Association of Author Gender With Sex Bias in Surgical Research

Gender based disparities in research on injuries in NCAA athletes

OBJECTIVES

Females participate in clinical research at a much lower rate than males, leading to clinical outcome disparities. The objective of this study was to determine whether gender-based disparities exist in orthopedic sports medicine injury research on NCAA college student-athletes.

METHODS

A PubMed search was conducted in September 2023 using the search terms 'NCAA,' 'injury,' and each of the 24 individual NCAA sports between 1980 and 2023. Statistical analysis was performed via determination of adjusted correlation coefficient R2 and multiple linear regression models. Gender was the independent variable, number of studies was the dependent variable.

RESULTS

Of 1,553 studies initially identified, 790 met inclusion criteria and underwent full-text review. Of NCAA studies that assessed injury rates (injury rate studies) and those that evaluated other outcomes such as performance (non-injury rate studies), 468 of 790 (59%) discussed male collegiate athletes and 318 (40%) discussed females. For females, there was a negative association between athlete-exposure rate and injury rate studies (expected decrease of 0.31 studies per 100,000 athlete-exposures) and between athlete-exposure rate and non-injury rate studies (decrease of 0.007). For males, there was a positive association for each (increase of 1.15 and 1.96). Injury rates were positively associated with injury rate study numbers for both males and females (increase of 3.71). There was no significant relationship between injury rates and non-injury rate study numbers for either gender.

CONCLUSION

This study demonstrates gender disparities in orthopedic sports medicine injury research for collegiate athletes. There was a negative association between athlete-exposure rate and injury rate or non-injury rate studies for female NCAA athletes, but a positive association for males.

CLINICAL RELEVANCE

It is important to ensure that sports medicine research is focused on both male and female NCAA athletes to be able to evaluate injuries, outcomes, and opportunities for injury prevention.

Gender Inequity in Institutional Leadership Roles in US Academic Medical Centers: A Systematic Scoping Review

Importance

Academic medical centers have focused their efforts on promoting gender equity in recent years, but the positive outcomes associated with those efforts remain to be seen in recruiting and retaining diverse institutional leadership.

Objective

To evaluate the current state of gender inequity in institutional leadership roles, such as deans, department chairs, and residency and fellowship program directors, at US academic medical centers.

Evidence Review

A search for articles published from January 1, 2019, to August 5, 2022, on gender inequity in institutional leadership roles at academic medical centers was performed using the PubMed, CINAHL, and ERIC databases. Studies were screened for inclusion by sets of 2 independent reviewers (with disagreements resolved by a third reviewer) and evaluated for risk of bias. The Methodological Expectations of Cochrane Intervention Reviews Standards were followed for conducting the review, and the Preferred Reporting of Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guideline was followed for reporting results.

Findings

A total of 8120 articles were retrieved, of which 6368 were screened by title and abstract, 6166 were excluded, and 202 underwent full-text review. Ultimately, 94 studies reported on institutional leadership roles, including deans (5 studies [5.3%]), department chairs (39 studies [41.5%]), division chiefs (25 studies [26.6%]), and program directors (67 studies [71.3%]), with some overlap. A total of 678 participants were deans (564 men [80.5%] and 132 women [19.5%]), 8518 were department chairs (7160 men [84.1%] and 1358 women [15.9%]), 3734 division chiefs (2997 men [80.3%] and 737 women [19.7%]), and 9548 program directors (7455 men [78.1%] and 2093 women [21.9%]). Even in specialties with 50% or more female faculty, none had equal representation of women as department chairs and division chiefs. Gender inequities were particularly pronounced in surgical specialties.

Conclusions and Relevance

This systematic scoping review suggests that even though emphasis has been placed on addressing gender inequities in academic medicine, considerable disparities remain at the leadership level. While certain positions and specialties have been observed to have more female leaders, niches of academic medicine almost or completely exclude women from their leadership ranks. Importantly, even female-dominated specialties, such as obstetrics and gynecology, have substantial inequity in leadership roles. It is past time for organizational and systems-level changes to ensure equitable gender representation in academic leadership.

The inclusion of sex and gender in research methodology, funding, and publication: A systematic review

IMPORTANCE

Gender inequity in access to and outcomes of orthopedic care demands research that properly analyses data based on sex and gender. Orthopedic surgeons have an obligation to mitigate gender inequity in the provision of care by addressing the sex and gender bias in orthopedic research methodology, grant funding, and publication demonstrated by this review. This study aimed to review the literature on known gender inequities in orthopedic care, as well as sex and gender bias in orthopedic research methodology, funding, and publication; and to then to outline mitigating strategies.

