Gender and Disparity in First Authorship in Cardiology Randomized Clinical Trials

Gender Trends in Authorship of Gastroenterology Randomized Controlled Trial Literature

INTRODUCTION

We describe female authorship trends in gastroenterology (GI) randomized controlled trial literature as a novel focus on gender bias in academic GI.

METHODS

Using a systematic PubMed search, we extracted GI randomized controlled trial reports published from 2011 to 2022. We describe time trends in proportions of females among first and last authors overall and within GI subspecialties and high-impact journals.

RESULTS

The proportion of females increased from 25.4% to 36.8% and from 14.3% to 24.8% among first and last authors, respectively. Smaller increases in female authorship occurred in most subgroups, although there were proportionately fewer females among authors in high-impact journals and advanced therapeutic endoscopy publications.

DISCUSSION

Over the past decade, female authorship in GI RCT reports has increased. However, female representation, particularly among senior authors and in high-impact journals, remains significantly lower. Despite recent improvements, female still constitutes a minority of the authors of original GI RCTs.

Gender disparity between first and senior authors on liver cancer research in the top journals of Gastroenterology and Hepatology

BACKGROUND

Gender disparity is pervasive in academic medicine. This study aimed to assess the disparity between men and women with regard to first and senior author positions in primary studies on liver cancer over the last two decades.

METHODS

We conducted a review of articles published in high-impact factor journals of the field of Gastroenterology and Hepatology in 2005, 2010, 2015 and 2020. First and senior authors of all ages were considered as the study population. The authors' genders were determined using the online artificial intelligence tool genderize.io (https://genderize.io/). The disparity between men and women authors was assessed using the linear-by-linear association test.

RESULTS

665 original articles from 10 journals were reviewed. The point prevalence of first women authors was 25.0% compared with 75.0% for men. The point prevalence of senior women authors was 16.3% compared with 83.7% for men. From 2000 to 2020, the proportion of first women authors increased 14.4% to 26.8% compared with 85.6%-73.2% for men (P = 0.009), and the proportion of senior women authors increased from 7.4% to 19.5%, compared with 92.6%-80.5% for men (P = 0.035). The factor independently associated with a reduced representation of women among first authors was the region of author. The factor independently associated with a reduced representation of women among senior authors was the impact factor of journals.

CONCLUSION

The findings indicated a remarkable increase in the proportion of women, both first and senior authors, over the past two decades in the field of liver cancers. However, the representation of women authors in this area is far less than that of men.

Mind the Gap! Working Toward Gender Equity in Pediatric and Congenital Heart Disease: Present and Future

Evidence from medicine and other fields has shown that gender diversity results in better decision making and outcomes. The incoming workforce of congenital heart specialists (especially in pediatric cardiology) appears to be more gender balanced, but past studies have shown many inequities. Gender-associated differences in leadership positions, opportunities presented for academic advancement, and recognition for academic contributions to the field persist. In addition, compensation packages remain disparate if evaluated based on gender with equivalent experience and expertise. This review explores these inequities and has suggested individual and institutional changes that could be made to recruit and retain women, monitor the climate of the institution, and identify and eliminate bias in areas like salary and promotions.

The gender composition of the members of the editorial board of toxicology journals: Assessment of gender equality

