Sex Differences in Authorship of Academic Cardiology Literature Over the Last 2 Decades

Sex Disparities in Cardiovascular Disease

Cardiovascular disease is the leading cause of death in women. It remains underdiagnosed, undertreated, and portends worse outcomes in women than men. Disparities exist in every stage of science, from bench research to the editorial board of major journals and in every cardiovascular subspecialty. This review summarizes differences in cardiovascular risk factors and disparities in management and outcomes of ischemic heart disease, heart failure, aortic stenosis, and atrial fibrillation. It also provides an overview of female representation as participants and leaders of clinical trials, editorial boards, and academic institutions. Strategies to overcome these disparities are proposed with examples of successful programs.

Unveiling the gender gap in research: a bibliometric analysis of the 100 most-cited articles on food-borne pathogen outbreaks from 1990 to 2020

Introduction

Despite a recent increase in the representation of female authors in scientific literature, a significant gap persists concerning the inclusion of women in research. This necessitates the analysis of published literature from a gender perspective. This study aimed to provide gender distribution in authorship in the 100 most-cited articles on food-borne pathogen outbreaks from 1990 to 2020.

Methods

Bibliometric analysis was conducted using the Scopus database. Two reviewers were selected to search the database. We included the 100 most-cited articles on foodborne outbreak investigations. The analysis was conducted using Statistical Package for Social Sciences (SPSS) version 26 and Microsoft Excel version 2016. The citation data, including total citations, citations per year, and representation of women as first and senior authors, was analyzed in terms of frequencies, mean, median, and interquartile range. The correlation between journal impact factor and the representation of women in high-impact factor journals was determined. A p-value of <0.05 was considered significant.

Results

Most of the top-cited articles were published between 2001 and 2010 (n=47). The top 3 most-cited articles were from the USA. Of the total 100 articles, women were the first and last authors in 46% and 28% of the articles, respectively, reflecting a significant gender gap. However, the proportion of females as principal investigators gradually increased from 25% (n=10/30) to 52% (n=24/47) during the period 2001-2010 and to 92% (n=12/13) during 2011-2020. The USA had the highest number of included articles (n=48), and women were principal authors in 56% (n=27) of them. The lowest representation of women was observed in Austria, Denmark, Japan, Netherlands, New Zealand, Nigeria, Portugal, and the United Kingdom.

Conclusion

Women are under-represented in published literature on food-borne pathogen outbreaks. Although the representation of women as principal authors has recently increased, disparities still exist at the senior-author level, calling for women's advancement in academic science.

Gender Inequality in Leadership Positions in Neurology and Neurosurgery Journals and Societies

OBJECTIVE

Gender inequalities persist in several areas of medicine, despite the growing number of female doctors and medical students. In this study, we aimed to reveal the gender inequality in the top journals' editorial boards and national societies' leadership positions in the field of neurology and neurosurgery.

METHOD

This is a cross-sectional study that uses public information accessed through the internet via journals' and academic societies' public websites. The medical journals are selected and included according to their h5-index in the field of neurology and neurosurgery. We evaluated the gender composition of the editorial boards and academic societies' leadership positions.

RESULTS

The female editorial board member ratio was 44.0% in the top 10 neurology journals. However, this ratio was significantly decreased to 29.7% in the other journals(P < 0.001). The top 10 neurosurgery journals had a female editorial board member ratio of 13.7%. This ratio was significantly decreased to 5.3% in the other 10 journals with lower h5-index(P < 0.001). A significantly lower number of female individuals are present in the editorial boards of the neurosurgery journals than in neurology(P < 0.001). The female president or delegate ratio was 19.3% in the World Federation of Neurology-affiliated countries, and it was 4% in the World Federation of Neurosurgical Societies-affiliated countries.

CONCLUSIONS

In conclusion, there is a significant gender inequality among editorial board members. The position of neurosurgical societies and journals is far different than the field of neurology. Furthermore, these findings should be evaluated as a continuum of the gender inequality in the professional societies' executive boards and delegates representing the national academical community.