METHODS

A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles published in English between 2000 and 2024. The databases searched included MEDLINE, PubMed, EMBASE, Scopus and Cochrane, and Scopus.

RESULTS

A total of 70 studies were identified that met inclusion criteria. Women often have poorer access to care and poorer outcomes than men for many common orthopedic procedures. Sex-specific analysis reached a maximum of 34% for combined basic science, translational and clinical research in major orthopedic journals. Women were less likely than men to be study participants. Orthopedic outcome measures do not adequately account for the epidemiological factors that predominantly affect women including pregnancy and care of the (often extended) family or differences in factors such as pain and return to work or sport. The probability of sex-related reporting was higher in papers with women as first and authors last, often in journals with lower impact factors. Women orthopedic researchers received only 55.2% of the funding of men orthopedic researchers. While women's first authorship increased statistically significantly from 1995 to 2020 (6.70%-15.37%, P ​< ​0.001) manuscripts submitted by women were less likely to be published, and those with a woman first author demonstrated a lower citation rate. Mitigating strategies to address biases in research methodology and publication include adopting evidence-based Gender Specific Analysis (GSA) methods into the orthopedic research process, considering GSA as a prerequisite for research grants and manuscript publication, increasing the diversity of orthopedic editorial boards, and supporting the careers of women in the orthopedic academic community through a more gender equitable environment and career-long mentorship and sponsorship.

CONCLUSION AND RELEVANCE

There are well-documented gender inequities in orthopedic care. Addressing the identified sex and gender bias in orthopedic research methodology, funding, and publication is a public health imperative. Mitigating strategies include education and the integration of sex and gender analysis in each step of the research to publication pathway, and increasing women in academic orthopedics through mentorship, sponsorship, and more inclusive department culture and policies.

LEVEL OF EVIDENCE

IV.

Sociodemographic reporting in videomics research: a review of practices in otolaryngology - head and neck surgery

OBJECTIVE

To assess reporting practices of sociodemographic data in Upper Aerodigestive Tract (UAT) videomics research in Otolaryngology-Head and Neck Surgery (OHNS).

STUDY DESIGN

Narrative review.

METHODS

Four online research databases were searched for peer-reviewed articles on videomics and UAT endoscopy in OHNS, published since January 1, 2017. Title and abstract search, followed by a full-text screening was performed. Dataset audit criteria were determined by the MINIMAR reporting standards for patient demographic characteristics, in addition to gender and author affiliations.

RESULTS

Of the 57 studies that were included, 37% reported any sociodemographic information on their dataset. Among these studies, all reported age, most reported sex (86%), two (10%) reported race, and one (5%) reported ethnicity and socioeconomic status. No studies reported gender. Most studies (84%) included at least one female author, and more than half of the studies (53%) had female first/senior authors, with no significant differences in the rate of sociodemographic reporting in studies with and without female authors (any female author: p = 0.2664; first/senior female author: p > 0.9999). Most studies based in the US reported at least one sociodemographic variable (79%), compared to those in Europe (24%) and in Asia (20%) (p = 0.0012). The rates of sociodemographic reporting in journals of different categories were as follows: clinical OHNS: 44%, clinical non-OHNS: 40%, technical: 42%, interdisciplinary: 10%.

CONCLUSIONS

There is prevalent underreporting of sociodemographic information in OHNS videomics research utilizing UAT endoscopy. Routine reporting of sociodemographic information should be implemented for AI-based research to help minimize algorithmic biases that have been previously demonstrated.

LEVEL OF EVIDENCE: 4

Meta Data Analysis of Sex Distribution of Study Samples Reported in Summer Biomechanics, Bioengineering, and Biotransport Annual Conference Abstracts