In many areas of medicine, gender equality has not yet been fully adopted despite recent developments. The inequality of gender in various areas of medicine is still debated. In this study, we analysed the gender composition of the editorial boards of toxicology journals in the Science Citation Index-Expanded (SCI-E) databases and the factors affecting this composition. The genders of the participants were determined by the data obtained from the official websites of the journals in September 2023. We analysed the journal metrics and publisher properties using Mann-Whitney U, Fisher's exact, Chi-square tests and Spearman's correlation coefficient. We used logistic regression analysis to reveal the independent factors related to gender parity. The representation rates of women were 28.62% on all editorial boards and 23.33% in editor-in-chief positions. The 'Neuroscience' (OR, 2.46 95%CI, 1.68-3.60, p < 0.001), 'Reproductive Biology'(OR, 2.05 95%CI, 1.22-3.42, p = 0.006) and 'Public, Environmental & Occupational Health'(OR, 1.49 95%CI, 1.18-1.88, p = 0.001) as a coverage category, the United States as a journal country (OR, 1.21, 95%CI, 1.04-1.40, p = 0.001), 5-year-IF≥3.6(OR, 1.54, 95%CI, 1.27-1.86, p < 0.001), 5-year H index≥29 (OR, 1.23, 95%CI, 1.01-1.49, p = 0.037) were the independent factors for gender parity. However, 'Oncology' (OR, 0.08 95%CI, 0.01-0.55, p = 0.011), 'Biochemistry, Molecular Biology' (OR, 0.62 95%CI, 0.44-0.86, p = 0.005) and 'Pharmacology & Pharmacy' (OR, 0.69 95%CI, 0.59-0.82, p < 0.001) as a coverage category, Japan as a publisher country (OR, 0.52 95%CI, 0.35-0.77, p = 0.001), and Switzerland as a journal country (OR, 0.61, 95%CI, 0.46-0.81, p = 0.001) were related to gender disparity. Greater endeavours are needed to reduce gender discrimination in toxicology. Toxicology authorities should continuously improve existing policies by optimising the analysis of objective information to eliminate barriers for toxicologists in terms of gender equality.

The Young European Resuscitation Council Resuscitation Science Masterclass - Concept and implementation

Nurturing the development of the next generation of resuscitation scientists is essential for creating a vibrant and enabled community equipped with the necessary knowledge, attitudes, and skills to transform resuscitation practice and improve outcomes. In this concept paper we will describe the development and implementation of the first Young European Resuscitation Council Resuscitation Science Masterclass. The masterclass aims to connect, inspire, and support the growth of the next generation of resuscitation scientists through education, networking, and joint scientific work. The masterclass provides 20 international, multi-professional early career resuscitation scientists with the opportunity to expand their knowledge and network as well as conduct joint scientific work over the course of one year. This is achieved by interactive webinars, innovative online workshops, engaging online journal clubs as well as an educational in-person event to conclude the masterclass. The Young European Resuscitation Council Resuscitation Science Masterclass aims to strengthen the global resuscitation community and next generation of resuscitation scientists by facilitating opportunities of broader international initiatives and collaboration for early career resuscitation scientists, potentially leading to accelerated recruitment of future resuscitation leaders. Ultimately, this masterclass may enable early career researchers to produce high impact research that can shape the future of resuscitation science and improve cardiac arrest patient care globally.

A Systematic Review of Gender Disparity in the Authorship of Clinical Trials and Clinical Practice Guidelines in Various Medicine Subspecialties

Authorship in clinical trials and clinical practice guidelines is considered prestigious and is associated with broader peer recognition. This systematic review investigated female representation among studies reporting authorship trends in clinical trials or clinical practice guidelines in different medicine subspecialties. Our search strategy yielded 836 articles, of which 30 met the inclusion criteria. Our findings indicate that females are severely underrepresented in authorship of clinical trials and clinical practice guidelines. Although the proportions of females may have improved in the past decade, the gains are marginal. Notably, studies in this domain predominantly focus on first/last authorship positions, and whether females are underrepresented in other positions as collaborative partners is currently unknown. Also, authorship trends in clinical trials or clinical practice guidelines of most medicine subspecialties besides cardiovascular medicine remain under-researched. Hence, standardizing the methodology for studying gender disparity in research output for comparative analysis between different subspecialties is as urgent as addressing the gender disparity in authorship.

Women authorship in pain research: A bibliometric analysis from 2002 to 2021

OBJECTIVES

There is a lack of data on the distribution of women first and senior authorships in pain journals. Using articles published in top North American pain journals over the past two decades, we sought to describe the prevalence and changes in women representation among first and last authors.

