a special issue on “Levels and Trends of Health Expectancy: Understanding its Measurement and Estimation Sensitivity”.

The Healthy Life Years (HLY) indicator is the official European Union indicator and a cornerstone of many health policies used in over 15 countries in the EU region to set national health plans and monitor targets. It is also used to investigate trends over time in the proportion of total life years spent in good or poor health, socioeconomic inequalities in health and mortality and the male-female health survival paradox. Based on the Global Activity Limitation Indicator (GALI) included in the European Union Statistics on Income and Living Conditions (EUSILC), a great amount of effort has been directed at harmonising and making HLY comparable across countries. Nonetheless, the characteristics of the age-specific prevalence distribution are still rarely accounted for, regardless of the fact that patterns of prevalence often fluctuate considerably by age. In addition, the impact of assumptions used at very young ages on HLY estimates are seldom discussed, despite the fact that the majority of policies and initiatives at the EU level use HLY at birth, while data on health is only available after age 16. In this paper, we assess whether smoothing the age-specific prevalence distributions by different methods, extrapolating to older ages and changing assumptions at younger ages affect HLY estimates. Overall, assumptions made before age 15 are the most important and affect women and men differently, thus affecting HLY at birth for some countries. Estimates at age 65 are very slightly impacted. Generalised linear models (GAMs) seem promising for harmonising and extrapolating to older ages, while using polynomials or aggregating into 5-year age groups seem best for younger ages. As most EU policies use HLY at birth and by sex for developing and monitoring health policies, caution is needed when estimating HLY at birth. [ABSTRACT FROM AUTHOR]

Healthy Life Years (HLY) is a prominent summary indicator for evaluating and comparing the levels of population health status across Europe. Variations in HLY, however, do not necessarily reflect underlying differences in health and mortality levels among countries and the indicator is particularly sensitive when broken down by subpopulations. For instance, despite European countries showing large HLY inequalities by educational level, these countries are also heterogenous regarding their population composition by educational attainment, which most likely affects their HLY levels. We demonstrate how this compositional effect shapes HLY levels by providing estimates for HLY by educational attainment and gender for 16 European countries using the Sullivan method. We use prevalence data about limitations in daily activities from the European Union Statistics on Income and Living Conditions (EU-SILC) and mortality data from the Eurostat database. Finally, we adjust for compositional effects by means of standardization. The education-adjusted HLY estimates do not differ much from conventional HLY. Yet, we find that in some countries HLY levels are indeed affected by the population composition by educational attainment. For example, low-, medium-, and high educated individuals in Portugal show more HLY than their counterparts in Poland. Still, Poland's total HLY value slightly exceeds that of Portugal, indicating favorable health and mortality conditions in Poland. It is Poland's lower relative number of low educated individuals in its population that is responsible for producing this higher total HLY value. We conclude that differentials in HLY due to differences in the relative size of educational subpopulations are generally small in HLY across Europe but they can play an important role for countries that experienced large differences in their educational expansion.

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Objective: The Global Activity Limitation Indicator (GALI), a single question measuring disability, had been introduced in various European surveys since 2004. The complexity of its wording has been questioned. Our study compares alternative variants aiming to simplify the wording. Method: We used the Health-Related Opinion Survey run in 2014 in France (N = 3,009). Its split sample design allows testing four variants of the questions. We analyzed the prevalence of activity limitation (AL) resulting from the four different constructs of the GALI using multinomial logistic regressions, adjusted for background variables and functional limitations (FLs). Results: The alternative GALI variants result in significantly different prevalences compared with the original question, in particular for people with FL. The current variant is more inclusive than the routed variants. Discussion: Our study suggests limited benefits of changing the GALI construct which do not outweigh the costs of breaking the established chronological series of the current variant. [ABSTRACT FROM AUTHOR]

Background: The increase in longevity along with a high prevalence of chronic conditions contribute to increased disability burden. Despite the high occurrence of multimorbidity observed in advanced ages, most studies are restricted to the investigation of individual diseases. In this study, we assessed the impact of chronic conditions and multimorbidity on the disability burden in the older population in Belgium.Methods: Data from 9,482 participants in the 2001, 2004, or 2008 Belgian Health Interview Surveys aged 55 years or older were analyzed. Disability was defined based on the Global Activity Limitation Indicator (GALI). To attribute disability to single chronic conditions and disease pairs, a multiple additive hazard model was fitted.Results: Musculoskeletal conditions (45.3%), chronic respiratory diseases (11.2%), and cardiovascular diseases (10.2%) diseases were the most frequent conditions. Cardiovascular diseases, the co-occurrence of chronic respiratory diseases and depression, neurological diseases, cancer, and the combination of diabetes and cardiovascular diseases were the top five disabling conditions. The disability prevalence in the older population in Belgium was 35.6% (confidence interval =35.0; 36.2%). The most important contributors to the disability burden were musculoskeletal, cardiovascular, and chronic respiratory diseases.Conclusions: The present findings provide a deeper understanding of the role of chronic conditions and multimorbidity on the disability burden in the older population in Belgium. Although the disease pairs showed a low contribution to the disability burden, their occurrence presented a high impact on disability. Prevention strategies to tackle disability should target the main contributors to the disability burden and the most disabling conditions/disease pairs, especially in the clinical practice. [ABSTRACT FROM AUTHOR]