Gender parity in high impact neurology journals

Background

Although female representation has been growing among physicians, women continue to be underrepresented in neurology, particularly regarding academic research in authorship and leadership. Analyzing recent trends in high-impact neurology journals highlights the underrepresentation of women and helps explore barriers to female representation in academic neurology.

Methods and results

Journal Citation Reports (JCR) for 2021 was used to screen neurology journals for selection. The first 15 journals with the highest impact factors (JIF) were included. 15,404 total articles in neurology were examined for gender distribution of editorial staff and authorship with the highest total citations from January 1st, 2018 to October 31st, 2021. Gender was classified using biographical information from public and personal media sources. Genderize.io was used in cases of ambiguity, predicting gender at probability of ≥95%. Our data demonstrated that these journals only had 13% female editor-in-chiefs and 35% female editorial staff. The data further demonstrated that females accounted for 39% of first authors and 26% for last authors. During the four years examined males continued to account for the vast majority of both first and last authors for publications accepted and journal editorial staff members.

Conclusion

Women are significantly under-represented in the field of neurological research in leadership positions as editor-in-chiefs, editorial board members as well as first or senior authors in top neurology medical journals. With continued underrepresentation of women occupying leading publishing roles, parity with men is still a work in progress. Additional work is needed to identify and address barriers to academic advancement for women physicians in academic neurology.

Gender equity of authorship in pulmonary medicine over the past decade

BACKGROUND

Gender disparity in authorship broadly persists in medical literature, little is known about female authorship within pulmonary medicine.

METHODS

A bibliometric analysis of publications from 2012 to 2021 in 12 journals with the highest impact in pulmonary medicine was conducted. Only original research and review articles were included. Names of the first and last authors were extracted and their genders were identified using the Gender-API web. Female authorship was described by overall distribution and distribution by country/region/continent and journal. We compared the article citations by gender combinations, evaluated the trend in female authorship, and forecasted when parity for first and last authorship would be reached. We also conducted a systematic review of female authorship in clinical medicine.

RESULTS

14,875 articles were included, and the overall percentage of female first authors was higher than last authors (37.0% vs 22.2%, p<0.001). Asia had the lowest percentage of female first (27.6%) and last (15.2%) authors. The percentages of female first and last authors increased slightly over time, except for a rapid increase in the COVID-19 pandemic periods. Parity was predicted in 2046 for the first authors and 2059 for the last authors. Articles with male authors were cited more than articles with female authors. However, male-male collaborations significantly decreased, whereas female-female collaborations significantly increased.

CONCLUSIONS

Despite the slow improvement in female authorship over the past decade, there is still a substantial gender disparity in female first and last authorship in high-impact medical journals in pulmonary medicine.

Gender Trends in First Authorship of Academic Publications Related to Wolff-Parkinson-White Syndrome

Wolff-Parkinson-White (WPW) syndrome is a congenital cardiac preexcitation syndrome that arises from abnormal cardiac electrical conduction through an accessory pathway and results in symptomatic and life-threatening arrhythmias. The aim of this study is to analyze the patterns of gender representation among first-author publications concerning "Wolf-Parkinson-White syndrome" within the PubMed-indexed publications from "January 1, 1973, to December 31, 2022," based on country and year. On May 9, 2023, bibliometric analysis was performed. The phrase "(Wolf-Parkinson-White Syndrome)" was looked up in PubMed. It covered articles released between January 1, 1973, and December 31, 2022. Articles accepted in the year 2022 and published in Pubmed in 2023 were included in the study. A total of 138 articles were considered and included in our analysis. Among these articles, 29 (21.01%) were authored by females, while 109 (78.99%) were authored by males. To conclude, this research study reveals a rising trend of females in lead authorship roles within the field of cardiac arrhythmia research. However, it remains evident that there is a significant gender gap, with male researchers still outnumbering their female counterparts.

Gender Bias in Clinical Trial Enrollment: Female Authorship Matters

BACKGROUND

Despite initiatives to promote equal enrollment of human subjects in clinical trials, females continue to be underrepresented. The goal of this work is to determine if female enrollment in human clinical trials published in 3 high-impact journals from 2015 to 2019 is correlated with gender of first and/or senior authors.

