The French experience with G eneral a ctivity L imitation i ndicator 6 th Tasf Force on health expectancies. June 2 d 2OO8

A research programme to list all the existing single questions, scientific material, survey data and analysis and make a proposal: Context of the GALI question « Are you limited, for at leat the past 6 mounth, in activities people usaully do » Severely; To some extend; No, not limited An increasing need for comparable information on disability in Europe The question has been disseminated in Europe, being used in SILC and various national surveys (French and Belgian HIS) – Need for a short-single question which intends to reflect the level & trends in disability in the EU populations, – To collect data on difficulties in daily activities, with no reference to specific age or people usual activities – To account for severity level being able to have both a large definition and a restricted one

Such questions screen a selected part of the population, even among those who should be captured Wording is important and orient the interpretation … is source of variability in understanding and inclination to report Conclusions on level, trends, disparities depends on how people understand the question and who are the “limited” Who report “being limited”? Research has to be conducted to better qualify the population reporting « limitations »

1. To define the disability situations of people reporting GALI as regard to the disability conceptual framework 2. To assess the variability in self-report, according to various sociodemographic variables Objectives of the study Ø We mobilise the various disability questions of the French-HIS and propose a “gold standard” defined on the basis of disablement process models Ø We analyse the specificity of the GALI referring to the “gold- standard” Ø We finally compare GALI in French-SILC and in the French-HIS

Disability concepts Diseases Injuries Mal- formation Impair- ment Social disadvantage or Restriction of participation DEPENDENCY Macular degenerescence Alteration of the vision central Need help for daily shopping… Do not go out and visit friend body functions and activities Disability Difficulty to see small details Cannot drive Different situations and needs…

Difficulty or unable to care for him/herself, to care for accomodation, to work… Difficulty to see, to walk, to climb stairs… Functional limitations (Sensory, physical…) Activity Restrictions Disability Assistive devices Accomodation… Daily assistance for personal care, pension… Activity Restrictions Functional limitations (Sensory, physical…) Disability measures: Diseases Injuries Mal- formation GaLi operationalization of the model Construction of a GOLD-STANDARD to compare groups with/without GaLi No Chronic conditions or compensated functional limitations (no consequences) Residual functional limitations (no activity restrictions) Activity restriction Work, chore (no ADL-AR) ADL Assistive devices Accomodation… + Assistance+ Daily care ? Daily care, pension, Disability status, inactivity Social dis- advantage

The French national health interview survey French health interview survey men and women / adults (18 years and older) Self-reported diseases, disability and medical consumption Disability: various perceptions, various experiences, various needs GaLi: self-perceived dysfuntions in activities Self-reported work limitation due to health problems Self-reported activity restriction (household / personal care activities) Sensory and physical functional limitations

GaLi in the HIS : description Prevalence of GaLi, by sex and by age 15% of the adult population report long term activity limitations Women report more limitations than men at each age Limitations increase with age

Age-standardized prevalence of GaLi, by occupational status GaLi in the HIS : description Significant inequalities with the population linked to occupational classes

GaLi and other indicators, men and women 20+ GaLi in the HIS : description More than twice as much diseases, occupational disruptions, disability status

 Does GALI capture people with disability / what type of disability?  Are people with « disability » captured GaLi?  Who is better captured by GaLi? GaLi in the HIS : Gold-standard

21 % 41 % 20 % 3%3% 16 % 15 % 39 % 21 % 4%4% 20 % GaLi Ø People with GaLi mostly have significant functional problems Ø Activity limitations are mainly activity restriction Ø Good specificity: 95% have Funct pb / 92% have AR / 88% have ADL  Does GALI capture people with disability / what type of disability ? 4%4% 16 % 15 % 23 % 42 % 3%3% 13 % 15 % 30 % 39 % Men Women No Conditions or compensated FL (no consequences) Residual FL (no AR) AR (no ADL) ADL GaLi in the HIS : Gold-standard

 Are people with « disability » captured GALI?  among the 20 years+ with disability (1/3 of the population)  among with Act Rest (20%)  among with ADL (4%) Ø A number of persons with problems do not report being limited Ø mostly people with no activity restriction Ø Sensitivity improves with restriction severity and with age GaLi in the HIS : Gold-standard  Is GaLi well representative of people with disability?

 GaLi: Who is better captured ? Are more prone to report being limited : Women compared to men Elderly compared to younger people Those who have or wait for administrative status (occupationally inactive people) GaLi in the HIS : Gold-standard

GaLi in the French SILC versus GaLi in HIS Ø Exactly the same wording in EU-SILC 2004 Ø … but not the same answer categories: SILC deals with the severity level while HIS is a Yes/No cathegory Much less people selected with the HIS-GaLi…

HIS-GaLi captures only a selection of the limited people compared to SILC, The more answer categories the more people concerned No mean to compare … BUT the selection could be more on the moderate level in France GaLi in the French SILC versus GaLi in HIS

Summary GaLi description:  15% of the adult population report being limited in France in 2003  The prevalence increases with age  Women report more being limited than men do  Large social differences in limitations in defavor of manual occupations  GaLi goes along with more diseases, disability status, work problems GaLi vs Gold standard:  GaLi captures people with problems, mainly activity restrictions  GaLi captures half of the people reporting activity restrictions (75% for ADL)  GaLi better captures women, people with admi disability status,  … but no differences for education or occupation GaLi HIS vs GaLi SILC:  GaLi SILC might be more precise with distinction of the severity levels