The biased use of male subjects in biomedical research has created limitations, underscoring the importance of including women to enhance the outcomes of evidence-based medicine and to promote human health. While federal policies (e.g., the 1993 Revitalization Act and the 2016 Sex as a Biological Variable Act) have aimed to improve sex balance in studies funded by the National Institutes of Health (NIH), data on sex inclusivity in non-NIH funded research remain limited. The objective of this study was to analyze the trend of sex inclusion in abstracts submitted to the Summer Biomechanics, Bioengineering, & Biotransport Conference (SB3C) over 7 years. We scored every abstract accepted to SB3C, and the findings revealed that approximately 20% of total abstracts included sex-related information, and this trend remained stable. Surprisingly, there was no significant increase in abstracts, including both sexes and those with balanced female and male samples. The proportion of abstracts with balanced sexes was notably lower than those including both sexes. Additionally, we examined whether the exclusion of one sex from the corresponding studies was justified by the research questions. Female-only studies had a 50% justification rate, while male-only studies had only 2% justification. Disparity in sex inclusion in SB3C abstracts was apparent, prompting us to encourage scientists to be more mindful of the sex of the research samples. Addressing sex inclusivity in biomechanics and mechanobiology research is essential for advancing medical knowledge and for promoting better healthcare outcomes for everyone.

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.

Gender Disparities in Academic Radiology Authorship: A 13-Year Review

RATIONALE AND OBJECTIVES

Underrepresentation of women in many scientific fields has been linked to biases against female-authored publications in peer-reviewed journals, thereby reducing their opportunities for career development and promotions. The objective of this study is to determine the representation of female academic radiologists in four flagship general radiology journals to elucidate gender-specific trends and disparities in academic radiology.

MATERIALS AND METHODS

We analyzed 23,741 peer-reviewed articles published in Radiology, American Journal of Roentgenology, Journal of the American College of Radiology and Academic Radiology from 2007 to 2020. Data abstraction and statistical analysis were performed for author gender, first and last authorship, research funding, and number of citations and grants. Baseline demographics data of academic radiologists was obtained from the Association of American Medical Colleges (AAMC).

RESULTS

A total of 72.4% of authors were male with 54% of articles were written by a male first author and male last author. When compared with assumed random pairing, there were significantly fewer Male/Female author combinations and more Female/Female author combinations than expected (p<0.01). Over the 13-year time period, the rate of increase in the number of female authors exceeded the rate of increase in women in academic radiology as reported by the AAMC. Female last authors received on average 3.2 less citations than their male counterparts (p=.03). Of manuscripts with last female authors, 31.7% of female last authors were funded compared to 25.9% of last male authors.

CONCLUSION

This study showed the increasing numbers and higher productivity of female authors in academic radiology, suggesting progress is being made in overcoming gender disparities.

Minimal influence of estrous cycle on studies of female mouse behaviors

Introduction

Sex bias has been an issue in many biomedical fields, especially in neuroscience. In rodent research, many scientists only focused on male animals due to the belief that female estrous cycle gives rise to unacceptable, high levels of variance in the experiments. However, even though female sexual behaviors are well known to be regulated by estrous cycle, which effects on other non-sexual behaviors were not always consistent in previous reports. Recent reviews analyzing published literature even suggested that there is no evidence for larger variation in female than male in several phenotypes.

Methods

To further investigate the impact of estrous cycle on the variability of female behaviors, we conducted multiple behavioral assays, including the open field test, forced swimming test, and resident-intruder assay to assess anxiety-, depression-like behaviors, as well as social interaction respectively. We compared females in the estrus and diestrus stages across four different mouse strains: C57BL/6, BALB/c, C3H, and DBA/2.

Results

Our results found no significant difference in most behavioral parameters between females in these two stages. On the other hand, the differences in behaviors among certain strains are relatively consistent in both stages, suggesting a very minimal effect of estrous cycle for detecting the behavioral difference. Last, we compared the behavioral variation between male and female and found very similar variations in most behaviors between the two sexes.

Discussion

While our study successfully identified behavioral differences among strains and between the sexes, we did not find solid evidence to support the notion that female behaviors are influenced by the estrous cycle. Additionally, we observed similar levels of behavioral variability between males and females. Female mice, therefore, have no reason to be excluded in future behavioral research.

Childbearing, Infertility, and Career Trajectories Among Women in Medicine

Importance

Although women are increasingly represented within medicine, gender disparities persist in time to promotion, achievement of academic rank, and appointment to leadership positions, with no narrowing of this gap over time. Career-specific fertility and family building challenges among women physicians may contribute to ongoing disparities and academic attrition.

Objective

To evaluate delayed childbearing and infertility among women in medicine and investigate the extent to which women physicians may alter career trajectories to accommodate family building and parenthood.

Design, Setting, and Participants

This survey study was conducted among women physicians, with surveys distributed through medical society electronic mailing lists (listserves) and social media from March to August 2022.

