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Gender Disparity in the Funding of Diseases by the U.S. National Institutes of Health.

ABSTRACT: Background: Gender bias has been an ongoing issue in health care, examples being underrepresentation of women in health studies, trivialization of women's physical complaints, and discrimination in the awarding of research grants. We examine here a different issue-gender disparity when it comes to the allocation of research funding among diseases. Materials and Methods: We perform an analysis of funding by the U.S. National Institutes of Health (NIH) to ascertain possible gender disparity in its allocation of funds across diseases. We normalize funding level to disease burden, as measured by the Disability Adjusted Life Year, and we specifically consider diseases for which both disease burden and funding level are provided. We apply a power-law regression analysis to model funding commensurate with disease burden. Results: We find that in nearly three-quarters of the cases where a disease afflicts primarily one gender, the funding pattern favors males, in that either the disease affects more women and is underfunded (with respect to burden), or the disease affects more men and is overfunded. Moreover, the disparity between actual funding and that which is commensurate with burden is nearly twice as large for diseases that favor males versus those that favor females. A chi-square test yields a p-value of 0.015, suggesting that our conclusions are representative of the full NIH disease portfolio. Conclusions: NIH applies a disproportionate share of its resources to diseases that affect primarily men, at the expense of those that affect primarily women.

SUBMITTER: Mirin AA

PROVIDER: S-EPMC8290307 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ImportanceThe US has historically resettled more refugees than any other country, with over 3.5 million refugees since 1980. The National Institutes of Health (NIH) is the largest public funder of biomedical research and development, but its role in mitigating many health disparities refugees experience through its funded research remains unknown.ObjectiveTo examine the NIH's research funding patterns on refugee health research over the last 2 decades.Design, setting, and participantsSecondary analysis of NIH-funded grants between 2000 and 2020 using a cross-sectional study design. The NIH Research Portfolio Online Reporting Tools database was used to find relevant grants. Data were analyzed from November 2021 to September 2022.Main outcomes and measuresNIH grants awarded by year, state, grant type, research area, funding institute, grant duration, and amount funded.ResultsOf 1.7 million NIH grants funded over the 20-year study period, only 78 addressed refugee health. Funded grants were mostly training grants (23 grants [29%]), followed by hypothesis-driven research (R01 grants; 22 grants [28%]), pilot or preliminary investigation proposals (13 grants [17%]), and other types of grants (20 grants [26%]). The most studied research domain was mental health (36 grants [46%]), followed by refugee family dynamics and women's and children's health (14 grants [18%]). A total of 26 grants (33%) were funded by the National Institute of Mental Health and 15 (19%) were funded by the National Institute of Child Health and Human Development. Most grants were US-based (60 grants [76%]) and the state of Massachusetts received the greatest amount of funding ($14 825 852 [18%]). In 2020, the NIH allocated about $2.3 million to refugee health research, or less than 0.01% of its $42 billion budget that year. The number of grants funded in each time period did not always reflect changes in the number of refugees resettled in the US over the years.Conclusions and relevanceThis cross-sectional study found that there remain significant gaps in the understanding of and interventions in the health research needs of refugees locally and along the migratory route. To close these gaps, the NIH should increase its investments in comprehensive studies assessing the physical, mental, and social well-being of this expanding population. This can be achieved by ensuring that all NIH institutes allocate budgets specifically for refugee health research and extend support for the training of refugee researchers.

Project description:ImportancePrior research suggests an association between burden of disease and National Institutes of Health (NIH) funding. The allocation of NIH funding should reflect, to some extent, the health needs of the population, along with other factors.ObjectiveTo examine the factors associated with NIH funding in 2019 for 46 diseases.Design, setting, and participantsThis cohort study used disability-adjusted life-years to measure the 2008 and 2019 US burden of disease and compared them with NIH categoric funding for 46 diseases.ExposuresDisability-adjusted life-years to measure the 2008 and 2019 US burden of disease, 2016 health spending, and 2008 NIH funding levels for 46 diseases.Main outcomes and measures2019 NIH funding levels for 46 diseases.ResultsThe 46 diseases accounted for 62 392 713 of 94 399 784 disability-adjusted life-years (66.1%) in 2008 and 75 706 718 of 111 074 472 disability-adjusted life-years (68.2%) in 2019, representing more than 66% of all disability-adjusted life-years in both years. By dollar volume, Alzheimer and dementia increased the most, with approximately $1.8 billion more funding in 2019 than 2008 (from $530 million in 2008 to $2398 million in 2019, a 352% increase), whereas interpersonal violence had the greatest decrease, $95 million, in 2019 NIH funding (from $236 million in 2008 to $141 million in 2019, a 40% decrease). For the 46 diseases in this study, the variable with the greatest association with NIH funding in 2019 was the level of NIH funding in 2008, with a simple correlation of 0.88. Burden of disease and changes in burden of disease were not statistically significantly associated with NIH funding levels once the prior level of funding was included in the model. The models suggested that a 1% higher level of NIH funding in 2008 was associated with a 0.91% higher level of NIH funding in 2019.Conclusions and relevanceIn this study, NIH spending for most diseases seemed to be based primarily on the level of NIH spending more than 10 years earlier, despite changes in burden of disease. Congress and the NIH should examine the allocation process to ensure NIH investments are responsive to changes in the health of the population.

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Gender Disparity in the Funding of Diseases by the U.S. National Institutes of Health.

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