ArticleFrontiers in public health2026
Gender equality and disease burden in 25 EU member states, 2006-2023: a fixed-effects panel analysis.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Gender equality is widely regarded as a social determinant of population health, but most evidence is cross-sectional or based on differences between countries. Whether within-country changes in gender equality are associated with the magnitude or composition of disease burden remains unclear, particularly in high-income settings. Objective: To examine whether within-country changes in gender equality, measured by the Global Gender Gap Index (GGGI), were associated with age-standardized all-cause disease-burden magnitude and mortality-morbidity composition in 25 EU member states from 2006 to 2023. Methods: This ecological longitudinal study used country-level panel data from 25 EU member states, yielding 450 country-year observations. The GGGI was linked to Global Burden of Disease Study 2023 estimates of age-standardized DALY, YLL, and YLD rates and the YLL/YLD ratio. The main models were two-way fixed-effects regressions with country and year fixed effects, country-clustered standard errors, and adjustment for log GDP per capita, log health expenditure per capita, and mean years of schooling. Robustness was assessed using wild cluster bootstrap-t inference, Mundlak within-between decomposition, restriction to the pre-pandemic period, and alternative education and macroeconomic specifications. Results: Within-country changes in the GGGI were not significantly associated with the two primary summary outcomes: the age-standardized total DALY rate (β = -19.1 per 0.01 increase; Conclusions: In high-income EU countries between 2006 and 2023, within-country changes in gender equality were not detectably associated with all-cause age-standardized disease burden or the YLL/YLD ratio. This does not imply that gender equality is unrelated to population health. Rather, broad parity indicators may be too general or slow-moving to register in all-cause burden over this time horizon. Future research should link specific gender-equality domains to disease-specific, sex-specific, health-system-sensitive, and longer-lag outcomes.
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