JCO global oncology · 2026
Disaggregating Gender Inequality Globally: Health Systems, Gender Inequality, and Female Pan-Cancer Outcomes.
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Shin Asher J, Venkateswaran Shivaek, Zhang Yue Helen, Ho Frances Dominique V, Wang Stephanie, Kohli Khushi, Cabaero Megan Lorenza L, Go Adrian E, Mantena Rohit V, Patel Milit S, Iyengar Ranvir, Ma Jessica, Gold Deena R, Nguyen Isabella, Nguyen Lilac, Wu James Fan, Willmann Jonas, Moraes Fabio Ynoe, Jacomina Luisa E, Magsanoc-Alikpala Kara, Dee Edward Christopher, Feliciano Erin Jay G
Аннотация
PURPOSE: Gender inequality shapes women's cancer outcomes through social, economic, and health system factors. This study disaggregated the Gender Inequality Index (GII) to identify which dimensions-reproductive health, educational attainment, workforce participation, and political empowerment-independently influence global female cancer outcomes.
METHODS: We conducted an ecologic, cross-national analysis using data from 185 countries. Age-standardized female cancer mortality-to-incidence ratios (MIRs) were derived from GLOBOCAN 2022. Independent variables included the composite GII and its five components: maternal mortality ratio, adolescent birth rate, female secondary education, labor force participation, and parliamentary representation. Univariable (Bonferroni-corrected significance threshold α = .01) and multivariable (α = .05) linear regressions assessed associations between these indicators and MIR, adjusting for health system variables including universal health coverage (UHC) index, gross domestic product (GDP) per capita, workforce availability, health spending, and radiotherapy access.
RESULTS: Univariable analyses showed that GII and all components associated with higher MIR (P < .001 for all except labor participation, P = .026). Upon examining GII components in a multivariable model, higher adolescent birth rate (β = .0014, P < .001), lower female secondary education (β = -.0020, P < .001), and lower women's parliamentary representation (β = -.0022, P < .001) were independently associated with higher female MIR (N = 168, R2 = 0.70). In fully adjusted models accounting for national wealth and system capacity (N = 124, R2 = 0.88), higher UHC index (P < .001) and GDP per capita (P = .007) predicted lower MIR, while adolescent birth rate may be positively associated (P = .084).
CONCLUSION: Structural gender inequalities, particularly those related to reproductive burden, education, and political representation, are linked to poorer female cancer outcomes. Advancing gender equity through reproductive health access, girls' education, and women's leadership is integral to improving cancer outcomes globally.
METHODS: We conducted an ecologic, cross-national analysis using data from 185 countries. Age-standardized female cancer mortality-to-incidence ratios (MIRs) were derived from GLOBOCAN 2022. Independent variables included the composite GII and its five components: maternal mortality ratio, adolescent birth rate, female secondary education, labor force participation, and parliamentary representation. Univariable (Bonferroni-corrected significance threshold α = .01) and multivariable (α = .05) linear regressions assessed associations between these indicators and MIR, adjusting for health system variables including universal health coverage (UHC) index, gross domestic product (GDP) per capita, workforce availability, health spending, and radiotherapy access.
RESULTS: Univariable analyses showed that GII and all components associated with higher MIR (P < .001 for all except labor participation, P = .026). Upon examining GII components in a multivariable model, higher adolescent birth rate (β = .0014, P < .001), lower female secondary education (β = -.0020, P < .001), and lower women's parliamentary representation (β = -.0022, P < .001) were independently associated with higher female MIR (N = 168, R2 = 0.70). In fully adjusted models accounting for national wealth and system capacity (N = 124, R2 = 0.88), higher UHC index (P < .001) and GDP per capita (P = .007) predicted lower MIR, while adolescent birth rate may be positively associated (P = .084).
CONCLUSION: Structural gender inequalities, particularly those related to reproductive burden, education, and political representation, are linked to poorer female cancer outcomes. Advancing gender equity through reproductive health access, girls' education, and women's leadership is integral to improving cancer outcomes globally.