{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T05:00:52Z","timestamp":1790830852818,"version":"4.1.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020586","name":"storbyuniversitetet","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020586","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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\u2013morbidity composition in 25 EU member states from 2006 to 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2013between decomposition, restriction to the pre-pandemic period, and alternative education and macroeconomic specifications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Within-country changes in the GGGI were not significantly associated with the two primary summary outcomes: the age-standardized total DALY rate (\u03b2 = \u221219.1 per 0.01 increase;\n                      <jats:italic>p<\/jats:italic>\n                      = 0.575) or the YLL\/YLD ratio (\u03b2 = \u22120.0026;\n                      <jats:italic>p<\/jats:italic>\n                      = 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                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1950297","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T04:50:40Z","timestamp":1790830240000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Gender equality and disease burden in 25 EU member states, 2006\u20132023: a fixed-effects panel analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Adnan","family":"Kisa","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences and Technology, Kristiania University of Applied Sciences","place":["Oslo, Norway"]},{"name":"Department of International Health and Sustainable Development, Tulane University","place":["New Orleans, LA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sezer","family":"Kisa","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo Metropolitan University","place":["Oslo, Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2440","DOI":"10.1016\/S0140-6736(19)30652-X","article-title":"Gender inequality and restrictive gender norms: framing the challenges to health","volume":"393","author":"Heise","year":"2019","journal-title":"Lancet."},{"key":"B2","doi-asserted-by":"publisher","first-page":"2455","DOI":"10.1016\/S0140-6736(19)30765-2","article-title":"et al. 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