METHODS

Clinical trials published in the Journal of the American Medical Association (JAMA), The Lancet, and the New England Journal of Medicine (NEJM) from January 1, 2015, to December 31, 2019, were reviewed. Trials were excluded for ongoing enrollment, sex-specific disease research, or author name without gender assignment. One-sample χ2 pairwise comparisons and two-tailed proportion tests on the proportion of females between gender author pairings were done overall and for each subset analysis.

RESULTS

In total, 1,427 articles enrolled a total of 2,104,509 females and 2,616,981 males (44.6% vs. 55.4%, P ≤ 0.0001) in clinical trials. Overall, more females were enrolled if both first and senior authors were female (51.7% vs. 48.3%, P ≤ 0.0001). Proportion of females enrolled decreased with the following first and senior author pairings: female-male (48.9%), male-female (48.6%), and male-male (40.5%, P ≤ 0.0001 compared to female-female authorship). Greater female enrollment in clinical trials with female-female compared to male-male authorship persisted in subset analyses by funding source, phase, randomization for study participants, drug and/or device trial, and geographic location. Female enrollment was higher in 3 surgical specialties: neurosurgery (all authors: 52%, P ≤ 0.01), ophthalmology (all authors: 53.6%, P ≤ 0.0001), and surgery (all authors: 54.4%, P ≤ 0.0001). The majority of surgical specialties did not publish trials with female-female authorship but when stratifying by author gender pairing, surgical oncology had the highest female enrollment with female-female authorship (98.4%, P ≤ 0.0001).

CONCLUSIONS

Female authorship of clinical trial publications, specifically having both first and senior authors as female, was correlated with higher female enrollment in clinical trials when compared to male authorship and endured with multiple subset analyses.

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.

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 Parity in High Impact Cardiology Journals

Despite increased female representation in medical training, women physicians continue to be under-represented in academic cardiology, particularly in senior roles of authorship and leadership. We analyzed the top 20 most-cited cardiology journals (31,540 total articles) between January 1, 2018 and October 31, 2021 for gender distribution of editorial staff and authorship. Our data demonstrated that only 27% of articles had women as first authors and 20% as senior authors. Women constituted 23% of editorial staff. There is a statistically significant negative correlation (R = 0.67, P = 0.0011) between the percentage of women as first authors and the percentage of men on editorial boards. Overall, female authorship increased from 26% first and 19% senior authors in 2018, to 29% first and 22% senior authors in 2021. Women authors are significantly under-represented in academic cardiology publications, and additional work is needed to identify and address barriers to publishing and academic advancement for women in cardiology.

Gender Representation Among Physician Authors of Practice Guidelines Developed, Endorsed, or Affirmed by the American Academy of Neurology

BACKGROUND AND OBJECTIVES

To assess American Academy of Neurology (AAN)-recommended Practice Guidelines (PGs) for equity in gender representation among physician authors.

METHODS

This cross-sectional study included AAN-recommended PG publications from January 1, 2015, to December 31, 2020. Author degrees and gender were identified by 2 reviewers using the publication and/or online searches. Gender was determined from pronouns or photographs. Gender representation was compared with Association of American Medical Colleges (AAMC) data on academic neurologists. Data were analyzed using Z tests of 2 proportions and descriptive statistics.

RESULTS

AAMC benchmarks report academic women neurologists represented 35% of the specialty in 2015, 38% in 2018, and 39% in 2020. We identified 68 unique PG publications with 709 physician authors, 31% (223) women, 68% (484) men, and 0.3% (2) gender could not be identified. Representation of women physicians was low among PG authors across all benchmarks, significantly so for 2018 and 2020 (p < 0.01). Among physician first authors, women were significantly underrepresented across all benchmarks (18% [12/65], p < 0.01). Representation of women physicians was lower when men physicians were first authors vs women physicians (31% [161/524] vs 43% [50/118], p = 0.02). Among subspecialties with 10+ PGs, women physician authorship was highest in child neurology (48% [57/120]) and lowest in stroke and vascular neurology (16% [18/113]).