Main Outcomes and Measures

Baseline demographic information and fertility knowledge were assessed. Descriptive data on delayed childbearing, infertility, use of assisted reproductive technology, and career alterations to accommodate parenthood were collected. Factors associated with timing of pregnancy and family building regret were assessed using Likert-type scales. Group differences in fertility knowledge, delayed childbearing, infertility, and family building regret were evaluated using χ2 analyses.

Results

A total of 1056 cisgender women (mean [SD] age, 38.3 [7.7] years) were surveyed across level of training (714 attending physicians [67.6%] and 283 residents or fellows [26.8%]), specialty (408 surgical [38.6%] and 638 nonsurgical [60.4%] specialties), and practice setting (323 academic [45.2%], 263 private [24.9%], and 222 community [21.0%] settings). Among respondents, 1036 individuals [98.1%] resided in the US. Overall, 910 respondents (86.2%) were married or partnered and 690 respondents (65.3%) had children. While 824 physicians (78.0%) correctly identified the age of precipitous fertility decline, 798 individuals (75.6%) reported delaying family building and 389 individuals (36.8%) had experienced infertility. Concerning measures taken to accommodate childbearing or parenthood, 199 women (28.8%) said they had taken extended leave, 171 women (24.8%) said they had chosen a different specialty, 325 women (47.1%) said they had reduced their work hours, 171women (24.8%) said they had changed their practice setting, and 326 women (47.2%) said they had passed up opportunities for career advancement among those with children. Additionally, 30 women with children (4.3%) had left medicine entirely.

Conclusions and Relevance

In this survey study, women physicians reported that career-related pressures influenced the timing of childbearing and led to marked alterations to career trajectories to accommodate family building and parenthood. These findings suggest that fertility and family building concerns among women in medicine may contribute to ongoing gender disparities and attrition and represent a potentially critical area for policy reform and future change.

Gender Distribution & Rank of Authorship in Surgical Literature

BACKGROUND

Authorship of surgical literature is important for the career advancement of surgeons, and gender disparities in authorship may hinder the representation and leadership of women within academic surgery. The aim of this systematic review and meta-analysis was to evaluate the gender distribution of first, senior, and overall authorship in peer-reviewed surgical journal studies across all surgical specialties to determine if disparities exist.

METHODS

PubMed, EMBASE, and Google Scholar databases were searched for studies investigating the gender distribution of authorship of surgical literature published before December 10th, 2021. Meta-analysis was performed and Cohen's Q test for heterogenous effects was used to determine whether random or fixed-effects models were appropriate.

RESULTS

Fifteen studies investigating gender distribution of authorship met inclusion, which included a total of 136,627 pooled studies. The meta-analysis demonstrated the meta-proportion of first authorship for women to be 20.6% (95% CI: 13.9, 28.2), the meta-proportion of senior authorship for women to be 11.9% (95% CI: 6.6, 18.5), and the meta-proportion of overall authorship for women to be 23% (95% CI: 16.2, 30.7). In addition, the proportion of senior authorship for women was found to be significantly lower than the proportion of overall authorship for women (11.9% versus 23.0%, P = .0106).

CONCLUSION

There is a significantly smaller proportion of women who are first, senior, and overall authors in surgical literature compared to their colleagues who are men. Sustainable and effective solutions aimed at improving the representation of women surgeons in surgical research and research leadership are necessary.

The sex gap in sports and exercise medicine research: who does research on females?

Females are underrepresented in sports and exercise medicine research, both as authors and as research participants. The aim of this study was therefore to explore who does sports and exercise medicine research on females. All original research articles with female-only samples published in six major sports and exercise medicine journals over a 7-year period (2014–2020; n = 334) were examined. Out of the 2027 authors of the articles in question, 1149 were categorized as male (56.7%) and 850 were categorized as female (41.9%; 28 [1.4%] could not be categorized). A slight majority of the articles had a female as first author (51.5%), while the majority of the last authors were male (62.3%). Binomial tests of proportions revealed that females were overrepresented in all author roles in this sample compared to the field at large, while chi-square tests of proportions indicated minimal variations in female authorship across the studied period. These findings indicate that females are relatively more likely to do research on females than males are, and that the rate of female authorship remained relatively constant over time.

The Persistence of Sex Bias in High-Impact Clinical Research

INTRODUCTION

Sex bias is present in clinical research resulting in disparities in the treatment of women. Our objective was to identify the prevalence of sex inclusiveness of participants in human clinical trials after the passage of National Institutes of Health (NIH) and United States Congress policies in 2015 and 2016 to increase female enrollment in clinical research.