METHODS

We retrieved all published research articles in four pain journals (Regional Anesthesia and Pain Medicine, Clinical Journal of Pain, Pain and The Journal of Pain) from 2002 to 2021 using the easyPubMed package. Subsequently, the 'gender' package in R was used to determine authors' gender by first names. Trends in gender authorship change over time were assessed.

RESULTS

The final cohort consisted of 20,981 authors (from an initial total of 11,842 publications and 23,684 authors retrieved). Women authors were more often first compared to senior authors (46.7% vs. 30.5%). The proportion of women first authors (46.2% in 2002 vs. 48.4% in 2021) and women senior authors (22.4% in 2002 vs. 36.3% in 2021) increased over the course of the study period (all p-value <0.001). The Clinical Journal of Pain having the highest percentage of women authors and Regional Anesthesia and Pain Medicine had the lowest percentage of women authors.

DISCUSSION

Our data demonstrated increasing women authorship in pain journals in the past 20 years, largely driven by an increase in first authorships. There still remains a large gap between first and senior authorship, indicative of disparity in the role that women play in research.

Evaluation of gender trends in first authorship in nephrology publications in four major US journals in the last decade

BACKGROUND

To date, no data exist on gender-related publication biases in nephrology. This study was conducted to determine whether gender differences exist in the current literature published in high-ranking US nephrology journals, and how they may have changed over time.

METHODS

The PubMed search was performed using the easyPubMed package in R, which extracted all articles indexed in PubMed from 2011 to 2021 from the US nephrology journals with the highest impact factors, i.e., Journal of the American Society of Nephrology (JASN), American Journal of Nephrology (AJN), American Journal of Kidney diseases (AJKD), and the Clinical Journal of the American Society of Nephrology (CJASN). Gender with predictions > 90% were accepted and the remaining were manually identified. Descriptive statistical analysis was carried out on the data.

RESULTS

We identified 11,608 articles. On average, the ratio of male to female first authors decreased from 1.9 to 1.5 (p < 0.05). Additionally, in 2011, women accounted for 32% of first authors, a number that rose to 40% in 2021. All but the American Journal of Nephrology showed a variation in the ratio of men to women first authors. For the JASN, the ratio changed from 1.81 to 1.58, p = 0.001, for CJASN, the ratio declined from 1.91 to 1.15, p = 0.005 and for AJKD, the ratio declined from 2.19 to 1.19, p = 0.002.

DISCUSSION AND CONCLUSIONS

Our study shows that gender biases in publications continue to exist in first-author publications in high-ranking Nephrology journals published in the US; the gap is however closing. We hope this study lays the groundwork to continue following and evaluating gender trends in publication.

Gender distribution of editorial board members in critical care journals: Assessment of gender parity

PURPOSE

To reveal factors related to gender parity on editorial boards of critical care journals indexing in SCI-E.

METHODS

The genders were defined according to data obtained from journals' websites between 01-30 September 2022. Publisher properties and journal metrics were analyzed by using Chi-square, Fisher exact, Mann-Whitney U tests, and Spearman's correlation coefficient. Logistic regression analysis was used to reveal independent factors.

RESULTS

Women's representation on editorial boards was 23.6%. The USA (OR, 0.04, 95% CI, 0.01-0.15, p < 0.001) and Netherlands (OR, 0.04, 95% CI, 0.01-0.16, p < 0.001) as publisher's countries, an IF >5 (OR, 0.25, 95% CI, 0.17-0.38, p < 0.001), publication duration <30 years (OR, 0.09, 95% CI, 0.06-0.12, p < 0.001), multidisciplinary perspective of editorial policy (OR, 0.46, 95% CI, 0.32-0.65, p < 0.001), journals categorized also in nursing (OR, 0.38, 95% CI, 0.22-0.66, p < 0.001), and being a section editor (OR, 0.49, 95% CI, 0.32-0.74, p = 0.001) were associated with gender parity. Europe as a journal continent (OR, 36.71, 95% CI, 8.39-160.53, p < 0.001) was related to gender disparity.