DISCUSSION

We found that women physicians were underrepresented as authors of AAN-recommended PGs. This suggests a missed opportunity for neurology because PGs that include expertise from women physicians may improve care and translation into practice. In addition, women physicians lose out on professional development from authorship. Further research is needed to understand causality and address gaps.

Dear colleagues: enough with the men-only author panels

Graphical Abstract.

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.

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.

Sex Differences in Cardiovascular Research: A Scientometric Analysis

Background We sought to investigate sex-specific differences in authorship of cardiovascular research over the past decade. Methods and Results All 387 463 cardiovascular publications between 2010 and 2019 were retrieved from Web of Science. Articles increased from 19 960 to 29 604 articles per year (P>0.001). The number of articles written by female first authors increased by 76.3% (6434-11 343 articles) and by 35.0% for male first authors (13 526-18 261) (P<0.001). The first author was more likely to be a female author in articles with female last authors. The median impact factor (IF) for articles by female first authors was lower (2.46 [interquartile range, 7 1.11-4.03] versus 2.51 [interquartile range, 1.17-4.10]; P<0.001). Female authorship articles reached the highest IF in North America (average IF, 3.7), with the lowest in Africa (average IF, 1.8). Conclusions Publications in cardiovascular research have increased over the past decade, particularly by female authors. Female researchers are cited less often compared with their male peers. The IF remains lower for articles by female researchers.

Temporal Trends and Clinical Trial Characteristics Associated With the Inclusion of Women in Heart Failure Trial Steering Committees: A Systematic Review

BACKGROUND

Trial steering committees (TSCs) steer the conduct of randomized controlled trials (RCTs). We examined the gender composition of TSCs in impactful heart failure RCTs and explored whether trial leadership by a woman was independently associated with the inclusion of women in TSCs.

METHODS

We systematically searched MEDLINE, EMBASE, and CINAHL for heart failure RCTs published in journals with impact factor ≥10 between January 2000 and May 2019. We used the Jonckheere-Terpstra test to assess temporal trends and multivariable logistic regression to explore trial characteristics associated with TSC inclusion of women.

RESULTS

Of 403 RCTs that met inclusion criteria, 127 (31.5%) reported having a TSC but 20 of these (15.7%) did not identify members. Among 107 TSCs that listed members, 56 (52.3%) included women and 6 of these (10.7%) restricted women members to the RCT leaders. Of 1213 TSC members, 11.1% (95% CI, 9.4%-13.0%) were women, with no change in temporal trends (P=0.55). Women had greater odds of TSC inclusion in RCTs led by women (adjusted odds ratio, 2.48 [95% CI, 1.05-8.72], P=0.042); this association was nonsignificant when analysis excluded TSCs that restricted women to the RCT leaders (adjusted odds ratio 1.46 [95% CI, 0.43-4.91], P=0.36).

CONCLUSIONS

Women were included in 52.3% of TSCs and represented 11.1% of TSC members in 107 heart failure RCTs, with no change in trends since 2000. RCTs led by women had higher adjusted odds of including women in TSCs, partly due to the self-inclusion of RCT leaders in TSCs.

Gender disparity between authors in leading medical journals during the COVID-19 pandemic: a cross-sectional review

OBJECTIVES

Evaluate gender differences in authorship of COVID-19 articles in high-impact medical journals compared with other topics.

DESIGN

Cross-sectional review.

DATA SOURCES

Medline database.

ELIGIBILITY CRITERIA

Articles published from 1 January to 31 December 2020 in the seven leading general medical journals by impact factor. Article types included primary research, reviews, editorials and commentaries.

DATA EXTRACTION

Key data elements were whether the study topic was related to COVID-19 and names of the principal and the senior authors. A hierarchical approach was used to determine the likely gender of authors. Logistic regression assessed the association of study characteristics, including COVID-19 status, with authors' likely gender; this was quantified using adjusted ORs (aORs).

