In the original published version of this article, the author has identified some errors in the classification of dependency. They have made the corrections and re-analysis the data, and the results and conclusions continued to be consistent.
The code in the published version does not accurately represent the definition of functional dependencies (Table 1). Specifically, "low dependency" is defined as "difficulty in bathing, managing money, shopping for groceries, using the telephone, or cleaning the house, as well as no difficulty in any of the items defined as medium and high dependency". Inadvertently, the analysis failed to exclude individuals who did not report difficulties with the items covered by medium and high dependency criteria. Also, there is a discrepancy in the definition of "Medium dependency." The analysis did not account for participants who did not display difficulties in items of high dependency. As a result, the proportion of high dependency cases is currently lower than anticipated.
Revised Table 2.
Descriptive statistics in HRS, ELSA, SHARE, CHARLS, and MHAS.
| HRS (N = 49,583) | ELSA (N = 27,338) | SHARE (N = 96,184) | CHARLS (N = 23,342) | MHASa (N = 26,968) | |
|---|---|---|---|---|---|
| Age, median (Q1–Q3) | 72 (65–78) | 69 (64–76) | 70 (12–77) | 67 (63–72) | 69 (65–76) |
| Male gender | 20,469 (41.3) | 12,853 (47.0) | 42,160 (43.8) | 11,261 (48.2) | 11,854 (44.0) |
| Labour force status | |||||
| Currently not working | 36,479 (73.6) | 21,670 (79.3) | 78,390 (81.5) | 11,214 (48.0) | 19,162 (71.1) |
| Currently working without retirement | 10,404 (21.0) | 4846 (17.7) | 10,737 (11.2) | 11,095 (47.5) | 7806 (28.9) |
| Currently working after retirement | 2700 (5.45) | 822 (3.01) | 7057 (7.34) | 1033 (4.43) | |
| Education | |||||
| Less than upper secondary | 9381 (18.9) | 8003 (29.3) | 42,587 (44.3) | 21,649 (92.7) | 23,949 (88.8) |
| Upper secondary and vocational training | 28,989 (58.5) | 13,955 (51.0) | 33,529 (34.9) | 1363 (5.84) | 691 (2.56) |
| Tertiary | 11,213 (22.6) | 5380 (19.7) | 20,068 (20.9) | 330 (1.41) | 2328 (8.63) |
| Household wealth | |||||
| Low tertile | 14,998 (30.2) | 7464 (27.3) | 28,993 (30.1) | 7253 (31.1) | 10,825 (40.1) |
| Medium tertile | 14,974 (30.2) | 9423 (34.5) | 33,028 (34.3) | 9231 (39.5) | 7322 (27.2) |
| High tertile | 19,611 (39.6) | 10,451 (38.2) | 34,163 (35.5) | 6858 (29.4) | 8821 (32.7) |
| Married or partnered | 29,735 (60.0) | 19,171 (70.1) | 69,294 (72.0) | 18,341 (78.6) | 17,000 (63.0) |
| Co-residence with children | 7908 (15.9) | 224 (0.82) | 13,692 (14.2) | 9270 (39.7) | 18,302 (67.9) |
| Smoking | 5181 (10.4) | 2462 (9.01) | 13,667 (14.2) | 6294 (27.0) | 2689 (9.97) |
| Alcohol drinking | 25,587 (51.6) | 23,557 (86.2) | 47,555 (49.4) | 7245 (31.0) | 5905 (21.9) |
| Ever had hypertension | 32,657 (65.9) | 12,854 (47.0) | 52,886 (55.0) | 9456 (40.5) | 16,907 (62.7) |
| Ever had stroke | 4957 (10.0) | 1341 (4.91) | 7320 (7.61) | 1365 (5.85) | 1192 (4.42) |
| Ever had cancer | 8946 (18.0) | 3621 (11.9) | 10,595 (11.0) | 378 (1.62) | 1101 (4.08) |
| Depressive symptom | 10,314 (20.8) | 5057 (18.5) | 26,091 (27.1) | 8931 (38.3) | 8760 (32.5) |
| Cognitive impairment | 2275 (4.59) | 1047 (3.83) | 5117 (5.32) | 327 (1.40) | 1652 (6.13) |
| Digital exclusion | 26,394 (53.2) | 8316 (30.4) | 55,201 (57.4) | 22,622 (96.9) | 17,653 (65.5) |
| BADL, median (Q1–Q3) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–1) | 0 (0–0) |
| IADL, median (Q1–Q3) | 0 (0–0) | 0 (0–0) | 0 (0–0) | 0 (0–1) | 0 (0–0) |
| Difficulty in BADL | 0.42 (1.07) | 0.33 (0.90) | 0.26 (0.85) | 0.54 (1.16) | 0.45 (1.10) |
| Difficulty in IADL | 0.30 (0.82) | 0.31 (0.81) | 0.33 (0.95) | 0.72 (1.29) | 0.26 (0.73) |
| Functional dependency | |||||
| Independent | 38,780 (71.2) | 26,429 (72.7) | 85,775 (77.6) | 20,843 (57.0) | 20,666 (70.7) |
| Low dependency | 2674 (4.9) | 3002 (8.3) | 8886 (8.0) | 4201 (11.5) | 919 (3.2) |
| Medium dependency | 1639 (3.0) | 577 (1.6) | 2208 (2.0) | 2191 (6.0) | 568 (1.9) |
| High dependency | 11,412 (20.9) | 6351 (17.5) | 13,655 (12.4) | 9358 (25.6) | 7066 (24.2) |
BADL: basic activities of daily living; CHARLS: China Health and Retirement Longitudinal Study; ELSA: English Longitudinal Study of Ageing; HRS: Health and Retirement Study; IADL: instrumental activities of daily living; MHAS: Mexican Health and Aging Study; SHARE: Survey of Health, Ageing and Retirement in Europe.
