Women bear higher economic burden of chronic disease costs in Mexico

For decades, the invisible weight of chronic, disabling illness has fallen unevenly across societies, and few places illustrate this as starkly as Mexico. A comprehensive new economic analysis has put hard numbers on that imbalance, and the results are striking: anxiety disorders, depressive disorders, migraine, and rheumatoid arthritis cost the Mexican economy on the order of 1.2 trillion international dollars over a sixteen-year period, and women bore substantially more of that burden than men across every condition examined and under every valuation method the researchers applied. The study, conducted by a team from Mexico’s National Institute of Public Health together with collaborators at The George Institute for Global Health and Imperial College London, is published open access in the International Journal for Equity in Health and represents one of the first attempts to jointly quantify the societal cost of four high-disability, low-mortality conditions from an explicitly gendered perspective.

The four disorders studied are frequently sidelined in health policy because they kill relatively few people compared with cardiovascular disease, cancer, or diabetes. Yet they are among the leading causes of years lived with disability worldwide, generating recurring treatment needs, diminished work capacity, and cascading productivity losses that accumulate over decades of life. Anxiety and depressive disorders affect hundreds of millions of people globally and are disproportionately diagnosed in women; migraine is one of the most prevalent neurological conditions on the planet and affects women at roughly two to three times the rate of men; and rheumatoid arthritis, an autoimmune disease that progressively damages joints and erodes functional capacity, also strikes women far more often. In Mexico, where the health system is segmented across multiple social insurance schemes and large swaths of the population face gaps in access and financial protection, the economic consequences of these conditions were essentially unquantified at the national level before this analysis.

The research team, led by co-first authors Carlos Manuel Guerrero-López and Edson Serván-Mori, performed a full cost-of-illness analysis from a societal perspective, covering adults aged twenty years and older between 2005 and 2021. In health economics, the societal perspective is the most encompassing lens available: it counts not only what the health system spends but also what patients, families, and the broader economy lose. Direct costs in the study were estimated by combining condition-specific prevalence figures from the Global Burden of Disease Study 2021 with normative per-case treatment costs derived from Mexican national clinical guidelines and official government cost sources. This prevalence-based, guideline-anchored approach means the cost estimates reflect what standard care should cost, expressed in 2021 international dollars to allow purchasing-power-adjusted comparisons.

The treatment of indirect costs was where the methodological ambition of the study becomes most apparent. Lost productivity is the hardest component of disease burden to value, and estimates can vary enormously depending on the economic framework chosen. To address this, the researchers used three complementary approaches. The first was the Human Capital Approach, a classical method that values lost production by predicting annual labour income from the National Survey of Occupation and Employment, a nationally representative employment survey conducted by Mexico’s statistics institute. The second was a GDP-per-capita benchmark that values each disability-adjusted life year, or DALY, lost at one gross domestic product per capita, a convention widely used in global burden-of-disease economics. The third and most expansive was a willingness-to-pay approach, which assigned each statistical life year a monetary value using the value of a statistical life year transferred to Mexico following Organisation for Economic Co-operation and Development methods. By triangulating across all three, the team sought to show that their central finding, the gender gap, does not depend on any single set of valuation assumptions.

The scale of the findings is difficult to overstate. Across the study period, the four disorders accounted for 28.8 million disability-adjusted life years lost in Mexico. Migraine emerged as the most prevalent of the four conditions, a reminder that a headache disorder often dismissed as trivial is in fact a mass-scale public health problem. But prevalence is not the same as cost: depressive disorders generated the highest direct medical costs, totalling 310.5 billion international dollars, and also contributed the largest share of indirect costs, at 41.1 percent. The indirect cost totals diverged dramatically by valuation method, underscoring how sensitive such estimates are to economic framing. Under the conservative Human Capital Approach, lost productivity was valued at 106.8 billion international dollars; under the GDP-per-capita benchmark, it rose to 582.2 billion; and under the willingness-to-pay framework, it reached a staggering 2.9 trillion international dollars. Combining the direct costs with the midpoint GDP-per-capita valuation of indirect costs, the total economic burden of the four disorders over sixteen years came to approximately 1.2 trillion international dollars, a figure that dwarfs most line items in Mexican health budgets.