RESULTS

We included 2252 articles, of which 748 (33.2%) were COVID-19-related and 1504 (66.8%) covered other topics. A likely gender was determined for 2138 (94.9%) principal authors and 1890 (83.9%) senior authors. Men were significantly more likely to be both principal (1364 men; 63.8%) and senior (1332 men; 70.5%) authors. COVID-19-related articles were not associated with the odds of men being principal (aOR 0.99; 95% CI 0.81 to 1.21; p=0.89) or senior authors (aOR 0.96; 95% CI 0.78 to 1.19; p=0.71) relative to other topics. Articles with men as senior authors were more likely to have men as principal authors (aOR 1.49; 95% CI 1.21 to 1.83; p<0.001). Men were more likely to author articles reporting original research and those with corresponding authors based outside the USA and Europe.

CONCLUSIONS

Women were substantially under-represented as authors among articles in leading medical journals; this was not significantly different for COVID-19-related articles. Study limitations include potential for misclassification bias due to the name-based analysis. Results suggest that barriers to women's authorship in high-impact journals during COVID-19 are not significantly larger than barriers that preceded the pandemic and that are likely to continue beyond it.

PROSPERO REGISTRATION NUMBER

CRD42020186702.

Ending Gender Inequality in Cardiovascular Clinical Trial Leadership: JACC Review Topic of the Week

Women are under-represented as leaders of cardiovascular randomized controlled trials, representing 1 in 10 lead authors of cardiovascular trials published in high-impact journals. Although the proportion of cardiovascular specialists who are women has increased in recent years, the proportion of cardiovascular clinical trialists who are women has not. This gap, underpinned by systemic sexism, has not been adequately addressed. The benefits of diverse randomized controlled trial leadership extend to patients and professionals. In this position statement, we present strategies adopted by some organizations to end gender inequality in research leadership. We offer an actionable roadmap for early-career researchers, scientists, academic institutions, professional societies, trial sponsors, and journals to follow, with the goal of harnessing the strength of women and under-represented groups as research leaders and facilitating a just culture in the cardiovascular clinical trial enterprise.

Is there a gender gap in national Cardiology research? Data review from the Portuguese Journal of Cardiology

gA ender gap is apparent in several professional areas, including in Medicine and particularly in the Cardiovascular field. We present a brief review of the subject and we analyse data from the Portuguese Journal of Cardiology regarding women authorship.

Gender and Disparity in First Authorship in Cardiology Randomized Clinical Trials

This cross-sectional study assesses the annual proportions and overall trend of female first authors in cardiology randomized clinical trials from 2011 to 2020.

Characteristics of Heart Failure Trials Associated With Under-Representation of Women as Lead Authors

BACKGROUND

Clinical trials change practice in cardiology, and leading them requires research training, mentorship, sponsorship, and networking. Women report challenges in obtaining these opportunities.

OBJECTIVES

The purpose of this review was to evaluate temporal trends in representation of women as authors in heart failure (HF) randomized controlled trials (RCTs) published in high-impact medical journals and explore RCT characteristics associated with women as lead authors.

METHODS

We searched MEDLINE, EMBASE, and CINAHL for HF RCTs published in journals with an impact factor ≥10 between January 1, 2000, and May 7, 2019. We assessed temporal trends in the gender distribution of authors, and used multivariable logistic regression to determine characteristics associated with women as lead authors.

RESULTS

We identified 10,596 unique articles, of which 403 RCTs met inclusion criteria. Women represented 15.6% (95% confidence interval [CI]: 12.2% to 19.6%), 12.9% (95% CI: 9.8% to 16.6%), and 11.4% (95% CI: 8.5% to 14.9%) of lead, senior, and corresponding authors, respectively. The proportion of women authors has not changed over time. Women had lower odds of lead authorship in RCTs that were multicenter (odds ratio [OR]: 0.58; 95% CI: 0.18 to 0.96; p = 0.037), were coordinated in North America (OR: 0.21; 95% CI: 0.08 to 0.70; p = 0.011) or Europe (OR: 0.33; 95% CI: 0.09 to 0.91; p = 0.039), tested drug interventions (OR: 0.42; 95% CI: 0.16 to 0.97; p = 0.043), or had men as the senior author (OR: 0.50; 95% CI: 0.21 to 0.93; p = 0.043).

