Griffith, Linda g.

Horne, Andrew w.

Hummelshoj, Lone

Missmer, Stacey a.

Stratton, Pamela

Zondervan, Krina t.

English

Edinburgh Research Explorer

The considerable disparities between funding for women’s health and their relative disease burden (Smith, Nature 20231) deliver a stark and important message.  The analyses were based on global burden of disease (GBD) data (Murray et al., 20132), and then related to NIH funding. Endometriosis - a common neuroinflammatory pain condition where endometrial-like tissue is found aberrantly at sites outside the uterus (Zondervan et al, NEJM 20203), is highlighted as a condition that receives a disproportionately low amount of NIH research funding relative to disease burden. However, the “burden” estimate for endometriosis is misleadingly small. First, established endometriosis-associated symptoms including pelvic pain, infertility, migraines, and anxiety/depression have a sizeable burdens not included within the endometriosis burden calculations.  Second, endometriosis is considerably underdiagnosed, even more so in low- and middle-income countries (World Health Organisation, 20234). The situation is compounded for adenomyosis, where endometrial-like tissue aberrantly grows into the myometrium causing severe period pain and heavy menstrual bleeding, which does not even have an NIH funding code. Notably, the women’s health funding examples provided by the UK Medical Research Council (Smith, Nature 2023) appear limited to childbirth and cancer, just two of eight priority areas identified in the 2022 Women’s Health Strategy for England requiring more research and investment. Given that funders may use GBD statistics to prioritise future research funding, it is important to highlight that these calculations underestimate the disease burden of endometriosis, and will likely do so for other conditions that lag behind in discovery due to severe under-investment. Krina T. Zondervan*: 1) Oxford Endometriosis CaRe Centre, Nuffield Dept of Women’s and Reproductive Health; 2) Wellcome Centre for Human Genetics, University of Oxford, UKLinda G. Griffith: 1) Biological Engineering Department; 2) Center for Gynepathology Research, Massachusetts Institute of Technology, Cambridge, MA, USAAndrew W. Horne: EXPPECT Edinburgh and MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UKLone Hummelshoj: Endometriosis.org, London, UKPamela Stratton: 1) Office of Research on Women's Health; 2) National Institutes of Neurological Disorder and Stroke, National Institutes of Health, Bethesda, MD, USAStacey A. Missmer: 1) Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, Grand Rapids, MI, USA; 2) Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA*krina.zondervan@wrh.ox.ac.ukReferences	Comment by Krina Zondervan: Will format references appropriately, EndNote formatting currently.1.	Smith, K. The funding gender gap. Nature 617, 28-29 (2023).2.	Murray, C.J. et al. The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. Jama 310, 591-608 (2013).3.	Zondervan, K.T., Becker, C.M. & Missmer, S.A. Endometriosis. N Engl J Med 382, 1244-1256 (2020).4.	Organisation, W.H. Endometriosis. (2023).

Women’s health: tackle the research funding deficit

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Women’s health: tackle the research funding deficit

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