Cross-national data on informal caregivers of older people with long-term care needs in the European population: time for a more coordinated and comparable approach

To promote long-term care policies for older adults, accurate mapping of the often invisible and insufficiently recognized role of their informal caregivers is needed. This paper measures the prevalence of informal caregivers in the European population, illustrates current difficulties in gathering unequivocal information on this topic and deals with the scientific and policy implications of the problem. Using the European Health Interview Survey (EHIS), the European Quality of Life Survey (EQLS) and the Study on Health and Ageing in Europe (SHARE), the current difficulties in gathering unequivocal information on this topic are illustrated. In most countries, the share of informal caregivers varies, sometimes markedly, among the three surveys. As for the sex of caregivers, while confirming the well-known higher prevalence of caregivers among women than among men, large variations emerge across the three surveys in most countries in respect of the two sexes. The takeaway message of the paper is that it is urgent to promote international concerted action in gathering comprehensive informal caregiving information and/or exploring in greater depth the different intercultural understandings of informal care itself.

Reliability and Validity of Slovenian Versions of IPAQ-SF, GPAQ and EHIS-PAQ for Assessing Physical Activity and Sedentarism of Adults

Health policies rely on physical activity (PA) and sedentary behavior data collected through PA questionnaires (PAQs). Validity of international PAQs varies among countries. Therefore, it is important to know the validity of the national versions of the PAQs to properly evaluate the results. We conducted a validation study of the Slovenian versions of the International PAQ Short Form (IPAQ-SF), the Global PAQ (GPAQ), and the PAQ used in the European Health Interview Survey (EHIS-PAQ) on 306 healthy adults. The most valid and reliable constructs in all tested were sedentary behavior and vigorous PA (VPA), however the criterion validity of these constructs was low (Spearman’s ρ 0.38–0.45 for sedentary behavior and 0.34–0.42 for VPA). Moderate to vigorous PA (MVPA) had low validity (0.26–0.29) despite being used as a standard measure of PA behavior. Participants over-reported MVPA for 17 to 156 min and underreported the sedentary behavior for more than two hours. The test-retest study found high reliability for sedentary behavior (0.69–0.81) and low to moderate reliability for PA behavior (0.42–0.76). The Slovenian versions of the observed PAQs are a useful tool for national PA surveillance, but for qualitative assessment of individual health-related PA behavior they should be combined with accelerometer-based devices.

Impact of Policies in Nutrition and Physical Activity on Diabetes and Its Risk Factors in the 28 Member States of the European Union

Since healthy eating and physically active lifestyles can reduce diabetes mellitus (DM) risk, these are often addressed by population-based interventions aiming to prevent DM. Our study examined the impact of nutritional and physical activity policies, national diabetes plans and national diabetes registers contribute to lower prevalence of DM in individuals in the member states of the European Union (EU), taking into account the demographic and socioeconomic status as well as lifestyle choices. Datasets on policy actions, plans and registers were retrieved from the World Cancer Research Fund International’s NOURISHING and MOVING policy databases and the European Coalition for Diabetes report. Individual-based data on DM, socioeconomic status and healthy behavior indicators were obtained via the European Health Interview Survey, 2014. Our results showed variation in types and numbers of implemented policies within the member states, additionally, the higher number of these actions were not associated with lower DM prevalence. Only weak correlation between the prevalence of DM and preventive policies was found. Thus, undoubtedly policies have an impact on reducing the prevalence of DM, its increasing burden could not be reversed which underlines the need for applying a network of preventive policies.