CONCLUSIONS

Women are under-represented as authors of HF RCTs, with no change in temporal trends. Women had lower odds of lead authorship in RCTs that were multicenter, were coordinated in North America or Europe, tested drug interventions, or had men as senior authors.

Representation of Women Authors in International Heart Failure Guidelines and Contemporary Clinical Trials

BACKGROUND

Gender disparities in authorship of heart failure (HF) guideline citations and clinical trials have not been examined.

METHODS

We identified authors of publications referenced in Class I Recommendations in United States (n=173) and European (n=100) HF guidelines and of publications of all HF trials with >400 participants (n=118) published between 2001 and 2016. Authors' genders were determined, and changes in authorship patterns over time were evaluated with linear regression and nonparametric testing.

RESULTS

The median proportion of women authors per publication was 20% (interquartile range [IQR], 8%-33%) in United States guidelines, 14% (IQR, 2%-20%) in European guidelines, and 11% (IQR, 4%-20%) in HF trials. The proportion of women authors increased modestly over time in United States and European guidelines' references (β=0.005 and 0.003, respectively, from 1986 to 2016; P<0.001) but not in HF trials (12.5% [IQR, 0%-20%] in 2001-2004 to 8.9% [IQR, 0%-20%] in 2013-2016; P>0.50). Overall proportions of women as first or last authors in HF trials (16%) did not change significantly over time (P=0.60). North American HF trials had the highest likelihood of having a woman as first or senior author (24%). HF trials with a woman first or senior author were associated with a higher proportion of enrolled female participants (39% versus 26%, P=0.01).

CONCLUSIONS

In HF practice guidelines and trials, few women are authors of pivotal publications. Higher number of women authors is associated with higher enrollment of women in HF trials. Barriers to authorship and representation of women in HF guidelines and HF trial leadership need to be addressed.

Assessing the Gap in Female Authorship in Neurosurgery Literature: A 20-Year Analysis of Sex Trends in Authorship

BACKGROUND

Publications are considered a major factor for advancement in academia. An effort has been made to study authorship trends in neurosurgery publications. The objective of this study was to investigate authorship trends in the neurosurgery literature for the last 20 years (1998-2018).

METHODS

Articles for the years 1998, 2008, and 2018 were extracted from Neurosurgery, Journal of Neurosurgery, and World Neurosurgery for this retrospective study. Only original articles, case reports, and review articles were included. The gender of the first, senior, and corresponding author was determined. Subspecialty topic, type of paper, geographic origin of articles, and the number of citations for each article were also collected.

RESULTS

A total of 3912 articles were included. The number of articles, the total number of authors, and nonexperimental studies increased in the successive decades. A total of 744 women (19.0%) were first authors and 520 (13.3%) were senior authors of their respective publications. A decreasing trend (P < 0.05) was noted between female first authors and male senior authors over time. All 3 journals showed an increasing pattern of female authorships across the 2 decades.

CONCLUSIONS

A rapid rise in female authorship positions in particular and authorship positions in general demonstrates the diversity that is slowly burgeoning to cater to perspectives and issues that require a multidimensional approach in neurosurgery. Increasing linkages among researchers in neurosurgery on a global scale are evident by the increase in multinational collaborations. Expansive efforts are needed at institutional and individual levels to eradicate sex-based pitfalls that hinder excellence in neurosurgery research.

Characteristics of highly cited articles in heart failure: a bibliometric analysis

Aim: Despite a vast array of research in heart failure (HF), no bibliometric analysis has been conducted for HF. Therefore, we sought to identify in-depth characteristics of 100 most cited publications in HF. Materials & methods: Two independent reviewers searched the Scopus Library Database using a variety of keywords to extract the top 100 articles. Results: Majority (36%) of top 100 cited articles were published between 2001 and 2005. The total number of citations ranged from 6294 to 1003. Females had less than a quarter representation in both first and senior author position. More than three-fourths (86%) of the articles were funded. Conclusion: Our analysis highlights focal areas of research activity in order to guide HF specialists toward impactful research areas.

