1. Nicolas Berger Herman Van Oyen
Assessing cross-national validity of the Global Activity Limitation Indicator (GALI)
Nicolas Berger
Herman Van Oyen
ESRA Conference, 19 July 2013
WIV-ISP Tuesday seminar
26 March 2013
Rue Juliette Wytsmanstraat 14 | 1050 Brussels | Belgium
T | F | |

2. Outline
Background
Objective
Methods
Results
Discussion

3. 1. Background

4. Healthy Life Years (HLY)
Life expectancy without disability in daily activities
Number of years that one can expect to live at the given age
Health state = generic term, many HEs. One of them is HLY, based on activity in daily living, calculation using the GALI. Obtained from annual Survey data (SILC: Statistics of Income and Living Conditions)
HLY indicator: used as explanatory variable for working capacities, predict health consumption, mortality
GALI DEVELOPPED IN THE CONTEXT OF HE;
ONLY HEALTH INDICATOR AT EU LEVEL

5. The GALI
For at least the last 6 months, to what extent have you been limited because of a health problem in activities people usually do? Would you say you have been:
Severely limited
Limited but not severely
Not limited
Recall: GALI= GLOBAL ACTIVITY LIMITATION INDICATOR
Four conceptual criteria
> 6 months of long- standing limitations
caused by a general health problem
usual activities = activities people usually do
severity of limitations is measured (at least 3 levels)

6. 2. Objective

7. Objective
The final objective is to measure the GALI and HLY accurately and in a comparable way.
This study investigates national variations in answering behaviours for the GALI in the adult EU population in order to validate and increase understanding of the GALI cross-nationally.
GIVEN THE IMPORTANC OF THE GALI FOR HLY, it is important to validate it
Past efforts/research:
Harmonization of the translation of the EU-SILC question in 2008
Assessment of Reliability and Validity in Belgium (Cox 2009; Van Oyen 2006)
Assessment of the Validity in older population in EU (Jagger, 2010)

8. 3. Methods

9. Approach Association GALI >< other measures of disability
Activity of Daily Living (ADL)
Instrumental Activity of Daily Living (IADL)
Physical functional limitations
No gold standard
Hypothesis: positive and comparable in all countries
Why? In disablement process, there are closely related;
(ADL) : (e.g. dressing)
(IADL) (e.g. shopping)
Physical functional limitations (e.g. walking)

10. Data European Health Interview Survey
Modules implemented in national health surveys
English questionnaire (translated according to protocol)
Variations: survey method, sampling method, question order
Available for 14 countries
Adult population
Sample size: 1, ,100
Response rate: 56.0% %
Participation comp
Relevance of meta-analysis
: BE, BG, CY, CZ, ES, FR, GR, HU, LV, MT, PL, RO, SI, SK
- Institutional population included in BE, CZ and MT
- (15 years and older)

11. Statistical Models
Logistic regression (per country) predictors: disability measure, gender, age
Random effect meta-analysis
NOTE : 1) the GALI was dichotomized (no activity limiation vs. one or more activity limitation)
2) Binary scores and counts of disability were both used to measure the predictors
…based on the odds ratios of the logistic regressions to assess the overall effect and heterogeneity between countries

12. 4. Results

13. Random Effect Meta-Analysis
ADL limitations
Slovakia excluded
dichotomized

14. Random Effect Meta-Analysis
IADL limitations
Slovakia and Romania excluded

15. Random Effect Meta-Analysis
Functional limitations

16. Random Effect Meta-Analysis
All odds ratios are significant which confirms the expected association between the GALI and the other disability measures in each country
ADL > IADL > Functional Limitations
Tests of heterogeneity are significant (P<0.001) : no homogeneous association with the GALI across countries

17. 5. Discussion

18. Explanations for the differences?
Survey effects : administration mode, question order, selection bias
Cross-cultural differences
predictors: interpretation of « limitations »
GALI: different understanding of the question or different response thresholds
Lack of harmonization;
If it’s a problem with the GALI: then we should increase it’s comparability; maybe modify the question.
=> more research is needed on the understanding of the GALI & its predictive power (on mortality, on health care consumption)

19. Thank you for your attention nicolas.berger@wiv-isp.be19

20. 6. Annex

21. Variables ADL eating transfer in-, out bed/chair dressing/undressing
using toilets
bathing/showering
Physical functional limitations
walking
climbing
squatting and kneeling
carrying in the hands or arms
fine hand use
biting and chewing
IADL
preparing meals
using the telephone
shopping
managing medication
light housework
occasional heavy housework
taking care of finances and everyday administrative tasks

22. Global Model
Probability distribution of the GALI against ADL

23. Global Model
Probability distribution of the GALI against IADL

24. Global Model
Probability distribution of the GALI against functional limitations

25. Global Model
Probability distribution of the GALI against other disability measures:
stronger association for ADL and IADL
GALI is broader than ADL, IADL or Functional Limitation separately
Functional limitation does not necessarily lead to GALI