TY - JOUR
T1 - Association between gender social norms and cardiovascular disease mortality and life expectancy
T2 - an ecological study
AU - Lyell, Iona
AU - Khan, Sadiya S.
AU - Limmer, Mark
AU - O'Flaherty, Martin
AU - Head, Anna
N1 - Funding Information:
IL is an Academic Clinical Fellow funded by the UK National Institute for Health and Care Research in conjunction with Lancaster University. They are employed by St Helens and Knowsley NHS Foundation Trust. AH is funded by a departmental studentship at the University of Liverpool and supported by the UK National Institute for Health and Care Research School for Public Health (Grant Reference Number PD-SPH-2015-10025). SSK receives funding from the National Heart, Lung and Blood Institute and the American Heart Association. These funders had no role in the study design, analysis or presentation of results. The views expressed are those of the authors and not necessarily those of the National Institute for Health and Care Research, the NHS, the National Heart, Lung and Blood Institute or the American Heart Association. MO is partly funded (among other grants) by ESRC grant ES/W007932/1: Developing public health policies for the out of home food sector to improve diet and reduce obesity, and NIHR grant NIHR130258: Unmet need for healthcare.
Publisher Copyright:
© 2023 BMJ Publishing Group. All rights reserved.
PY - 2023/4/27
Y1 - 2023/4/27
N2 - Objective Examine the association between country-level gender social norms and (1) cardiovascular disease mortality rates; (2) female to male cardiovascular disease mortality ratios; and (3) life expectancy. Design Ecological study with the country as the unit of analysis. Setting Global, country-level data. Participants Global population of countries with data available on gender social norms as measured by the Gender Social Norms Index (developed by the United Nations Development Programme). Main outcome measures Country-level female and male age-standardised cardiovascular disease mortality rates, population age-standardised cardiovascular disease mortality rates, female to male cardiovascular disease mortality ratios, female and male life expectancy at birth. Outcome measure data were retrieved from the WHO and the Institute for Health Metrics and Evaluation. Multivariable linear regression models were fitted to explore the relationship between gender social norms and the outcome variables. Results Higher levels of biased gender social norms, as measured by the Gender Social Norms Index, were associated with higher female, male and population cardiovascular disease mortality rates in the multivariable models (β 4.86, 95% CIs 3.18 to 6.54; β 5.28, 95% CIs 3.42 to 7.15; β 4.89, 95% CIs 3.18 to 6.60), and lower female and male life expectancy (β -0.07, 95% CIs -0.11 to -0.03; β -0.05, 95% CIs -0.10 to -0.01). These results included adjustment within the models for potentially confounding country-level factors including gross domestic product per capita, population mean years of schooling, physicians per 1000 population, year of Gender Social Norms Index data collection and maternal mortality ratio. Conclusions Our analysis suggests that higher levels of biased gender social norms are associated with higher rates of population cardiovascular disease mortality and lower life expectancy for both sexes. Future research should explore this relationship further, to define its causal role and promote public health action.
AB - Objective Examine the association between country-level gender social norms and (1) cardiovascular disease mortality rates; (2) female to male cardiovascular disease mortality ratios; and (3) life expectancy. Design Ecological study with the country as the unit of analysis. Setting Global, country-level data. Participants Global population of countries with data available on gender social norms as measured by the Gender Social Norms Index (developed by the United Nations Development Programme). Main outcome measures Country-level female and male age-standardised cardiovascular disease mortality rates, population age-standardised cardiovascular disease mortality rates, female to male cardiovascular disease mortality ratios, female and male life expectancy at birth. Outcome measure data were retrieved from the WHO and the Institute for Health Metrics and Evaluation. Multivariable linear regression models were fitted to explore the relationship between gender social norms and the outcome variables. Results Higher levels of biased gender social norms, as measured by the Gender Social Norms Index, were associated with higher female, male and population cardiovascular disease mortality rates in the multivariable models (β 4.86, 95% CIs 3.18 to 6.54; β 5.28, 95% CIs 3.42 to 7.15; β 4.89, 95% CIs 3.18 to 6.60), and lower female and male life expectancy (β -0.07, 95% CIs -0.11 to -0.03; β -0.05, 95% CIs -0.10 to -0.01). These results included adjustment within the models for potentially confounding country-level factors including gross domestic product per capita, population mean years of schooling, physicians per 1000 population, year of Gender Social Norms Index data collection and maternal mortality ratio. Conclusions Our analysis suggests that higher levels of biased gender social norms are associated with higher rates of population cardiovascular disease mortality and lower life expectancy for both sexes. Future research should explore this relationship further, to define its causal role and promote public health action.
KW - cardiac epidemiology
KW - epidemiology
KW - public health
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U2 - 10.1136/bmjopen-2022-065486
DO - 10.1136/bmjopen-2022-065486
M3 - Article
C2 - 37105692
AN - SCOPUS:85158911897
SN - 2044-6055
VL - 13
JO - BMJ open
JF - BMJ open
IS - 4
M1 - e065486
ER -