We compare the divergence of orbits and the reversibility error for discrete time dynamical systems. These two quantities are used to explore the behavior of the global error induced by round off in the computation of orbits. The similarity of results found for any system we have analyzed suggests the use of the reversibility error, whose computation is straightforward since it does not require the knowledge of the exact orbit, as a dynamical indicator. The statistics of fluctuations induced by round off for an ensemble of initial conditions has been compared with the results obtained in the case of random perturbations. Significant differences are observed in the case of regular orbits due to the correlations of round off error, whereas the results obtained for the chaotic case are nearly the same. Both the reversibility error and the orbit divergence computed for the same number of iterations on the whole phase space provide an insight on the local dynamical properties with a detail comparable with other dynamical indicators based on variational methods such as the finite time maximum Lyapunov characteristic exponent, the mean exponential growth factor of nearby orbits and the smaller alignment index. For 2D symplectic maps, the differentiation between regular and chaotic regions is well full-filled. For 4D symplectic maps, the structure of the resonance web as well as the nearby weakly chaotic regions are accurately described. [ABSTRACT FROM AUTHOR]

Copyright of Archaeologia Adriatica is the property of Sveuciliste u Zadru and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Összefoglaló. Bevezetés: A lakosság idősödésével növekvő betegségteher egyéni és társadalmi szinten is fokozódó nyomást jelent. Célkitűzés: Felmérni a hazai általános felnőtt lakosságnak a korlátozottsággal, a gondozási igényekkel és a munkavégzéssel kapcsolatos időskori szubjektív várakozásait. Módszer: Online keresztmetszeti felmérést végeztünk. A korlátozottsággal kapcsolatos várakozásokat a hivatalos szakstatisztikákban alkalmazott globális tevékenységkorlátozottsági mutató (Global Activity Limitation Indicator, GALI) segítségével elsőként vizsgáltuk. A jelen és szubjektíve várt munkavégzést, gondozási igényt, gondozói tevékenységet, valamint a jelen egészségi állapotot és szociodemográfiai helyzetet vizsgáló kérdéseket is feltettünk. Statisztikai analízis: A mintában mért adatokat lokális polinom segítségével simítottuk, és a 60/70/80/90 éves korra adott szubjektív várakozásokkal hasonlítottuk össze. A szubjektív várakozásokat meghatározó tényezőket intervallumregresszióval becsültük. Eredmények: 1000 kitöltőtől 914 érvényes választ kaptunk. Az átlagéletkor (± szórás) 51,2 (± 15,2) év, a minta 55,8%-a nő volt. A férfiak között a fizetett munkát végzők (p<0,001), a nők között az informális gondozók aránya volt magasabb (p = 0,010). Az átlagos (± szórás) szubjektíve várható élettartam (81,0 ± 11,1 év) a minta statisztikailag várható élettartamánál (79,6 ± 3,7 év) 1,3 évvel volt hosszabb (p<0,001), azonban az átlagos, szubjektíve várható egészséges élettartam (64,6 ± 15,2 év) 5,3 évvel volt rövidebb a statisztikailag várható értéknél (70,0 ± 4,2 év; p<0,001). A szubjektíve várható egészséges élettartamot és gondozási igényt elsősorban a válaszadók jelenlegi egészségi állapota befolyásolta. Az életmód és a szubjektíve várható egészséges élettartam között nőknél nem találtunk összefüggés, míg a túlzott gyakorisággal alkoholt fogyasztó vagy elhízott férfiak hosszabb egészséges élettartamra számítottak. A szubjektív várakozások meghatározó tényezői jelentős nemi különbségeket mutattak. Következtetés: Az egészséggel, munkával és gondozással kapcsolatos szubjektív várakozások eltérőek a populációban mért valós adatoktól, és különböznek a nemek között. Orv Hetil. 2021; 162(23): 911-923., Introduction: The growing disease burden due to ageing populations poses a challenge on both individuals and societies., Objective: To explore the general population's subjective expectations concerning disability, care needs and employment at older ages., Method: We conducted an online cross-sectional survey. We were the first to measure subjective health expectations using the Global Activity Limitation Indicator (GALI) of official health statistics. Respondents' actual status and subjective expectations concerning employment, care needs and informal caregiver status, self-perceived health and sociodemographic factors were queried., Statistical Analysis: We estimated sample characteristics by local polynomial smoothing and compared with subjective expectations at ages of 60/70/80/90 years. Determinants of subjective expectations were analyzed via interval regression., Results: From 1000 subjects, 914 provided valid responses. Mean (± SD) age was 51.2 (± 15.2) years, and 55.8% of respondents were women. Paid employment was more frequent among men (p<0.001), while informal caregiver status among women (p = 0.010). Mean (± SD) subjective life expectancy (81.0 ± 11.1 years) was 1.3 years longer (p<0.001) than actuarial life-expectancy (79.6 ± 3.7 years), while mean subjective healthy life expectancy (sHLE) (64.6 ± 15.2 years) was 5.3 years shorter than actuarial healthy life expectancy (70.0 ± 4.2 years; p<0.001). sHLE and care needs were mainly determined by respondents' self-perceived health. Lifestyle risks were not associated with sHLE in women, while pervasive drinker or obese men expected longer healthy life span. Determinants of sHLE showed considerable gender differences., Conclusion: Subjective expectations concerning health, employment and care needs differ from actual values of the general population, with considerable gender differences. Orv Hetil. 2021; 162(23): 911-923.