Weight Status and Depression in Italy: Evidence from the Second Wave of the European Health Interview Survey

This study tests the association between weight status and depression in Italy using the Second Wave of the European Health Interview Survey (EHIS2) microdata, which also provide information on weight/height and eight depressive symptoms. Using a probit regression, the empirical results show a strong positive association between weight status, proxied by body mass index, and sleep troubles and eating disorders, with females suffering more than males. In addition, low interest is negatively associated with medium and high sources of income, while depressive mood and sense of failure are negatively associated with employment status. Individuals in midlife (45–54 years old) suffer from all depressive symptoms more than those in other age classes, with females suffering more than males, with the exception of low interest and depressive mood. Furthermore, individuals with a higher level of education have a lower likelihood of suffering from all depressive symptoms. These findings suggest that policies aimed at reducing obesity rates could also reduce new and emerging types of depressive symptoms correlated with overweight/obesity, such as sleep troubles and eating disturbances. JEL: J24, I12, I1, C25

Investigating unmet need for healthcare using the European Health Interview Survey: a cross-sectional survey study of Luxembourg

ObjectivesWe investigate the prevalence of unmet need arising from wait times, distance/transportation and financial affordability using the European Health Interview Survey. We explore associations between individual characteristics and the probability of reporting unmet need.DesignCross-sectional survey conducted between February and December 2014.Setting and participants4004 members of the resident population in private households registered with the health insurance fund in Luxembourg aged 15 years and over.Outcome measuresSix binary variables that measured unmet need arising from wait time, distance/transportation and affordability of medical, dental and mental healthcare and prescribed medicines among those who reported a need for care.ResultsThe most common barrier to access arose from wait times (32%) and the least common from distance/transportation (4%). Dental care (12%) was most often reported as unaffordable, followed by prescribed medicines (6%), medical (5%) and mental health (5%) care. Respondents who reported bad/very bad health were associated with a higher risk of unmet need compared with those with good/very good health (wait: OR 2.41, 95% CI 1.53 to 3.80, distance/transportation: OR 7.12, 95% CI 2.91 to 17.44, afford medical care: OR 5.35, 95% CI 2.39 to 11.95, afford dental care: OR 3.26, 95% CI 1.86 to 5.71, afford prescribed medicines: OR 2.22, 95% CI 1.04 to 4.71, afford mental healthcare: OR 3.58, 95% CI 1.25 to 10.30). Income between the fourth and fifth quintiles was associated with a lower risk of unmet need for dental care (OR 0.29, 95% CI 0.16 to 0.53), prescribed medicines (OR 0.38, 95% CI 0.17 to 0.82) and mental healthcare (OR 0.17, 95% CI 0.05 to 0.61) compared with income between the first and second quintiles.ConclusionsRecent and planned reforms to address waiting times and financial barriers to accessing healthcare may help to address unmet need. In addition, policy-makers should consider additional policies targeted at high-risk groups with poor health and low incomes.

The epidemiology of muscle-strengthening activity among adolescents from 28 European countries

Aims: This study aimed to describe the prevalence and socio-demographic and lifestyle-related correlates of muscle-strengthening activity (MSA; strength/resistance training, sit-ups/push-ups, etc.) among a large sample of European adolescents. Methods: Data were drawn from the European Health Interview Survey Wave 2 (2013–2014), including 8818 adolescents (15–17 years) from 28 European countries. Self-reported MSA was assessed using a previously validated survey item. Population-weighted prevalence ratios were calculated for (a) ‘none’ (0 days/week), (b) ‘insufficient MSA’ (1–2 days/week) or (c) ‘sufficient MSA’ (⩾3 days/week). Generalised linear models using Poisson regression with robust error variance were used to calculate the prevalence ratios for adolescents reporting sufficient MSA by socio-demographic/lifestyle characteristics and by European region. Results: Overall, 19.4% (95% confidence interval (CI) 18.3–20.7) reported sufficient (⩾3 days/week) MSA and 57.9% (95% CI 56.4–59.6) reported none. Females, adolescents from Southern and Eastern European regions, those not meeting the aerobic guideline and adolescents classified as overweight were significantly associated with a lower likelihood of reporting sufficient MSA, independent of other characteristics. Conclusions: The majority of European adolescents do not meet the MSA guidelines. Future large-scale MSA public-health interventions should target female and currently inactive adolescents, as well as those from Southern and Eastern European regions.