CONCLUSIONS

Further efforts are needed to expand diversity policies in critical care medicine.

Gender equality in national cardiology societies: a cross-sectional study

BACKGROUND

Higher productivity and team stability has been shown for gender diverse teams. However, there is a relevant and well-known gender gap in clinical and academic cardiovascular medicine. So far, no data concerning gender distribution in presidents and executive boards of national cardiology societies exist.

METHODS

In this cross-sectional analysis, gender equality in presidents and representatives of all national cardiology societies, which are members of or affiliated with the European Society of Cardiology (ESC) in 2022 was analyzed. In addition, representatives of the American Heart Association (AHA) were evaluated.

RESULTS

A total of 106 national societies were screened of which 104 were included in the final analysis. Overall, in these 104 societies, 90 out of 106 (85%) presidents were men while 14 (13%) were women. In the analysis of board members and executives, a total of 1128 individuals were included. Overall, 809 (72%) board members were men, 258 (23%) women and 61 (5%) of unknown gender. Except for society presidents in Australia, women were relevantly outnumbered by men in all world regions.

CONCLUSION

Women were globally underrepresented in leading positions of national cardiology societies in all world regions. As national societies are important regional stakeholders, improving gender equality in executive boards might create women role models, help foster careers and narrow the global cardiology gender gap.

Contributions of Women to Cardiovascular Science Over Two Decades: Authorship, Leadership, and Mentorship

Background Women remain underrepresented in cardiology. We aimed to assess gender trends in research authorship, authorship in leading roles, mentorship, and research team diversity. Methods and Results We identified "cardiac and cardiovascular systems" journals from 2002 to 2020 using Journal Citation Reports 2019 (Web of Science, Clarivate Analytics). Gender authorship, mentorship, research team diversity, and trends were assessed. Associations between author gender and impact factor, journal region, and cardiology subspecialties were analyzed. Analysis of 396 549 research papers from 122 journals showed the percentage of women authors increased from 16.6% to 24.6% (β=0.38 [95% CI, 0.29-0.46]; P<0.001), whereas the proportion of women first (β=-0.03 [95% CI, -0.06 to 0.004]; P=0.09) or last authors (β=-0.017 [95% CI, -0.04 to 0.006]; P=0.15) was unchanged. Compared with men last authors, women last authors were more likely to mentor women first authors and lead more diverse research teams (both P<0.001). Journal impact factor was related to percentage of women authors overall (Spearman's correlation coefficient R_S=0.208 [95% CI, 0.02-0.38]; P=0.03) but not first or last women authors (both P>0.5). Women comprised 18.4%-25.7% of authors in cardiology subspecialties. Journal region and author gender were unrelated (all P>0.4). Conclusions Women's inclusion as authors of cardiology papers increased slightly over the past 2 decades, yet the proportions of women in first and last authorship roles were unchanged. Women are increasingly likely to mentor women first authors and lead diverse research teams. Women last authors are essential to increasing diversity of future independent investigators and inclusive research teams, both of which are associated with innovation and excellence in science.

Gender Disparity in First and Senior Authorship in Brazilian Cardiology Journals

BACKGROUND

Despite the importance of women in clinical research, no assessment has been made of the fraction of women in a leadership positions in the Cardiology journals of the SBC.

OBJECTIVES

To assess the fraction of female authors in the International Journal of Cardiovascular Sciences (IJCS) and the Arquivos Brasileiros de Cardiologia (ABC Cardiol) over the last decades.

METHODS

We searched the original articles of the ABC Cardiol, from 2000 to 2019, and of the IJCS, from 2010 to 2019. We surveyed the number of first and senior female authors and the total number of original articles from 2010 to 2019. We calculated the total proportion of female authorship and compared the first quinquennium with the second. Only data from the ABC Cardiol were analyzed to assess the temporal evolution of the two decades. We used the chi-square test to assess the differences within each journal and between them. The IBM® SPSS® software was used in the analyses. The level of significance adopted was 5%.