A Quantitative and Narrative Evaluation of Goodman and Gilman's Pharmacological Basis of Therapeutics

Goodman and Gilman's The Pharmacological Basis of Therapeutics (_GGPBT) has been a cornerstone in the education of pharmacists, physicians, and pharmacologists for decades. The objectives of this study were to describe and evaluate the 13^th edition of _GGPBT on bases including: (1) author characteristics; (2) recency of citations; (3) conflict of interest (CoI) disclosure; (4) expert evaluation of chapters. Contributors' (N = 115) sex, professional degrees, and presence of undisclosed potential CoI-as reported by the Center for Medicare and Medicaid's Open Payments (2013-2017)-were examined. The year of publication of citations was extracted relative to Katzung's Basic and Clinical Pharmacology (_KatBCP), and DiPiro's Pharmacotherapy: A Pathophysiologic Approach (_DiPPAPA). Content experts provided thorough chapter reviews. The percent of _GGPBT contributors that were female (20.9%) was equivalent to those in _KatBCP (17.0%). Citations in _GGPBT (11.5 ± 0.2 years) were significantly older than those in _KatBCP (10.4 ± 0.2) and _DiPPAPA (9.1 ± 0.1, p < 0.0001). Contributors to _GGPBT received USD 3 million in undisclosed remuneration (Maximum author = USD 743,718). In contrast, _DiPPAPA made CoI information available. Reviewers noted several strengths but also some areas for improvement. _GGPBT will continue to be an important component of the biomedical curriculum. Areas of improvement include a more diverse authorship, improved conflict of interest transparency, and a greater inclusion of more recent citations.

Female Authorship in Preclinical Cardiovascular Research: Temporal Trends and Influence on Experimental Design

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In this analysis of 3,396 preclinical studies published in 5 leading cardiovascular journals over a 10-year period, women accounted for 24 ± 17% of authors per manuscript.

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Female authorship is increasing in preclinical cardiovascular science, but the proportions of articles with first and senior authors of different sex have remained unchanged, which suggests that segregation by sex in mentorship relationships exists and persists.

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In preclinical studies that reported the sex of the animals used, female authorship was positively associated with studying female animals, using animals of both sexes, and reporting sex-specific results, which are findings that persisted in adjusted and sensitivity analyses.

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Author sex was not associated with other measures of methodological rigor or with 60-month citation counts.

In this analysis of 3,396 preclinical cardiovascular studies, women were first, senior, and both first and senior authors in 41.3%, 20.7%, and 11.0% of the studies, respectively. Female authorship increased over a 10-year period. However, the proportion of studies with first and senior authors of differing sex was low and stable, suggesting that segregation by sex in mentorship relationships exists and persists. Female authors were more likely to consider sex as a biological variable, but author sex was not associated with other measures of experimental rigor or research impact, indicating that women’s underrepresentation was not due to differences in research capacity or impact.

Gender differences amongst board members of endocrinology and diabetes societies

PURPOSE

Although women's status has shown marked improvement over the years in many areas, women still face a gender bias, especially in the workforce. Despite the best efforts of organizations to promote diversity and equality, women still dominate the lower-paying administrative ranks while men continue to dominate at the executive level. The present study examines gender disparity in the leadership positions in the national and international endocrinology and diabetes societies across the globe.

METHODS

We first composed a list of Diabetes and Endocrinology societies from online databases, including the International Diabetes Federation, European Society of Endocrinology, and other similar online directories. The Scopus database author search was used to find the total number of publications, publication range (in years), h-indices, number of citations, and years of active research of each member.

RESULTS

Our study included 524 board members of whom 31.3% (164/524) were women. The institutional academic rank of 310 of the total board members was found. The proportion of women in higher-faculty ranks (Assistant Professor, Associate Professors, and Professors) is much lower than males. Female endocrinologists also have fewer publications, citations, and years of active research.

CONCLUSIONS

Endocrinology is becoming a female-predominant subspecialty of internal medicine. As women are becoming a more significant portion of the endocrinology workforce, it is imperative to study and mitigate gender differences and disparities to optimize the endocrinology workforce.