Abstract
ObjectivesTo assess the sensitivity of prevalence and inequality estimates of Global Activity Limitation Indicator (GALI) to the choice of survey in European countries.MethodsWe use logistic regression to estimate adjusted risk ratios, quantifying differences in prevalence and educational inequalities, the impact of survey characteristics and Kendall’s tau to assess similarity in country rankings between surveys. We include the European Health Interview Survey (EHIS), European Social Survey (ESS) and European Union Statistics on Income and Living Conditions (EU-SILC).ResultsEHIS estimates higher prevalence than EU-SILC 17% (men) and 23% (women), and ESS 24% (men) and 29% (women). Prevalence does not differ significantly between EU-SILC and ESS. EU-SILC estimates 52.5% (men) and 28.1% (women) higher inequalities than EHIS and 63.2% (men) and 32.7% (women) higher inequalities than ESS. Survey characteristics do not account for differences in prevalence or inequalities. Country rankings do not agree for prevalence or inequalities.ConclusionsSurvey choice strongly impacts estimates of GALI prevalence and educational inequalities. Further study is necessary to understand these discrepancies. Caution is required when using these surveys for cross-country comparisons of (educational inequalities in) GALI disability.
Highlights
Composite health metrics that combine data on mortality and health into a single measure of health expectancy are increasingly used to describe and understand changes in population health (Hyder et al 2012; Brønnum-Hansen et al 2015)
Caution is required when using these surveys for cross-country comparisons of Global Activity Limitation Indicator (GALI) disability
The adjusted risk ratios (ARRs) using as reference EU-Survey Income Living Conditions (EU-SILC) indicate that European Health Interview Survey (EHIS) provides statistically significantly higher prevalence estimates for 11 of the 15 countries, while European Social Survey (ESS) yields lower prevalence for 2 countries (Belgium, Cyprus) and no significant difference for the 2 remaining countries (Greece, Romania)
Summary
Composite health metrics that combine data on mortality and health into a single measure of health expectancy are increasingly used to describe and understand changes in population health (Hyder et al 2012; Brønnum-Hansen et al 2015). The construction of these measures requires selecting from a range of health indicators. The GALI has been shown to have good and sufficient concurrent and predictive validity, and reliability as well as fitting all conceptual characteristics of a global measure of participation restriction (Van Oyen et al 2018). It is unknown whether different surveys that measure the GALI indicator lead to similar conclusions regarding prevalence and educational inequalities. Surveys differ in various characteristics, including sampling design, method of data collection, response rate, whether or not proxy
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