RESULTS

From 2010 to 2019, 1,157 original articles were published in the ABC Cardiol and 398 in the IJCS. We observed that women are more prevalent as first authors in the IJCS compared to the ABC Cardiol, but men prevail as senior authors in both journals. From 2010 to 2019, there was no significant change in the proportion of female authorship. Throughout the decades analyzed for the ABC Cardiol, there was a projection of linear growth of female authorship, with the slope of the line being greater in the first authorship than in senior authorship.

CONCLUSIONS

There is gender disparity, with lower female representativeness in authorship in the articles from the Brazilian Cardiology journals analyzed: Arquivos Brasileiros de Cardiologia and International Journal of Cardiovascular Sciences. We believe that based on these results, more efforts should be implemented in the search for gender equity in the cardiology scientific production published by these journals.

Trends in Women's Leadership of Oncology Clinical Trials

It has been widely reported that women are underrepresented in leadership positions within academic medicine. This study aimed to assess trends in women representation as principal investigators (PIs) in oncology clinical trials and to characterize trends in women’s leadership in such trials conducted between 1999 and 2019. The gender of 39,240 PIs leading clinical trials was determined using the gender prediction software Genderize.io. In total, 11,516 (27.7%) women served as PIs. Over the past 20 years, an annual increase of 0.65% in women PIs was observed. Analysis by geographic distribution revealed higher women representation among PIs in North America and Europe compared to Asia. Industry-funded trials were associated with lower women PI representation than academic-funded trials (31.4% vs. 18.8%, p<0.001). Also, women PIs were found to be underrepresented in late-phase as compared to early-phase studies (27.9%, 25.7%, 21.6%, and 22.4% in phase I, II, III, and IV, respectively; Cochran-Armitage test for trend, p<0.001). Furthermore, an association was found between the PI’s gender and enrolment of female subjects (50% vs. 43% female participants led by women vs men PIs, respectively, p<0.001). Taken together, while the gender gap in women’s leadership in oncology trials has been steadily closing, prominent inequalities remain in non-Western countries, advanced study phases, industry-funded trials and appear to be linked to a gender gap in patient accrual. These observations can serve for the development of strategies to increase women’s representation and to monitor progress toward gender equality in PIs of cancer clinical trials.

Sex-Related Outcomes of Medical, Percutaneous, and Surgical Interventions for Coronary Artery Disease: JACC Focus Seminar 3/7

Biological and sociocultural differences between men and women are complex and likely account for most of the variations in the epidemiology and treatment outcomes of coronary artery disease (CAD) between the 2 sexes. Worse outcomes in women have been described following both conservative and invasive treatments of CAD. For example, increased levels of residual platelet reactivity during treatment with antiplatelet drugs, higher rates of adverse cardiovascular outcomes following percutaneous coronary revascularization, and higher operative and long-term mortality after coronary bypass surgery have been reported in women compared with in men. Despite the growing recognition of sex-specific determinants of outcomes, representation of women in clinical studies remains low and sex-specific management strategies are generally not provided in guidelines. This review summarizes the current evidence on sex-related differences in patients with CAD, focusing on the differential outcomes following medical therapy, percutaneous coronary interventions, and coronary artery bypass surgery.

Gender Parity in Authorship of Published Randomized Clinical Trials in Stroke Neurology From 2000 to 2021

This cross-sectional study examines proportions of male and female first and last authors in randomized clinical trials on stroke neurology published from 2000 to 2021.