Diabetes Mellitus and Associated Factors in Slovakia: Results from the European Health Interview Survey 2009, 2014, and 2019

Diabetes mellitus (DM) is a high-risk non-communicable disease with an emerging burden for the European Union (EU) member states in the past decades. The unfavorable trend of the burden is striking compared to the declining disease burden due to cardiovascular diseases or stagnation of neoplasms. The goal of this study is to describe the temporal changes of diabetes in the adult population of Slovakia through the three European Health Interview Survey (EHIS) waves and to assess the association between DM and socioeconomic and/or lifestyle characteristics. These cross-sectional studies were carried out using microdata derived from Slovakia’s EHISs conducted in the years 2009 (n = 4972), 2014 (n = 5490), and 2019 (n = 5527). The DM variable was compared to the independent variables such as sociodemographic and lifestyle characteristics including dietary patterns and physical activity. DM prevalence for the EHIS in 2009, 2014, and 2019 were 6.1%, 8.2%, and 9.8%, respectively. In bivariate analysis, the relationship between DM and age, education level, job status, BMI, walking for at least 10 min, and physical activity was significant in the three EHISs. In 2014 and 2019, there was an inverse association between the risk of DM and walking regularly. There was no association between the frequency of eating fruits or vegetables and DM, with the exception of 2009, where a negative association between eating vegetables one to six times a week and DM was observed. Present health policies and activities in Slovakia were unable to reverse the increasing DM burden, indicating that a more systematic approach is needed. Complex policy strategies and legislative measures must be developed and implemented at both the national and EU levels.

Health status and health behaviour of the Hungarian homeless people

Background Homelessness has risen recently in Europe, but there is lack of comprehensive health data on this population. Our aim was to characterize the health of the Hungarian homeless population. Methods We performed a health survey with 453 homeless individuals. The results were compared to the age and sex standardized data of the general Hungarian population and its lowest income quintile from the European Health Interview Survey 2014. The differences by the ETHOS classification within the homeless population were also studied. Results Significantly fewer homeless people reported good health status than in the general population or in its lowest income quintile (p< 0.001). Of the participants 70% had at least one chronic disease, only 41% of them visited a GP and 35% took medication in the previous 12 months. While 59% of the lowest income quintile and 50% of the general population had at least one chronic disease, almost all of them visited a physician and took medication. The highest prevalence of morbidity (80%) and multimorbidity (46%) was reported in the houseless group. The majority of the homeless people were current smokers, the prevalence was much higher than in the two reference populations (p< 0.001). The prevalence of heavy drinkers was the highest among the roofless participants (40%). Conclusions Homeless people have much poorer health and they utilize health services less than the most disadvantaged quintile of the general population. There is a clear social gradient within the homeless population, as well, which calls for integrated approaches for specific interventions to improve their health.

Desigualdades socioeconómicas en salud en la Argentina e Italia en 2015-2018

En la literatura hay una falta de investigación acerca de las desigualdades en salud en Sudamérica y sus diferencias con respecto a las de los países desarrollados. Como en Italia se han registrado tendencias similares en los últimos años y muestra similaridades con la Argentina, se ha decidido utilizar el país mediterráneo con fines comparativos. La hipótesis planteada consistió en que, más allá de las diferencias estructurales, las desigualdades en salud presentarían patrones similares en ambos países, caracterizados por una economía capitalista. Los grupos sociales en posiciones educativas y ocupacionales favorables exhibirían un mejor estado de salud que los grupos desfavorecidos. Se presentaron algunas estadísticas descriptivas sobre la situación general en los dos países, y luego se analizaron datos provenientes de dos encuestas que recolectan información individual sobre condiciones sociales y estados de salud (EDSA, de 2017 a 2018, y “EHIS - European Health Interview Survey”, ISTAT, 2015). Los resultados muestran que la Argentina e Italia poseen diferentes niveles de bienestar, tasa de mortalidad y servicios de salud, pero que las disparidades relativas en salud parecen muy similares, confirmando la hipótesis de Marmot (2017) sobre la forma general de las desigualdades en salud. Trabajadores manuales y precarios, particularmente las personas desempleadas, sistemáticamente presentan un peor estado de salud percibido con respecto a las clases sociales más altas.