METHODS

We performed an observational analysis of data from registered clinical trials published in three high-impact biomedical journals from January 1, 2015 to December 31, 2019.

RESULTS

One thousand four hundred and forty two manuscripts with 4,765,783 human subjects were included for analysis. Significantly more males (56%) than females (44%) were included in all three journals (P < 0.0001). Sex matching ≥ 80% was found in 24.6% of publications. Industry funded 43.7% of all studies enrolling significantly more males than females (60.8% versus 39.2%, P < 0.0001). NIH funded 10.2% of studies enrolling significantly more females than males (52.7% versus 47.3%, P < 0.0001). North America and Europe contributed 82.6% of the studies with each enrolling significantly more males than females (P < 0.0001). The United States was the country contributing the most studies (36.1%), enrolling significantly more males than females (55.5% versus 45.5%, P < 0.0001). Cardiovascular disease was the subject area of the most manuscripts among medical specialties (19%), enrolling significantly more males than females (64.9% versus 35.1%, P < 0.0001). Studies analyzed by clinical trial phase, type, trial, and allocation enrolled significantly more males than females (P < 0.0001).

CONCLUSIONS

Sex bias remains prevalent in human clinical research trials. Improvements have been made in NIH-funded clinical trials; however, this constitutes a small percentage of overall studies.

Discrimination Toward Women in Surgery: A Systematic Scoping Review

BACKGROUND

Over the past twenty years explicit gender bias toward women in surgery has been replaced by more subtle barriers, which represent indirect forms of discrimination and prevents equality.

OBJECTIVE

The aim of our scoping review is to summarize the different forms of discrimination toward women in surgery.

METHODS

The database search consisted of original studies regarding discrimination toward female surgeons.

RESULTS

Of 3615 studies meeting research criteria, 63 were included. Of these articles, 11 (18%) were focused on gender-based discrimination, 14 (22%) on discrimination in authorship, research productivity, and research funding, 21 (33%) on discrimination in academic surgery, 7 (11%) on discrimination in surgical leadership positions and 10 (16%) on discrimination during conferences and in surgical societies. The majority (n = 53, 84%) of the included studies were conducted in the U.S.A. According to our analysis, female surgeons experience discrimination from male colleagues, healthcare workers, but also from patients and trainees. Possible solutions may include acknowledgment of the problem, increased education of diversity and integration for the younger generations, mentorship, coaching, and more active engagement by male and female partners to support women in the surgical field.

CONCLUSIONS

Gender-based discrimination toward women in the field of surgery has evolved over the past twenty years, from an explicit to a more subtle attitude. A work-environment where diversity and flexibility are valued would allow female surgeons to better realize their full potential.

Gender Disparity in the Citation of Surgical Research

BACKGROUND

Women surgeons face numerous barriers to career advancement. Inequitable citation of surgical literature may represent a contributing factor to gender disparities in academic surgery.

STUDY DESIGN

This was a cross-sectional analysis of publications from 50 top-ranking surgery journals in 2017 and 2018, as defined by the 2019 InCites Journal Citation Reports. The citation rate of publications by women vs men first authors was compared. Similarly, the citation rate of publications by men vs women last authors was also compared. Adjusted regression analyses of citation rates accounted for the time interval since publication as well as the journal within which the article was published, among other potential confounding factors.

RESULTS

A total of 19,084 publications from 48 surgery journals with a median (interquartile range) of 8 (4 to 15) citations contributing to a median (interquartile range) Journal Impact Factor of 4.0 (3.4 to 4.6) were analyzed. Compared with man-first author publications, woman-first author publications demonstrated a 9% lower citation rate (incidence rate ratio 0.91, p < 0.001). Similarly, compared with publications by man-last authors, woman-last author publications demonstrated a 4% lower citation rate (incidence rate ratio 0.96, p = 0.03). These associations persisted after multivariable adjustment for additional confounding factors, however, not on sensitivity analysis of 24 of the highest-ranking journals.

CONCLUSIONS

Among top-tier surgical journals, publications by women-first and -last authors were less cited compared with publications by men-first and -last authors, but not among the highest-tier surgical journals. Gender bias may exist in the citation of surgical research, contributing to gender disparities in academic surgery.

