Women's Excess Disease Burdens
The 2001 global burden-of-disease data underestimate both women's and men's disease burdens because of the incompleteness of health statistics, especially in the developing world. This underestimation is probably more pronounced for women because they experience more disability—which is less well recorded than mortality—than men. This underestimation is aggravated by underreporting resulting from the stigma associated with certain diseases in women, such as sexual infections; the prevalence of asymptomatic illness, such as sexually transmitted infections among women; the differences in health-seeking behaviors that favor males accessing formal health care, which is the main source for health statistics; and the exclusion of some conditions that affect only women, such as FGM, from global burden-of-disease estimations (Hanson 2002). Thus, the findings in the preceding section may be affected by a quality problem, and the estimates in this section are probably conservative.
Table 10.2 breaks down 11 conditions specific to women by region. In 2001, conditions specific to women accounted for 5.3 percent of women's total DALY losses, compared with 0.7 percent for two conditions (prostate cancer and benign prostate hypertrophy) specific to men.2 Most causes of mortality or morbidity specific to women are related to maternal conditions and malignant neoplasms. The DALY losses associated with conditions specific to women are around 6 percent in both HICs and LMICs, but maternal conditions are more prevalent in LMICs, whereas neoplasms cause more DALY losses in HICs.
[Table .]
Table 10.3 shows the gender ratio and burden of disease of eight conditions, by region, that are more prevalent among women than among men. The selection of diseases was done using as the threshold the mean plus one standard deviation (SD) of the distribution of gender ratio scores for each disease. The diseases selected were then screened for their importance in women's disease burden, using the same criterion of the mean plus one SD in the distribution of DALY scores for women. Although some diseases, such as unipolar depressive disorders and osteoarthritis, are priorities for both HICs and LMICs, others, such as Alzheimer's disease, are more relevant in HICs, reflecting women's longer life expectancy. Conditions such as age-related vision disorders, migraine, fires, and cerebrovascular diseases have particular relevance in specific regions.
[Table .]
Combining gender-specific conditions and shared conditions that disproportionately affect women gives a total of 19 priority conditions for women. Taken together, these conditions represent about one-fifth of women's total DALY losses and indicate priorities for research and the search for cost-effective methods of promotion, prevention, and treatment. Note that some important contributors to females' health burdens, such as malaria and HIV/AIDS, have been omitted because females do not currently suffer disproportionately from these diseases. However, the growing feminization of the HIV/AIDS epidemic in developing countries should result in excess disease burdens for women in the near future.
We determined priority conditions affecting females in different age groups using a method that took into account both the gender ratio and the weight of specific conditions in females' total DALYs lost. The results indicate that women are affected by communicable diseases and maternal conditions until age 29 and by noncommunicable diseases after age 30, with chronic diseases having a heavy weight during the last stages of the life cycle. Conditions for which females' burden of disease is more or less double that of males at a specific stage in the life cycle are migraine at age 5 to 14, fires and panic disorder at age 15 to 29, and unipolar depressive disorders at age 60 to 69.