Data are N (%) for categorical variables or mean (SD) or median (Q1–Q3) for continuous variables.
For MHAS, the question on retirement was unavailable, so labour force status was recoded into currently working and currently not working.
Revised Fig. 1.
Proportion of digital exclusion, difficulties in BADL, difficulties in IADL, and functional dependency.
Table 1.
Functional dependency by interval-of-need dependency categorization.
| Categories | Definition |
|---|---|
| High dependency | Difficulty in eating, dressing, getting in/out of bed, using the toilet, or walking |
| Medium dependency | Difficulty in preparing hot meals or taking medications, and no-difficulty in the items defined in high dependency |
| Low dependency | Difficulty in bathing, managing money, shopping for groceries, using the telephone, or cleaning the house, and no-difficulty in the items defined in medium and high dependency |
| Independent | No-difficulty in the items above |
Below, we take part of the Stata code for example to show the differences of generation of functional dependency variable. The variable r`wv'dependency was defined as functional dependency, where the values are categorized as follows: 0 for independence, 1 for low dependency, 2 for medium dependency, and 3 for high dependency. Variables including r`wv'dressa, r`wv'eata, r`wv'beda, r`wv'toilta, r`wv'walk100a, r`wv'medsa, r`wv'mealsa, r`wv'moneya, r`wv'shopa, r`wv'housewka, r`wv'phonea, r`wv'batha refers to items contributing to the determination of functional dependency. r`wv'adl and r`wv'iadl represent the count of difficulties in items related to activities of daily living (ADL) and instrumental activities of daily living (IADL), respectively. ADL and IADL variables include all the above variables contributing to the definition of functional dependency.
Original Stata code
forvalues wv = 2/4{
gen r`wv'dependency = .
replace r`wv'dependency = 3 if (r`wv'dressa == 1 | r`wv'eata == 1 | r`wv'beda == 1 | r`wv'toilta == 1 | r`wv'walk100a == 1)
replace r`wv'dependency = 2 if (r`wv'medsa == 1 | r`wv'mealsa == 1)
replace r`wv'dependency = 1 if (r`wv'moneya == 1 | r`wv'shopa == 1 | r`wv'housewka == 1 | r`wv'phonea == 1 | r`wv'batha == 1)
replace r`wv'dependency = 0 if (r`wv'adl == 0 & r`wv'iadl == 0)
}
Revised Stata code
forvalues wv = 2/4{
gen r`wv'dependency = .
replace r`wv'dependency = 0 if (r`wv'adl == 0 & r`wv'iadl == 0)
replace r`wv'dependency = 1 if (r`wv'moneya == 1 | r`wv'shopa == 1 | r`wv'housewka == 1 | r`wv'phonea == 1 | r`wv'batha == 1)
replace r`wv'dependency = 2 if (r`wv'medsa == 1 | r`wv'mealsa == 1)
replace r`wv'dependency = 3 if (r`wv'dressa == 1 | r`wv'eata == 1 | r`wv'beda == 1 | r`wv'toilta == 1 | r`wv'walk100a == 1)
}
Adjustments were made to the relevant results, including one figure and two tables in the main text, as well as one table in the appendix.
In general, there has been an increase in the proportion of individuals with high dependency while the proportions of other functional statuses have shown relative changes. In Table 4, we now observe the statistical significance of medium dependency in Health and Retirement Study (HRS) and high dependency in Mexican Health and Aging Study (MHAS).
Revised Table A1.
