Public health
Stark differences between sexes in disease burden
A new study highlights the need for sex- and gender-informed strategies that recognise the unique health challenges faced by females and males.
Globally, there are substantial differences between females and males when it comes to health, with limited progress in bridging these health gaps over the past 30 years, according to a new study examining the disparities in the 20 leading causes of disease burden between females and males, published in The Lancet Public Health journal.
Non-fatal conditions that lead to health
loss through illness and disability, including musculoskeletal conditions, mental health conditions, and headache disorders, particularly affect females globally, while males are disproportionally affected by conditions that lead to more premature death, such as COVID-19, road injuries, cardiovascular diseases, and respiratory and liver diseases. Importantly, these health differences between females and males continue to grow with age, leaving females with higher levels of illness and disability throughout their lives, because they tend to live longer than males. The authors explain that ‘sex’ refers to the biological and physiological characteristics of females and males, while ‘gender’ pertains to the socially constructed roles, behaviours, and identities of women and men – as well as gender- diverse individuals – which are also shaped by historical and cultural contexts. These two factors interact, leading to different health and disease experiences among men and women. The study is a call to action for countries
to increase their reporting of sex and gender data and to use these data to overhaul their approach to health. It clearly highlights the need for sex- and gender-informed strategies that recognise the unique health challenges faced by females and males. The modelling research uses data from the Global Burden of Disease Study 2021 to compare the total number of life years lost to illness and premature death – a measurement known as
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disability-adjusted life years (DALYs) – for the 20 leading causes of disease in females and males older than 10 years at the global level and in seven world regions, between 1990 and 2021.1 The authors note that the analysis does not
include sex-specific health conditions, such as gynaecological conditions or prostate cancers, but does examine the health differences between conditions affecting both females and males. “The timing is right for this study and call to action – not only because of where the evidence is now, but because COVID-19 has starkly reminded us that sex differences can profoundly impact health outcomes,” says senior author Dr. Luisa Sorio Flor at the Institute for Health Metrics and Evaluation (IHME), University of Washington, US. “One key point the study highlights is how females and males differ in many biological and social factors that fluctuate and, sometimes, accumulate over time, resulting in them experiencing health and disease differently at each stage of life and across world regions. The challenge now is to design, implement, and evaluate sex- and gender-informed ways of preventing and treating the major causes of morbidity and premature mortality from an early age and across diverse populations.”
Males face a higher disease burden overall The analysis estimates that for 13 out of the top 20 causes of disease burden, including COVID-19, road injuries, and a range of cardiovascular, respiratory, and liver diseases, health loss was higher in males than females in 2021. For example, overall COVID-19 was the leading cause of health loss in 2021, with males experiencing 45% more health loss from COVID-19 than females (3,978 vs 2,211 age-standardised DALYs per 100,000). COVID-19 disproportionately affected men in all regions, with the widest sex difference observed in sub- Saharan Africa (10,559 vs 5,565 DALYs per 100,000) and Latin America and the Caribbean (8,124 vs 4,473 DALYs per 100,000). Ischaemic heart disease had the second
largest absolute difference in health loss between females and males, with males experiencing 45% more health loss from heart disease compared to females (3,599 vs 1,987 DALYs per 100,000) in 2021. The greatest difference was seen in Central Europe, Eastern Europe, and Central Asia, where males experienced a 49% higher burden than females (6,789 vs 3,456 DALYs per 100,000). For conditions with a disproportionate burden in males, such as ischaemic heart disease,
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