{
  "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.\n\nObjective: 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.\n\nMethods: 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.\n\nResults: 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; p = 0.575) or the YLL/YLD ratio (β = −0.0026; p = 0.296). The same null pattern was observed for YLL, YLD, and sex-specific outcomes. The conclusions were unchanged across robustness and sensitivity analyses. A negative cross-country gradient did not persist after adjustment, and within- and between-country coefficients could not be statistically distinguished.\n\nConclusions: 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.",
  "abstract_shown": true,
  "affiliations": [
    "Faculty of Health Sciences and Technology, Kristiania University of Applied Sciences , ,",
    "Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University , ,"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 2,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Adnan Kisa"
    },
    {
      "affs": [
        1
      ],
      "name": "Sezer Kisa"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dt2f408ym2kwd.bib",
  "cited_by": 0,
  "doi": "10.3389/fpubh.2026.1950297",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668557/?tool=EBI",
  "id": "dt2f408ym2kwd",
  "issns": [
    "2296-2565"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13668557",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "3312|Gender, Health, and Social Inequality"
    ]
  ],
  "openalex": "W7215082851",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668557/pdf/?tool=EBI",
  "pmcid": "PMC13668557",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/dt2f408ym2kwd.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:18Z",
      "native_id": "PMC:PMC13668557",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13668557"
    },
    {
      "first_seen": "2026-10-30T12:20:22Z",
      "native_id": "10.3389/fpubh.2026.1950297",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fpubh.2026.1950297/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "issn:2296-2565",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Gender equality and disease burden in 25 EU member states, 2006–2023: a fixed-effects panel analysis",
  "title_text": "Gender equality and disease burden in 25 EU member states, 2006–2023: a fixed-effects panel analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:22Z",
  "url": "https://research.draconitic.com/paper/dt2f408ym2kwd",
  "venue": "Frontiers in public health",
  "versions": []
}