Distribution of digital exclusion, difficulties in BADL/IADL, and functional dependency of study participants by geographic regions.
| Digital exclusion | Difficulty in BADL | Difficulty in IADL | Functional dependency |
||||
|---|---|---|---|---|---|---|---|
| Independent | Low dependency | Medium dependency | High dependency | ||||
| HRS | |||||||
| United States | 53.2 | 19.6 | 16.3 | 71.2 | 4.9 | 3.0 | 20.9 |
| ELSA | |||||||
| England | 35.1 | 17.5 | 17.3 | 72.7 | 8.3 | 1.6 | 17.5 |
| SHARE | |||||||
| Austria | 59.3 | 11.2 | 17.0 | 77.9 | 8.9 | 1.9 | 11.2 |
| Germany | 52.1 | 11.7 | 13.6 | 80.8 | 6.5 | 1.5 | 11.3 |
| Sweden | 28.6 | 8.5 | 10.9 | 83.7 | 6.2 | 1.2 | 8.9 |
| Netherlands | 30.5 | 7.0 | 12.6 | 83.3 | 7.8 | 1.8 | 7.2 |
| Spain | 79.9 | 13.0 | 17.2 | 75.7 | 7.3 | 2.8 | 14.2 |
| Italy | 79.5 | 12.3 | 13.7 | 79.7 | 6.3 | 1.6 | 12.5 |
| France | 51.3 | 14.4 | 17.7 | 74.9 | 9.8 | 1.4 | 14.0 |
| Denmark | 23.8 | 8.5 | 13.1 | 81.5 | 6.9 | 2.3 | 9.4 |
| Greece | 83.0 | 8.9 | 16.0 | 81.9 | 9.1 | 1.2 | 7.8 |
| Switzerland | 37.9 | 6.7 | 8.7 | 87.0 | 5.7 | 1.1 | 6.2 |
| Belgium | 47.1 | 16.8 | 20.9 | 70.4 | 12.0 | 2.5 | 15.0 |
| Israel | 52.9 | 13.9 | 25.0 | 68.3 | 10.4 | 4.7 | 16.6 |
| Czech Republic | 60.7 | 13.7 | 16.6 | 76.2 | 8.1 | 2.1 | 13.6 |
| Poland | 84.6 | 17.4 | 24.1 | 72.6 | 9.7 | 1.7 | 16.0 |
| Luxembourg | 49.5 | 11.0 | 15.1 | 79.4 | 6.6 | 2.1 | 11.9 |
| Portugal | 82.2 | 25.5 | 21.2 | 68.2 | 6.0 | 2.7 | 23.1 |
| Slovenia | 72.1 | 11.9 | 14.8 | 79.5 | 6.2 | 2.0 | 12.3 |
| Estonia | 67.4 | 17.8 | 21.6 | 71.5 | 10.0 | 2.4 | 16.1 |
| Croatia | 80.0 | 11.5 | 12.2 | 82.1 | 5.3 | 1.7 | 11.0 |
| CHARLS | |||||||
| China | 96.9 | 25.7 | 33.1 | 57.0 | 11.5 | 6.0 | 25.6 |
| MHAS | |||||||
| Mexico | 65.5 | 21.5 | 15.0 | 70.7 | 3.2 | 1.9 | 24.2 |
BADL: basic activities of daily living; CHARLS: China Health and Retirement Longitudinal Study; ELSA: English Longitudinal Study of Ageing; HRS: Health and Retirement Study; IADL: instrumental activities of daily living; MHAS: Mexican Health and Aging Study; SHARE: Survey of Health, Ageing and Retirement in Europe.
Revised Table 4.
Association between digital exclusion and functional dependency.
| HRS |
ELSA |
SHARE |
CHARLS |
MHAS |
|||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RRR | 95% CI | p value | RRR | 95% CI | p value | RRR | 95% CI | p value | RRR | 95% CI | p value | RRR | 95% CI | p value | |
| Independent | Ref | Ref | Ref | Ref | Ref | ||||||||||
| Low dependency | 1.59 | (1.25–2.04) | <0.001 | 0.97 | (0.75–1.26) | 0.812 | 1.06 | (0.84–1.33) | 0.639 | 1.31 | (0.52–3.35) | 0.567 | 0.78 | (0.57–1.08) | 0.131 |
| Medium dependency | 1.85 | (1.28–2.66) | 0.001 | 1.52 | (0.79–2.93) | 0.212 | 1.19 | (0.69–2.06) | 0.527 | 1.14 | (0.38–3.42) | 0.820 | 0.73 | (0.47–1.12) | 0.151 |
| High dependency | 1.33 | (1.11–1.59) | 0.002 | 1.05 | (0.81–1.36) | 0.717 | 1.09 | (0.87–1.37) | 0.461 | 1.58 | (0.69–3.58) | 0.277 | 0.80 | (0.68–0.95) | 0.009 |
CHARLS: China Health and Retirement Longitudinal Study; CI: confidence interval; ELSA: English Longitudinal Study of Ageing; HRS: Health and Retirement Study; MHAS: Mexican Health and Aging Study; RRR: relative-risk ratio; SHARE: Survey of Health, Ageing and Retirement in Europe.
Models were adjusted for the minimal sufficient adjustment set (MSAS) identified using a causal directed acyclic graph (DAG) including gender, age, education, labour force status, marital status, household wealth, and co-residence with children.
Contributor Information
Yao Yao, Email: yao.yao@bjmu.edu.cn.
Yinzi Jin, Email: yzjin@bjmu.edu.cn.