Disfunción sexual femenina: una mirada a los últimos 44 años. Análisis bibliométrico

Objetivo La disfunción sexual femenina (DSF) es un trastorno prevalente que afecta la calidad de vida de las mujeres y combina factores biológicos, psicológicos e interpersonales. Su estudio ha sido de poco interés, en campos como la investigación y el tratamiento, debido a la dificultad en la medición de las respuestas sexuales en las mujeres y otros factores, como el tabú acerca de la sexualidad femenina. Este estudio caracteriza las tendencias de publicaciones científicas acerca del tema, para que los urólogos puedan comprender la necesidad de realizar la búsqueda de este trastorno en la práctica diaria.

Métodos Se realizó una búsqueda de la literatura en las bases de datos PubMed, FABUMED y Scopus, utilizando la estrategia «((«female sexual dysfunction» [Title/Abstract])». Se realizó un análisis bibliométrico descriptivo, de corte retrospectivo, de la literatura médica obtenida en MEDLINE. A través de las herramientas estadísticas FABUMED, PubReminer y Scopus, se recopilaron los datos y se obtuvo los resultados de las variables que posteriormente fueron analizadas de forma estadística y descriptiva. Con base en esta información, elaboramos tablas y gráficas en Microsoft Office Excel 2017. Adicionalmente, realizamos un análisis de mapeo bibliométrico utilizando el programa VOSviewer. Para la obtención del factor de impacto (FI), utilizamos el Journal Citation Reports 2017/2018.

Resultados Desde 1975 hasta 2019, se publicaron 1.292 estudios, y la tasa anual de publicación permaneció estable entre 1975 y 2000. Pero, a partir del año 2000, se evidenció un aumento en el número de publicaciones, con un crecimiento del 92,1%. De las veinte revistas con más publicaciones, sólo cuatro son de urología. Los países con más publicaciones fueron: Estados Unidos (31,4%), Reino Unido (12,9%), Italia (8,9%), Turquía (5,9%), y Australia (4%). Estos datos son muy diferentes a los de los países de América Latina, en los que se encontraron muy pocas publicaciones, como Colombia, con tan sólo tres estudios.

Conclusiones Este análisis bibliométrico mostró las diferentes tendencias y tasas de publicación de estudios sobre DSF, y evidenció una baja tasa de producción con relación a otras temáticas, sobre todo en las revistas urológicas, con predominio de mujeres como autores, aunque en los últimos años se ha identificado un crecimiento importante y sostenido. Se hace evidente la necesidad de desarrollar estrategias para mejorar la formación tanto en los niveles de posgrado como de pregrado y, así, generar más adhesión a este tema en una especialidad quirúrgica como la nuestra.

Publication bias is the consequence of a lack of diversity, equity, and inclusion

Publication bias has been shown to exist in research across medical and surgical specialties. Bias can occur at any stage of the publication process and can be related to race, ethnicity, age, religion, sex, gender, or sexual orientation. Although some improvements have been made toward addressing this issue, bias still spans the publication process from authors and peer reviewers, to editorial board members and editors, with poor inclusion of women and underrepresented minorities throughout. The result of bias remaining unchecked is the publication of research that leaves out certain groups, is not applicable to all people, and can result in harm to some populations. We have highlighted the current landscape of publication bias and strived to demonstrate the importance of addressing it. We have also provided solutions for reducing bias at multiple stages throughout the publication process. Increasing diversity, equity, and inclusion throughout all aspects of the publication process, requiring diversity, equity, and inclusion statements in reports, and providing specific education and guidelines will ensure the identification and eradication of publication bias. By following these measures, we hope that publication bias will be eliminated, which will reduce further harm to certain populations and promote better, more effective research pertinent to all people.

Bibliometric Analysis of the English Musculoskeletal Literature over the Last 30 Years

Publication and authorship are important in academia for career advancement, obtaining grants, and improved patient care. There has been a recent interest in bibliometric changes over time, especially regarding the gender gap. The purpose of this study was to explore bibliometric changes in the musculoskeletal literature. Bibliometric variables (number of authors, institutions, countries, pages, references, corresponding author position, author gender, geographic region of origin, and editorial board makeup) were analyzed for 5 basic science and 12 clinically oriented musculoskeletal journals from 1985 through 2016. Statistical analyses comprised bivariate analyses, multifactorial ANOVAs, and logistic regression analyses. A p < 0.005 was considered significant. Nearly, all variables increased over time. Asia had the highest number of authors and corresponding author positions, Australia/New Zealand the highest number of institutions and references, North America the highest number of pages, and Europe the highest number of countries. Those with a female first author had more authors, institutions, countries, references, and pages. Likewise, those with a female corresponding author had more authors, institutions, countries, references, and pages. Single-authored manuscripts decreased over time. The percentage of female first authors rose from 10.8% in 1985-1987 to 23.7% in 2015-2016. There were more female 1^st authors in the basic science journals compared to the clinical journals (33.2% vs. 12.7%). Single-authored manuscripts were more likely to be written by males (5.1 vs. 2.4%) and decreased over time. The many differences by geographic region of origin likely reflect different socio/cultural attitudes regarding academia and research, as well as the gender composition of the disciplines by geographic region. Overall, there has been an increase in the number of female 1^st and corresponding authors, editorial board members, and chief editors, indicating a slow but progressive narrowing of the gender gap.

