Gender and Access to Medicines in 15 Low- and Middle-Income Countries: Does Physician Prescribing for Men and Women Differ?
Abstract
Problem Statement: Hypotheses of gender differences in access to medicines exist but information about these is lacking.
Objectives: To assess whether gender differences exist in access to medicines for acute (Upper respiratory infections –URI) and chronic (diabetes, depression) diseases.
Setting: Private sector physicians recruited by IMS HEALTH who recorded patient age, sex, diagnoses, and medicines prescribed.
Study Population: Fifteen countries—1 low-income and 14 middle- income—from six regions: Americas (6);East Mediterranean (3); Europe (2); South East Asia (2); Africa (1) and Western Pacific (1). Between 2007 and 2010, 92,969 consultations for depression (median across countries: 1,758), 143,087 for diabetes (median 6,747), and 251,785 (median 17,224) for URI were included. Diabetes and depression consultations were defined by drug prescribed and physician’s diagnosis, URI consultations by diagnosis only. Analyses limited to treated consultations.
Outcomes: Gender differences by age group defined as (1) a statistical difference in the observed number of consultations for men and women for each disease compared to the expected number (estimated based on WHO Estimated Disability Adjusted Life Years by cause tables); and (2) statistical differences between women and men in the observed proportions for new oral drugs among products for diabetes, and for different types of drugs among products for URI, compared to that compared to that expected from the observed visit numbers.
Results: A significant difference between the observed number of visits for depression and that expected was detected on 36% of 45 comparisons across countries and age groups, for diabetes on 58%, and for URI on 87%. Where a statistical difference was found, the observed number of visits was higher than expected for women on 75% of occasions for depression, on 18% occasions for diabetes, and on 44% of occasions for URIs. A statistical difference between the expected and observed number and type of prescriptions was found in fewer than 26% of comparisons made in URI and diabetes. Where a statistical difference was found in URI, the observed number was higher than expected for women twice as often as for men.
Conclusions: The present results suggest gender differences in access to medicines. Depending on country, disease, and age group, both women and men may have preferential access. These analyses may provide an important basis for addressing equity concerns in medicines policy decision making.
Citation
Stephens, P.; Ross-Degnan, D.; Wagner, A. Gender and Access to Medicines in 15 Low- and Middle-Income Countries: Does Physician Prescribing for Men and Women Differ? Presented at Third International Conference for Improving Use of Medicines (ICIUM2011), Antalya, Turkey, 14-18 November, 2011.. (2011) 13 pp.
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