What elevates the study from a routine costing exercise to an equity analysis is its consistent gender lens, and here the pattern was unambiguous. Women carried a greater burden than men across all four conditions and under all three valuation methods, without exception. Total indirect costs borne by women were 2.0 times higher than those borne by men for anxiety disorders, 2.1 times higher for depressive disorders, 2.2 times higher for migraine, and 3.8 times higher for rheumatoid arthritis. The arthritis figure is especially striking and reflects a compounding of factors: the disease is far more common in women, tends to be disabling over long durations, and its costs accumulate across both paid employment and unpaid domestic labour, the latter of which is systematically undervalued in conventional human capital calculations. The researchers note that these ratios held steady throughout the study period, from 2005 through 2021, spanning economic cycles, health system reforms, and the COVID-19 pandemic.

The COVID-19 pandemic deserves particular mention because the study period captures its onset and immediate aftermath. Mental health deteriorated markedly worldwide during the pandemic, with anxiety and depression prevalence rising sharply in 2020 and 2021, and women shouldered a disproportionate share of both the psychological toll and the disruptions to employment and caregiving. While the study’s methods are prevalence-based and normative rather than tracking individual patient trajectories, the inclusion of the pandemic years means the estimates likely capture at least some of the surge in mental disorder burden, making the recorded gender inequities arguably conservative. The researchers also observed that in Mexico’s segmented system, in which workers in the formal sector are covered by institutions such as the Mexican Institute of Social Security while others rely on separate public or private pathways, continuity of care for chronic mental and musculoskeletal conditions varies widely, amplifying the downstream economic consequences for the most vulnerable.

The authors are careful about what their numbers do and do not represent. Because per-case costs were derived from normative clinical guidelines rather than observed claims data, the figures describe what care should cost if guidelines were followed, which in practice may understate the true societal burden in a system with significant under-treatment. The three valuation methods span a wide range precisely because the economics of valuing disability and lost life quality remain contested. Yet the robustness of the gender disparity across this entire range is the study’s central strength: no reasonable set of assumptions erases it. The team adhered to the Consolidated Health Economic Evaluation Reporting Standards 2022 guidelines and reported the work transparently, with extensive supplementary materials breaking down direct and indirect costs by condition and year. Funding came from the Mexican Association of Pharmaceutical Research Industries, though the funder played no role in study design, analysis, or the decision to publish, and the authors declare no competing interests.

The policy implications extend well beyond Mexico’s borders. Low- and middle-income countries with fragmented health systems share Mexico’s structural features: multiple insurers, uneven drug availability, thin mental health infrastructure, and weak financial protection against long-duration chronic illness. The study argues that mortality-centred planning systematically deprioritises conditions that disable rather than kill, and that this bias is itself a gendered phenomenon given that the disabling conditions in question disproportionately affect women. The researchers call for gender-responsive priority setting in prevention, diagnosis, and treatment continuity, alongside stronger financial protection and better information systems capable of supporting equity-oriented resource allocation. In practical terms, that means screening and treating depression and anxiety as core chronic disease management rather than optional extras, ensuring reliable access to migraine and rheumatoid arthritis medications, and designing benefit packages that recognise how these conditions interact with women’s dual roles in paid and unpaid work.

There is also a broader conceptual lesson for health economics itself. By running three valuation frameworks side by side, the study demonstrates that choices about how to value a life year or a lost day of work are not technical trivia; they determine whether a trillion-dollar burden registers as a rounding error or a crisis. Under the most conservative method, the indirect costs of these four conditions appear modest; under the willingness-to-pay framework they exceed the value of many national economies’ annual output. The authors’ insistence on reporting all three, and on showing that the gender pattern survives all of them, offers a template for future burden-of-disease research in other countries where women’s economic contributions, formal and informal, remain undercounted.

For the millions of Mexican women living with depression that goes untreated, migraines that force missed workdays, or joints progressively stiffened by rheumatoid arthritis, the study’s findings will not come as news. What is new is the formal accounting: a documented, sixteen-year, 1.2 trillion international dollar demonstration that the economics of chronic disability in Mexico are, inescapably, the economics of gender inequality. Turning that accounting into policy, the researchers conclude, will require treating anxiety, depression, migraine, and rheumatoid arthritis not only as clinical problems but as matters of health equity, deserving of the same urgency and investment that Mexico and other countries devote to their deadliest diseases.