Sex-Specific Analysis Is Lacking in Abstracts Presented at Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine Annual Meetings From 2016 to 2019

Purpose

To evaluate the presence of sex-specific analysis (SSA) in abstracts accepted for podium presentation at the Arthroscopy Association of North America (AANA) and American Orthopaedic Society for Sports Medicine (AOSSM) annual meetings from 2016 to 2019.

Methods

Abstracts accepted for podium presentation at the AANA and AOSSM annual meetings from 2016 to 2019 were selected for review. Studies that included sex as a variable in a multifactorial statistical model were considered to have performed adequate SSA. Secondary data collected included whether the abstract had a female lead or senior author, the degrees of the female authors, and the anatomic focuses of studies with SSA.

Results

Of the 891 total abstracts accepted for podium presentation at the AANA and AOSSM annual meetings from 2016 to 2019, 90 (10%) included SSA. There were 284 AANA abstracts, 24 (8%) of which reported SSA. Of the 607 AOSSM abstracts, 66 (11%) reported SSA. There were 43 female first authors (15%) and 33 female senior authors (12%) of the AANA abstracts compared with 92 female first authors (15%) and 39 female senior authors (6%) of the AOSSM abstracts. Of the 891 total abstracts, 135 (15%) listed a female lead author and 72 (8%) had a female senior author. Of the 135 female first authors, 92 (68%) had an M.D., whereas 40 of the 72 female senior authors (56%) had an M.D. Analysis of all abstracts combined showed a positive correlation between SSA and a female first author (Pearson correlation coefficient = 0.035, P = .147), as well as between SSA and a female senior author (Pearson correlation coefficient = 0.052, P = .059).

Conclusions

From 2016 to 2019, only 10% of abstracts accepted for podium presentation at the AANA and AOSSM annual meetings included SSA. Altogether, women represented 15% of first authors and 8% of senior authors.

Clinical Relevance

This study highlights the low percentage of SSA in abstracts presented at the AANA and AOSSM annual meetings from 2016 to 2019. Future studies should attempt to perform SSA when relevant to better evaluate differences in outcomes between male and female patients.

Gender Disparities in Authorships and Citations in Transplantation Research

Background.

Over the past decades, there has been a rapid change in the gender ratio of medical doctors, whereas gender differences in academia remain apparent. In transplantation research, a field already understaffed with female doctors and researchers, there is little published data on the development in proportion, citations, and funding of female researchers over the past years.

Methods.

To evaluate the academic impact of female doctors in transplantation research, we conducted a bibliometric analysis (01 January 1999 to 31 December 2018) of high-impact scientific publications, subsequent citations, and funding in this field. Web of Science data was used in combination with software R-Package “Gender,” to predict gender by first names.

Results.

For this study, 15 498 (36.2% female; 63.8% male) first and 13 345 (30.2% female; 69.8% male) last author gender matches were identified. An increase in the percentage of female first and last authors is seen in the period 1999–2018, with clear differences between countries (55.1% female authors in The Netherlands versus 13.1% in Japan, for example). When stratifying publications based on the number of citations, a decline was seen in the percentage of female authors, from 34.6%–30.7% in the first group (≤10 citations) to 20.8%–23.2% in the fifth group (>200 citations), for first (P < 0.001) and last (P = 0.014) authors, respectively. From all first author name-gender matches, 6574 (41.6% female; 58.4% male, P < 0.001) publications reported external funding, with 823 (35.5% female; 64.5% male, P = 0.701) reported funding by pharmaceutical companies and 1266 (36.6% female; 63.4% male, P < 0.001) reporting funding by the National Institutes of Health.

Conclusions.

This is the first analysis of gender bias in scientific publications, subsequent citations, and funding in transplantation research. We show ongoing differences between male and female authors in citation rates and rewarded funding in this field. This requires an active approach to increase female representation in research reporting and funding rewarding.

