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. 2021 Apr 24;11(4):e047388.
doi: 10.1136/bmjopen-2020-047388.

Gender inequality and the double burden of disease in low-income and middle-income countries: an ecological study

Mirte van der Ham  1 , Renee Bolijn  2 , Alcira de Vries  1 , Maiza Campos Ponce  3 , Irene G M van Valkengoed  1
Affiliations

Gender inequality and the double burden of disease in low-income and middle-income countries: an ecological study

Mirte van der Ham et al. BMJ Open. .

Abstract

Introduction: Many low-income and middle-income countries (LMIC) suffer from a double burden of infectious diseases (ID) and non-communicable diseases (NCD). Previous research suggests that a high rate of gender inequality is associated with a higher ID and NCD burden in LMIC, but it is unknown whether gender inequality is also associated with a double burden of disease. In this ecological study, we explored the association between gender inequality and the double burden of disease in LMIC.

Methods: For 108 LMIC, we retrieved the Gender Inequality Index (GII, scale 0-1) and calculated the double burden of disease, based on disability-adjusted life-years for a selection of relevant ID and NCD, using WHO data. We performed logistic regression analysis to study the association between gender inequality and the double burden of disease for the total population, and stratified for men and women. We adjusted for income, political stability, type of labour, urbanisation, government health expenditure, health infrastructure and unemployment. Additionally, we conducted linear regression models for the ID and NCD separately.

Results: The GII ranged from 0.13 to 0.83. A total of 37 LMIC had a double burden of disease. Overall, the adjusted OR for double burden of disease was 1.05 per 0.01 increase of GII (95% CI 0.99 to 1.10, p=0.10). For women, there was a borderline significant positive association between gender inequality and double burden of disease (OR 1.05, 95% CI 1.00 to 1.11, p=0.06), while there was no association in men (OR 0.99, 95% CI 0.95 to 1.04, p=0.75).

Conclusion: We found patterns directing towards a positive association between gender inequality and double burden of disease, overall and in women. This finding suggests the need for more attention for structural factors underlying gender inequality to potentially reduce the double burden of disease.

Keywords: epidemiology; public health; social medicine.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Gender inequality and the occurrence of double burden of disease among the total population, per country. LMIC, low-income and middle-income country; HIC, high-income countries.
Figure 2
Figure 2
Median disease burden (DALYs) of all included diseases, per tertile group of Gender Inequality Index (GII), stratified by sex. DALYs, disability-adjusted life-years.
See this image and copyright information in PMC

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