There are large variations between chronic diseases in the size and pattern of socioeconomic differences in their prevalence. The large inequalities that are found for some specific fatal diseases (e.g. stroke) and non-fatal diseases (e.g. arthritis) require special attention in equity-oriented research and policies.

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ObjectivesTo evaluated the female–male health–survival paradox by estimating the contribution of women’s mortality advantage versus women’s disability disadvantage.MethodsDisability prevalence was measured from the 2006 Survey on Income and Living Conditions in 25 European countries. Disability prevalence was applied to life tables to estimate healthy life years (HLY) at age 15. Gender differences in HLY were split into two parts: that due to gender inequality in mortality and that due to gender inequality in disability. The relationship between women’s mortality advantage or disability disadvantage and the level of population health between countries was analysed using random-effects meta-regression.ResultsWomen’s mortality advantage contributes to more HLY in women; women’s higher prevalence of disability reduces the difference in HLY. In populations with high life expectancy women’s advantage in HLY was small or even a men’s advantage was found. In populations with lower life expectancy, the hardship among men is already evident at young ages.ConclusionsThe results suggest that the health–survival paradox is a function of the level of population health, dependent on modifiable factors.

I ncreases in life expectancy make remaining free of disease and in good functional health for as long as possible an important objective for the present and future generations.1 Most research in this domain has focused on risk factors for single health outcomes, such as mortality, chronic diseases or functioning. However, good health at older ages is a multidimensional concept, having been defined variously with reference to absence of disease and good functional status. [2][3][4][5] There is considerable research on disability outcomes at older ages, 2,6-8 but less attention has been paid to successful aging combining favourable functioning outcomes with good mental health and the absence of chronic diseases and disability. [9][10][11][12][13] Smoking, alcohol consumption, poor diet and physical inactivity are among the top 10 leading risk factors for death and disability in intermediate-and high-income countries.14 There is increasing interest in the combined effect of these behaviours on health. Studies show that people who engage in multiple unhealthy behaviours have a higher risk of death, 15-23 chronic disease 24-30 and poor cognitive function than people who do not engage in as many unhealthy behaviours. 31 However, whether healthy behaviours determine good functional status at older ages, combined with the absence of chronic diseases, remains unknown.Our objective was to examine the extent to which individual and combined healthy behaviours in midlife predict successful aging about 16 years later, at 60 years of age or older. We used a comprehensive definition of successful aging that included having good mental health, having good cognitive, physical and cardiorespiratory function, and being free of disability and chronic disease (coronary artery disease, stroke, diabetes and cancer).

BackgroundThe 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.MethodsData 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.ResultsWhen 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.ConclusionThe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2288-15-1) contains supplementary material, which is available to authorized users.