Female under-representation in sepsis studies: a bibliometric analysis of systematic reviews and guidelines

OBJECTIVES

The objective of the study was to assess female representation in primary studies underpinning recommendations from clinical guidelines and systematic reviews for sepsis treatment in adults.

STUDY DESIGN AND SETTING

We conducted a bibliometric study. We removed studies pertaining to sex-specific diseases and included quasirandomized, randomized clinical trials (RCTs), and observational studies. We analyzed the female participation-to-prevalence ratio (PPR).

RESULTS

We included 277 studies published between 1973 and 2017. For the 246 studies for which sex data were available, the share of female participation was 40%. Females overall were under-represented relative to their share of the sepsis population (PPR 0.78). Disaggregated results were reported by sex in 57 studies. In univariate analyses, non-intensive care unit setting and consideration of other social health determinants were significantly associated with greater female participation (P < 0.001 and P = 0.023, respectively). In regression models, studies published in 1996 or later were likely to report sex, while RCTs were unlikely to do so (P = 0.019 and P < 0.001, respectively).

CONCLUSION

Our study points to female underenrollment in sepsis studies. Primary studies underpinning recommendations for sepsis have poorly reported their findings by sex.

Closing the Gender Gap in Global Surgery: Trends at the Academic Surgical Congress

INTRODUCTION

Female researchers are underrepresented in academic surgery. While they are increasingly producing original research, they lag male researchers in productivity. This disparity is not well understood within the nascent field of global surgery. The following study examines gender parity in global surgery research presented at the Academic Surgical Congress and within subsequent publications.

METHODS

Abstracts presented at the Academic Surgical Congress (ASC) between 2015 and 2019 in "Global Surgery" sessions were reviewed to obtain title, the first author (FA) and senior author (SA). The authors were classified by gender. The Scopus database was queried by two reviewers for abstracts with corresponding publications, citations, and journal impact factors. Statistical analysis was conducted using chi-square analysis and t-tests where appropriate.

RESULTS

Of a total of 6635 abstracts, 218 global surgery abstracts over a 5-year period were identified. Of these abstracts, 96 (44%) had female FAs, while 56 (26%) had female SAs. When comparing gender, female (44%) FAs and male (56%) FAs were equally represented. While SAs were significantly less likely to be female (26% versus 74%, P < 0.0001), female senior authorship increased significantly within the study period. Output with respect to publications, citations, and journal impact factors were equal by gender.

CONCLUSIONS

This study presents 5 y of gender trends in global surgery scholarly work presented at the ASC. Despite an overall predominance of male senior authors, the paradigm is shifting with a recent trend to gender parity. Male and female authors have equal output and are equally impactful. Findings of gender equity in academic global surgery are encouraging, and further study of other disciplines are warranted.

Sex Bias in Laryngology Research and Publishing

OBJECTIVE

To investigate sex bias in laryngology research and publishing.

MATERIALS AND METHODS

Articles published in 2019 in seven mainstream otolaryngology journals were reviewed. Original manuscripts were included. Study type (medical, speech-language pathology, basic science, or pedagogy), subject sex, ≥50% sex-matching (SM_≥50), sex-based analysis, and bibliometric data including author sex were recorded.

RESULTS

Of 1619 publications reviewed, 259 patient-centered original laryngology studies were included, totaling 7,130,991 subjects (3,411,741 [47.8%] male; 3,718,694 [52.1%] female; 556 [0.0%] unreported). 29 studies included subjects of a single sex and 14 did not report sex. 114 (44%) studies met SM_≥50, and 95 (37%) used sex-based analysis; no differences were found among study types or location. Sex-based analysis was used less in single-institution (33%) than database studies (62%, P = 0.01). No difference in SM_≥50 was found among single or multi-institution, or database. There were 1340 total authors (578 [43%] female). First, corresponding, and senior authors were 47%, 39%, and 35% female, respectively. Studies that had female first and/or senior authors did not differ in rates of SM_≥50 or sex-based analysis or mean enrollment of females compared to studies with male first and senior authors. The proportion of female physician first and senior authors did not differ from the proportion of female Association of American Medical Colleges otolaryngology faculty, but was non-significantly smaller than the proportion of female laryngology fellows at four academic institutions.

CONCLUSION

Laryngology research exhibits sex bias in subject enrollment and sex-based analysis. Female authorship was representative of national demographics and author sex did not influence the rate of sex bias.