PMID- 33895719
OWN - NLM
STAT- MEDLINE
DCOM- 20210520
LR  - 20210520
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 11
IP  - 4
DP  - 2021 Apr 24
TI  - Gender inequality and the double burden of disease in low-income and 
      middle-income countries: an ecological study.
PG  - e047388
LID - 10.1136/bmjopen-2020-047388 [doi]
LID - e047388
AB  - 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.
CI  - (c) Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - van der Ham, Mirte
AU  - van der Ham M
AD  - Department of Public and Occupational Health, Amsterdam UMC, University of 
      Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
FAU - Bolijn, Renee
AU  - Bolijn R
AUID- ORCID: 0000-0002-0803-6118
AD  - Department of Public and Occupational Health, Amsterdam UMC, University of 
      Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands r.bolijn@amsterdamumc.nl.
FAU - de Vries, Alcira
AU  - de Vries A
AD  - Department of Public and Occupational Health, Amsterdam UMC, University of 
      Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
FAU - Campos Ponce, Maiza
AU  - Campos Ponce M
AD  - Department of Health Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1091, 
      Amsterdam, The Netherlands.
FAU - van Valkengoed, Irene G M
AU  - van Valkengoed IGM
AD  - Department of Public and Occupational Health, Amsterdam UMC, University of 
      Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20210424
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
SB  - IM
MH  - Cost of Illness
MH  - *Developing Countries
MH  - Female
MH  - Humans
MH  - Income
MH  - Male
MH  - *Noncommunicable Diseases/epidemiology
MH  - Poverty
MH  - Socioeconomic Factors
PMC - PMC8074552
OTO - NOTNLM
OT  - epidemiology
OT  - public health
OT  - social medicine
COIS- Competing interests: None declared.
EDAT- 2021/04/26 06:00
MHDA- 2021/05/21 06:00
PMCR- 2021/04/24
CRDT- 2021/04/25 20:48
PHST- 2021/04/25 20:48 [entrez]
PHST- 2021/04/26 06:00 [pubmed]
PHST- 2021/05/21 06:00 [medline]
PHST- 2021/04/24 00:00 [pmc-release]
AID - bmjopen-2020-047388 [pii]
AID - 10.1136/bmjopen-2020-047388 [doi]
PST - epublish
SO  - BMJ Open. 2021 Apr 24;11(4):e047388. doi: 10.1136/bmjopen-2020-047388.