Objective Studies assessing the contribution of specific conditions to disability can help policymakers decide on intervention and preventive strategies. However, the contribution of diseases may vary according to the definition and the level of disability chosen for the analyses. Here, we aimed to describe whether the contributions of diseases to disability vary considering different disability indicators with different severity level. Material/patients and methods We used data from the 2008–09 French Disability-Health survey, a cross-sectional study including 29,990 individuals living in private households, where diseases and disabilities are self-reported. We compared the contributions of 9 chronic diseases to the following disability indicators: the Global Activity Limitation Indicator (GALI), mobility limitations (restriction in carrying a bag, climbing stairs, kneeling or walking), limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). For each one, we considered a moderate and a severe level of disability. To account for comorbidities, we assessed the contribution of chronic disorders to disability by using the average attributable fraction (AAF). Results Musculoskeletal conditions were the first contributor to moderate disabilities, whatever the disability indicator. Their impact on GALI (AAF 25.4%) and mobility limitations (26.9%) was higher than on ADL (17.8%) and IADL limitations (11%). Considering severe disability, AAFs were high for GALI (19.9%) and mobility limitations (28.3%) but low for ADL (0.0%) and IADL limitations (7.2%). Neurologic had a high contribution to ADL and IADL limitations, and their impact increased with the level of severity (AAF for moderate and severe ADL limitations: 16.5% and 28.3%; for IADL: 9.4% and 13.2%). The impact of cardiovascular diseases remained stable for all disability indicators and level of severity (AAF from 9.8% for severe mobility limitations to 16.2% for severe ADL limitations). The contribution of psychiatric conditions was high for GALI and IADL limitations, but low for mobility and ADL limitations (AAF for moderate and severe GALI: 6.7% and 10.6%; for IADL: 9.5% and 7.4%). Discussion – conclusion Musculoskeletal, neurologic, cardiovascular and psychiatric diseases mainly contribute to disability in France. Their respective impact vary according to the definition and the level of disability, what should be taken into account for interpreting results. [ABSTRACT FROM AUTHOR]

Background: The purpose of this study is to compare the ability of the Global Activity Limitation Indicator (GALI) and self-rated health (SRH) to predict all-cause mortality in the general adult population., Methods: We linked the 2001 Belgian Health Interview Survey with mortality and migration registers 2001-2010. The baseline sample included 8,583 individuals aged 15 years and older. Poisson regression models were used to estimate the effect of the GALI and SRH on mortality rate during follow-up. We investigated the impact of gender, age, education and follow-up period on the association between the GALI/SRH and mortality., Results: The GALI and SRH were strong and complementary predictors of mortality in the Belgian adult population. Although the two global instruments shared some traits, they predicted mortality concurrently, with some indication of a somewhat stronger effect for SRH. We found neither significant differences between men and women, nor between education groups. The predictive effect of the GALI and SRH slightly decreased over time and the predictive effect of SRH slightly decreased with age., Conclusions: Our findings suggest that the GALI and SRH are useful and complementary measures for assessing the health and functional status of adults in population surveys.