title: Assessing the validity of the Global Activity Limitation Indicator in fourteen European countries.
abstract: BACKGROUND
  The Global Activity Limitation Indicator (GALI), the measure underlying the European indicator Healthy Life Years (HLY), is widely used to compare population health across countries. However, the comparability of the item has been questioned. This study aims to further validate the GALI in the adult European population.
  
  
  METHODS
  Data from the European Health Interview Survey (EHIS), covering 14 European countries and 152,787 individuals, were used to explore how the GALI was associated with other measures of disability and whether the GALI was consistent or reflected different disability situations in different countries.
  
  
  RESULTS
  When considering each country separately or all combined, we found that the GALI was significantly associated with measures of activities of daily living, instrumental activity of daily living, and functional limitations (P < 0.001 in all cases). Associations were largest for activity of daily living and lowest though still high for functional limitations. For each measure, the magnitude of the association was similar across most countries. Overall, however, the GALI differed significantly between countries in terms of how it reflected each of the three disability measures (P < 0.001 in all cases). We suspect cross-country differences in the results may be due to variations in: the implementation of the EHIS, the perception of functioning and limitations, and the understanding of the GALI question.
  
  
  CONCLUSIONS
  The study both confirms the relevance of this indicator to measure general activity limitations in the European population and the need for caution when comparing the level of the GALI from one country to another.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Berger
authors.affiliation: Public Health and Surveillance, Scientific Institute of Public Health, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium. hvanoyen@wiv-isp.be.
authors.forename: Herman
authors.initials: H
authors.lastname: Van Oyen
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Cambois
authors.forename: Tony
authors.initials: T
authors.lastname: Fouweather
authors.forename: Carol
authors.initials: C
authors.lastname: Jagger
authors.forename: Wilma
authors.initials: W
authors.lastname: Nusselder
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Robine
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D003625:Data Collection; D004185:Disability Evaluation; D005060:Europe; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires