Gender inequality refers to the imbalance in treatment and opportunities individuals experience based on gender, resulting in disparities across various facets of life (EIGE 2023a). Women in low, middle-, and high-income countries are disproportionately affected by cancer due to vulnerabilities related to gender inequality, poverty, and environmental factors (Cesario 2012). Based on the research by Donington and Colson (2011), it becomes evident that gender inequality has played a pivotal role in contributing to a substantial rise in cancer cases among women. This distressing trend has propelled cancer to the forefront as the primary cause of mortality among women in the United States.

The extent of this disparity transcends social realms and permeates into health outcomes, casting a prominent shadow over women's cancer fatality rates, as highlighted in the research by Vaccarella et al. (2023) and the Organisation for Economic Co-operation and Development (OECD 2015). The intricate tapestry of gender inequality intertwines with myriad facets, giving rise to discrepancies in cancer-related consequences. Elements including socioeconomic conditions, educational disparities, healthcare accessibility, and societal norms synergistically contribute to the vulnerability of women to cancer, dictating the trajectory of diagnosis, therapeutic interventions, and ultimate survival rates (WHO 2021; Allen and Sesti 2018; Mobaraki and Soderfeldt 2010).

This concept is further reinforced by the work of Donington and Colson (2011), who emphasize the multifaceted role of gender inequality in the aetiology, prevention, and management of cancer. Their research underscores the complexity of this issue, which is intricately woven with physiological variations, behavioural influences, lifestyle factors, and equitable access to medical care. As evidenced by the findings of Jolidon (2022) and Willems et al. (2020), the presence of macro-level gender inequality has a detrimental impact on women's engagement in cancer screening initiatives. This lamentable circumstance has subsequently contributed to an alarming surge in cancer mortality rates. Indeed, Wellems et al. (2020) employed Bird and Rieker's (2008) theory of constrained choices, which explains how policy, community, work, and family contexts shape gender-related health differences and individuals' health decisions. This approach highlighted that women's health benefits from policies promoting political participation, autonomy, family roles, and increased macro-level empowerment.

Moreover, increased autonomy and decision-making authority boost women's use of healthcare services (Osamor and Grady 2016). Conversely, unfavourable social contexts and policies can limit women's ability to prioritize health, constraining their control over health choices and presenting conflicts between health and family responsibilities (Bird and Rieker 2008). Similarly, gender inequalities perpetuated through reproductive health, family, employment, and political policies can worsen women's health via stress, discrimination, financial strain, violence, and the double burden of work (Borrell et al. 2014).

Across European nations, a spectrum of variations in gender inequality comes into view, indicating that certain countries contend with more pronounced disparities than others. For instance, in 2013, Latvia (0.231), Hungary (0.251), Romania (0.315), and Bulgaria (0.214) experienced notable gender inequality, evident through values surpassing the threshold of 0.2. Conversely, Sweden (0.048), Denmark (0.039), the Netherlands (0.042), Finland (0.062), Germany (0.079), Slovenia (0.070), Luxembourg (0.071), Belgium (0.074), Austria (0.085), Italy (0.087), Spain (0.084), and Portugal (0.098) demonstrated lower levels of gender inequality, each registering values under 0.1. Despite concerted efforts aimed at addressing gender inequality, Hungary (0.222), Romania (0.283), and Bulgaria (0.211) have consistently maintained high levels of inequity even as of 2021 (see Fig. 1A, B). These nations offer insights into the unique attributes of gender inequality within the European context, encompassing dimensions such as gender pay disparity, occupational segregation, inadequate representation in leadership positions, and the intricate dynamics surrounding work/life balance.

Illustrates the assessment of the gender inequality index across European countries from 2013 to 2021 (A, B). This index represents the extent of gender inequality within the 27 European countries during the specified years. Furthermore, an examination of the gender inequality index within the European countries was conducted from 2013 to 2021 (C). The map graph, a critical visualization in this study, was meticulously crafted by the authors utilizing data from the United Nations Development Programme (UNDP 2022)

Undoubtedly, gender inequality persists as a prevalent concern within European countries, encompassing disparities across domains such as education, employment, decision-making, healthcare, and societal interactions. Women's educational opportunities often remain constrained, limiting their entrance into traditionally male-dominated professions. The labour market reflects this inequality through employment gaps, occupational segregation, and a persistent gender pay disparity. Despite strides in various sectors, women's representation in political and economic decision-making positions continues to lag behind. Within healthcare, discernible gaps in service access and reproductive health persist. The broader issues of gender-based violence and discrimination further compound these challenges. Pursuing equitable solutions necessitates unwavering commitment, as ongoing policy initiatives and advocacy endeavours seek to shape a society that is inclusive and fair to all (European Institute for Gender Equality 2023a; European Commission 2020).

Through legislative measures, policy frameworks, and awareness campaigns, European countries have embarked on a journey to cultivate gender equality and empower women. These collective efforts have resulted in a reduction in gender inequality, from a value of 0.126 in 2013 to 0.100 in 2021—an encouraging 2.6% decline (refer to Fig. 1C). This approach signifies a step forward in the quest for parity and serves as a testament to the potential impact of dedicated initiatives on reshaping the gender landscape.

This intersection of varying gender inequality levels with a pressing concern within European countries, namely cancer mortality, is a significant aspect to consider. In European countries, cancer-related deaths carry considerable weight with regard to public health. In 2013, several European countries registered elevated cancer mortality rates among women. Notably, Hungary (268.6), Denmark (258.4), Slovakia (234.4), the Netherlands (233.1), Slovenia (234.7), Ireland (244.0), Croatia (242.5), Czechia (223.5), Poland (219.8), Latvia (215.5), Sweden (207.8), Estonia (207.3), Germany (205.4), and Belgium (200.5) faced relatively higher rates. On the contrary, Greece (175.9), Bulgaria (175.2), Cyprus (151.0), Portugal (167.4), and Spain (160.4) displayed comparably lower rates of cancer mortality among women. The year 2020 marked a reduction in cancer mortality rates among women in several European countries, including France, Germany, Belgium, Sweden, Estonia, Luxembourg, and Austria. These countries have demonstrated progress in addressing the issue of cancer-related deaths among women. Nonetheless, Slovakia, Hungary, Poland, Latvia, Ireland, Denmark, Czechia, and Croatia still grapple with persistently high cancer mortality rates among women (refer to Fig. 2A, B). Remarkably, European countries have witnessed a notable decline in the cancer mortality rate among women over time. Concerted efforts and initiatives led to a reduction from 262 in 2013 to 241 by the year 2020 (see Fig. 2C).

Illustrates the landscape of cancer-related mortality among women in European countries, delineating crucial aspects across distinct time frames and geographical extents: (A, B) Cancer-related mortality in women across various European countries for the years 2013 and 2020, offering a comparative view of how this vital metric has evolved. (C) Overall cancer-related mortality among women encompassing all European countries from 2013 to 2020, enabling a comprehensive understanding of the cumulative trends over this period. The authors have meticulously crafted the visual representation presented in this map graph. It draws upon data sourced from Eurostat (2023a)

Moreover, breast cancer emerges as the predominant contributor to cancer-related deaths among women in European countries, representing 28.75% of cases in 2020. Lung cancer follows closely at 27.18%, colorectal cancer at 21.60%, pancreatic cancer at 13.94%, and ovarian cancer at 8.54% (refer to Fig. 3A). This distribution underscores the significant impact of these specific cancer types on women's health in European countries.

Cancer-related mortality patterns among women in the European countries, 2020: (A) Distribution of cancer-related deaths by the most common causes—percentage distribution (%) across the European countries in 2020. (B) Estimated cancer mortality by age group—percentage distribution (%) among women across the European countries in 2020. (C) Distribution of cancer mortality by cancer type—percentage distribution (%) among women across the European countries in 2020. (D) Age-standardized cancer mortality rates among women across the European countries in 2020. The authors crafted this graphical representation, using data from the European Cancer Information System (ECIS 2023)

Within the European countries, the distribution of cancer-related deaths among women in 2020 reveals distinct variations across diverse age groups: Among women aged 0–44 years, breast cancer is the principal cause of cancer-related deaths, contributing to 31% of cases. Cervical/uterine cancer follows at 11%, accompanied by brain central nervous system (CNS) cancer at 10%, lung cancer at 6%, and other cancer sites at 42% (refer to Fig. 3B). In the age group of 45–64 years, lung cancer is the primary cause of cancer-related deaths among women, accounting for 24% of cases. Breast cancer closely follows at 20%, while colorectal cancer constitutes 9%, pancreatic cancer is 7%, and other cancer sites 40% (refer to Fig. 3B).

For women aged 65 years and above, breast cancer remains a notable cause of cancer deaths, contributing to 16% of cases. Lung cancer ranks second at 15%, colorectal cancer at 14%, pancreatic cancer at 9%, and other cancer sites account for 46% of the distribution (refer to Fig. 3B).

The percentage distribution of cancer mortality among women in the European countries for 2020 reveals noteworthy patterns. Breast cancer accounts for 16.53% of cancer-related deaths, making it a substantial contributor. Lung cancer follows closely behind at 15.61%, with colorectal cancer representing 12.4% of mortality cases. Pancreatic cancer contributes to 8.01% of cancer deaths among women. Remarkably, other cancer sites encompass 26.58% of the overall mortality distribution (Fig. 3C).

Regarding mortality among women in European countries, the age-standardized mortality rate attributed to breast cancer stands at 34.1 per 100,000, while lung cancer registers at 33.2 per 100,000. Colorectal cancer is characterized by an age-standardized rate of 24.5 per 100,000, while pancreatic cancer is recorded at 16.2 per 100,000 population. Meanwhile, ovarian cancer demonstrates an age-standardized rate of 10.2 per 100,000 population (Fig. 3D). This comprehensive overview of cancer mortality statistics among women underscores the critical health implications and provides a basis for further exploration and analysis.

The above statistics unequivocally underscore the imperative nature of delving into the factors contributing to women's susceptibility to cancer-related mortality within European countries. Extensive research consistently reveals that gender-based discrepancies in cancer mortality emanate from intricate interplays among biological, behavioural, societal, and systemic elements. A notable instance is the potential hindrance women encounter in obtaining timely cancer diagnoses, often due to lower levels of health literacy or constrained access to healthcare services. Furthermore, prevailing societal norms and gender-specific expectations can dissuade women from seeking swift medical attention or participating in vital cancer screening initiatives, as Jolidon (2022) and Willems et al. (2020) mentioned.

Ameliorating gender inequality in cancer mortality necessitates a multifaceted and comprehensive strategy. Gaining a profound understanding of the precise mechanisms by which gender-based disparities impact cancer outcomes empowers healthcare systems and policymakers to enact targeted measures and policies to alleviate such inequalities. This proactive approach includes promoting gender-sensitive healthcare practices, enhancing accessibility to cancer screening and treatment, and addressing the underlying social determinants of health that disproportionately affect women. These interventions must acknowledge and cater to the distinct challenges encountered by diverse subsets of women, whether rooted in age, socioeconomic status, or geographical location. By embracing a holistic framework, this investigation can aspire to diminish gender-driven disparities in cancer mortality, thus enhancing the overall well-being and prospects of women across European countries.

Exploring the link between gender inequality and cancer mortality is a topic addressed by a limited number of researchers in the existing literature. A few authors have explored this topic (e.g., Vaccarella et al. 2023; Jolidon 2022; Chan et al. 2022; Gedefaw et al. 2020; Raghupathi and Raghupathi 2020; Bosetti et al. 2013; World Cancer Research Fund/American Institute for Cancer Research 2018; Lugo et al. 2017; Donington and Colso 2011). As an illustration, Bosetti et al. (2013) delved into European cancer mortality data from 1980 to 2009. Their findings highlighted persistent gender disparities, with men exhibiting higher mortality rates across most cancer types. Breast and lung cancers emerged as the foremost causes of cancer-related deaths among women. This investigation emphasized the need to scrutinize the underlying factors contributing to the observed gender-based gaps in cancer mortality rates.

Socioeconomic factors are instrumental in shaping these disparities. For instance, Vaccarella et al. (2023) conducted an insightful study examining the correlation between socioeconomic status and cancer survival in Europe from 1990 to 2015. Their findings revealed that women from lower socioeconomic backgrounds faced higher mortality rates. Socioeconomic disparities, encompassing education, income, and occupation, contribute significantly to the gender inequality manifested in cancer-related fatalities.

Additionally, risk behaviours, such as alcohol and tobacco consumption, further contribute to the variance in cancer mortality rates between genders. Lugo et al. (2017) explored smoking prevalence in Italy, offering insights that resonate with the broader European context. While the study focused on Italy, its implications extend to the general trend within the European Union (EU). The research revealed that, although smoking rates were generally higher among men, the gender disparity was diminishing in numerous countries. This shift suggests that women are becoming increasingly susceptible to the detrimental health effects of smoking, including lung cancer, thus exacerbating the gender discrepancy in cancer-related deaths.

Moreover, dietary habits and physical activity influence cancer mortality rates among women. A balanced intake of fruits and vegetables, coupled with regular exercise, is recognized for contributing to overall well-being and reducing specific cancer risks (World Cancer Research Fund/American Institute for Cancer Research 2018; Chan et al. 2022).

Most investigations thus far have focused primarily on examining the influence of inequalities solely on cancer mortality. As a result, the potential correlation between gender inequality and cancer mortality among women has been largely overlooked. To put it differently, a significant gap within the current literature necessitates thorough exploration. Furthermore, it is noteworthy that the preceding studies mentioned have not incorporated gender inequality indicators into their investigative methodologies or econometric models. Hence, these existing gaps create an opportunity for this investigation into the intricate relationship between gender inequality and cancer mortality in women.

This investigation seeks to answer the following question to address this knowledge gap. To what extent does gender inequality among women in Europe impact cancer mortality? Two potential hypotheses are proposed to explore this inquiry:

H1: Gender inequality in European countries influences women's cancer mortality rates through educational disparities, socioeconomic status, healthcare access, and risk behaviours. Greater gender inequality may result in limited education and awareness, promoting unhealthy behaviours and impeding healthcare access. These combined factors could contribute to higher cancer mortality rates (e.g., Donington and Colson 2011; OECD 2015; Gavurova et al. 2020; Willems et al. 2020; Jolidon 2022; and Vaccarella et al. 2023).

H0: Gender inequality within European countries is not significantly associated with cancer mortality rates among women. This suggests that lower levels of gender inequality, characterized by reduced discrepancies in socioeconomic status, healthcare access, and risk behaviours, do not correlate with increased mortality rates among women with cancer in European nations.

This study will examine the impact of gender inequality indicators on cancer mortality rates among women in European countries from 2013 to 2020 to validate these hypotheses and address the research gap. This impact will be achieved by applying econometric methods, such as pooled ordinary least squares (OLS) regression. The study aims to offer insights into gender disparities in cancer mortality and to identify the contributing factors. While the chosen methodology enables quantitative analysis and the examination of large-scale trends, it is essential to acknowledge its limitations, including aggregated data that may conceal individual-level variations, reliance on existing data sources with potential accuracy and completeness issues, and the study's observational nature.

This research aims to fill a significant gap in the existing literature by exploring the intricate relationship between gender inequality and cancer mortality, specifically focusing on women within the European context. While previous studies have examined gender disparities in cancer outcomes and the factors influencing them, few have undertaken a holistic approach that delves into the multifaceted dimensions of gender inequality and its intersection with cancer-related mortality rates.

The motivation behind this research stems from recognizing that gender inequality is a persistent issue that permeates various aspects of individuals' lives, including health outcomes. The observed disparities in cancer mortality rates between genders highlight the need for a comprehensive investigation into the underlying factors contributing to these differences. By unravelling the complexities of this relationship, this investigation can reveal the mechanisms through which gender inequality influences cancer outcomes, thereby informing targeted interventions and policies that aim to reduce these disparities.

The relevance and significance of this research lie in its potential to drive evidence-based interventions and strategies aimed at mitigating gender-driven disparities in cancer-related mortality. As cancer continues to be a significant public health concern within European countries, understanding the role of gender inequality in exacerbating these disparities is pivotal. This study's findings can potentially inform healthcare systems, policymakers, and advocacy efforts in devising interventions that foster equitable access to healthcare services, promote gender-sensitive healthcare practices, and address systemic gender inequalities that impact women's health outcomes.

This research introduces novel contributions to the existing body of work by adopting a comprehensive approach that considers the multifaceted dimensions of gender inequality and their interplay with cancer mortality outcomes. By employing pooled OLS regression, this investigation seeks to provide quantitative insights into the specific socioeconomic, healthcare, and behavioural factors that contribute to gender-based disparities in cancer mortality rates. Integrating economic and health-related methodologies adds depth and rigour to the analysis, offering a nuanced understanding of the complex interactions at play.

In contrast to existing studies that often focus on specific aspects of cancer disparities or gender inequality, this investigation's unique contribution lies in its holistic approach that considers the comprehensive spectrum of factors contributing to gender-driven disparities in cancer-related deaths. By considering a wide range of variables, including socioeconomic status, healthcare access, risk behaviours, and societal norms, this study aims to provide a comprehensive view of the multifaceted landscape of the impact of gender inequality on cancer outcomes. As such, this research promises to advance our understanding of the gender-related dynamics within cancer mortality and to inform evidence-based strategies to effectively address these disparities.

This study, striving for a thorough and all-encompassing inquiry, will rigorously follow a structured sequence of theoretical research procedures. These deliberately chosen steps, artistically illustrated in Fig. 4, have been meticulously crafted to guarantee a coherent and robust exploration of the focal topic.

Scientific method steps. The authors created this figure

This paper introduces the related literature in the following section as a basis for the subsequent sections. Section 2 outlines the research methodology and data, while Section 3 presents the empirical results. The main findings are thoroughly discussed in Section 4, and Section 5 presents the conclusions.