Gender Differences in International Cardiology Guideline Authorship: A Comparison of the US, Canadian, and European Cardiology Guidelines From 2006 to 2020

Background Women continue to be underrepresented in cardiology and even more so in leadership positions. We evaluated the trends and gender differences in the guideline writing groups of the American College of Cardiology/American Heart Association (ACC/AHA), Canadian Cardiovascular Society (CCS), and European Society of Cardiology (ESC) guidelines from 2006 to 2020. Methods and Results We extracted all guidelines authors from 2006 to 2020, assessed their gender from publicly available profiles, and compared differences based on subspecialties and specific societies. Stratified and trend analyses were performed using χ² and average annual percentage change/average 5 year percentage change. A total of 80 ACC/AHA (1288 authors [28% women]), 64 CCS (988 authors [26% women]), and 59 ESC (1157 authors [16% women]) guidelines were analyzed. A significant increase in inclusion of women was seen in ACC/AHA (12.6% [2006] to 42.6% [2020]; average annual percentage change, 6.6% [2.3% to 11.1%]; P=0.005) and ESC (7.1% [2006] to 25.8% [2020]; average annual percentage change, 6.6% [0.2% to 13.5%]; P=0.04), but the trend remained similar in CCS (20.6% [2006] to 36.3% [2020]; average annual percentage change, -0.1% (-3.7% to 3.5%); P=0.94), guideline authors. More women were coauthors in the ACC/AHA and ESC guidelines when women were chairs of guidelines. There was a persistent disparity of women among guideline authors for general cardiology and all subspecialties, except for pediatric cardiology and heart failure guidelines. The appointment of women authors as a chair was significantly low in all societies (22.4% [ACC/AHA], 16.9% [CCS], and 7.2% [ESC]; P=0.008). Conclusions There is a significant disparity in the inclusion of women on all national guideline committees, in addition to serving as a chair of cardiology guidelines. Further advocacy is required to promote equity, diversity, and inclusion in our cardiology guidelines globally.

Diversity in high-impact psychiatric publishing: gender parity within reach?

Gender parity and authorship diversity are declared goals in the publishing world. This study assessed the progress of authorship gender distribution over a quarter of a century and geographic diversity over the last 15 years in high-impact psychiatric journals. All articles published in 2019 in the American Journal of Psychiatry, the British Journal of Psychiatry, and JAMA Psychiatry were included and compared with data from three points in time starting in 1994. Descriptive statistics were gathered, and chi-square tests were performed. All tests were conducted as two-tailed, and p-values < 0.05 were considered to be statistically significant. Inter-rater reliability was calculated via Cohen's kappa. In 2019 a total of 473 articles were published. Forty percent of all authors, 42.3% of first authors, and 29.4% of senior authors were female. Counting original research articles only, female first authorship reached 50.4%. In the 25-year period between 1994 and 2019, female first (p < .001), female senior (p < .001), and female overall (p < .001) authorship has increased. In the specific period between 2014 and 2019, overall female senior authorship in all articles (p = .940) as well as first (p = .101) and senior (p = .157) in original research plateaued. In non-original research articles, female first authorship was higher in 2019 compared to 2014 (p = .014), whilst female senior authorship plateaued (p = .154). Geographic diversity was low and did not change over time. Gender parity in the subcategory original research articles was reached for the first time in 2019. Senior female authorship and geographic diversity remain areas of concern that need further investigation and specific interventions.

The Pivotal Role of Women in Cardiology Sections in Medical Organizations: From Leadership Training to Personal Enrichment

Women in cardiology (WIC) sections have emerged as important leadership, career development, and advocacy forums for female cardiologists. Over the past 3 decades, they have grown from small groups to large sections within volunteer science organizations. In addition to providing a sense of community and promulgating the principles of diversity, equity, inclusion, and belonging, the WIC sections have contributed to improving workplace culture and dynamics by generating evidence-based and actionable data, fostering leadership by and scientific enrichment of women, developing task forces and health policy documents targeted toward reduction of burnout and bias in medicine, and providing a platform to voice the unique challenges and opportunities of female cardiologists. The future holds great promise, as the WIC sections continue to play a pivotal role by being intentional, transparent, iterative, and sustainable, and working with important stakeholders, including men, to share data, best practices, and strategies to create and maintain a culture of equity and achieve its core principles.