key: cord-0619772-t9rowygx
authors: Andersen, Jens Peter; Nielsen, Mathias Wullum; Simone, Nicole L.; Lewiss, Resa E.; Jagsi, Reshma
title: Meta-Research: Is Covid-19 Amplifying the Authorship Gender Gap in the Medical Literature?
date: 2020-05-13
journal: nan
DOI: nan
sha: feb26f362411960f7c35aa2d521e4dd649e2ea1f
doc_id: 619772
cord_uid: t9rowygx

The COVID-19 pandemic has affected work and family life for many, including academic researchers. Anecdotal evidence suggests that university shutdowns have influenced the article submission rates of men and women differently. Here we present a timely analysis that compares the proportion of men and women medical researchers publishing on the coronavirus to those publishing in the same journals in 2019. This is presently the most direct means of gauging gender variations in ongoing research activities. For clarity of context, we delimit our analysis to researchers in the United States. Using mixed-effects regression models, we estimate that women's shares of first authorships, last authorships and general representation per author group are 23%, 16% and 16% lower for COVID-19 papers compared to 2019 papers published in the same journals. Our findings are consistent with the idea that the research productivity of women, especially early-career women, is being affected more than the research productivity of men.

During the COVID-19 pandemic, many governments have shuttered schools and implemented social distancing requirements that limit options for childcare, while simultaneously requiring researchers to work from home (Minello, 2020) . Robust evidence suggests that women in academic medicine shoulder more of the burden of domestic labor within their households than do men. One study of an elite sample of NIHfunded physician-researchers showed that women spent 8.5 hours more per week on parenting and domestic tasks than their men peers (Jolly et al., 2014) . Recent research also suggests that women in academia take on more domestic responsibilities than men, even in dual-career academic couples (Derrick et al., 2019) . Therefore, the recent restrictions in access to childcare might reasonably be expected to have disproportionate impact on women in academic medicine, as compared to men. The impact of new professional service demands that now compete with time for scholarly productivity in academic medicine, including restructuring of teaching and clinical care using virtual platforms, may also disproportionately impact women medical researchers, who are disproportionately represented on clinician-educator tracks .

Here, we focus on the published medical research literature, where it may be possible to provide an early evaluation of whether the gender gap in academic productivity is widening. The medical literature now includes a substantial number of articles directly relating to COVID-19, mostly generated rapidly after the broader social restrictions came into being, in most US states, in March 2020. Therefore, we report the results of a global analysis of possible variations in women's proportion of authorships of articles on 050) , as compared to the proportion of women among authorships of all articles published in the same journals the previous year (N = 193,098) . Specifically, we used mixed logit and tobit models with scientific journal as random effect parameter, to estimate women's share of first authorships (logit), last authorships (logit) and proportional representation per article (tobit), for Covid-19 papers (treatment) and papers published in the same journals in 2019 (control). To obtain a closer approximation of differences across research areas, we calculated the proportion of women authorships per journal specialty. As shown in Table 1 , women are represented at lower rates across most specialty groupings in the COVID-19 sample as compared to the 2019 sample. The relative gap in women's participation is most salient in infectious diseases, radiology, pathology, and public health.

Importantly, none of these groups show extreme deviations variations from the overall trend. This indicates that the observed differences are not due to a specialty bias, where specialties with a high representation of men produce the majority of COVID-19 research. 

Prior research has raised concerns about women's underrepresentation among authors of medical research, including both original research and commentaries (Clark et al., 2017; Hart and Perlis, 2019; Jagsi et al., 2006; Larson et al., 2019; Silver et al., 2018) . Our analysis suggests that the COVID-19 pandemic may be amplifying this gender gap in the medical literature. Specifically, we find that women constitute a lower proportion of authors of articles on COVID-19, as compared to the proportion of women among authors of all articles published in the same journals the previous year. The difference in women's participation before and after the pandemic is most striking for first authorships. This finding is consistent with the idea that restricted access to child-care and increased work-related service demands might take the greatest toll on early-career women, although our observational data cannot conclusively support causal claims. As more robust evidence becomes available, mechanisms which disadvantage specific ethnic, age and gender groups should be monitored and inform policies that promote equity (Donald, 2020) .

Some have argued that the authorship gender gap in academic medicine is best explained by a slow pipeline and the historical exclusion of women from medical school enrollment 1 . However, as time has passed, and women have reached parity in the United States and even begun to constitute the majority of the medical student body in many other countries, their persistently low participation as authors has raised concerns about bias in unblinded peer review processes and unequal opportunities prior to manuscript submission Silver, 2019) . Studies have demonstrated differences in the very language used by men and women to describe their research findings (Lerchenmueller et al., 2019) , and evidence suggests that women's writing may be held to higher standards (Hengel, 2017) . In any case, the current study suggest that if authorship of COVID-19-related papers is a bellwether, women's participation in the medical research literature may now be facing even greater challenges than before the pandemic, especially if ongoing or repeated episodes of social distancing are required as expected (Kissler et al., 2020) .

This study is limited to a relatively small sample produced early in the course of the pandemic and misses information on important covariates. However, descriptive analysis that breaks down our results by specialty does not suggest that those specialties that might dominate research related to COVID had low proportions of women among authors in 2019. Indeed, many such specialties, including infectious disease and public health, qualitatively appear to have a markedly lower proportion of women among authors in the 2020 COVID-related dataset than in the 2019 dataset within those fields. Therefore, despite limitations, this early look suggests that the previously documented gender gap in academic medical publishing may warrant renewed attention (Jagsi et al., 2006) and that ongoing research on this subject is necessary as more data become available.

Although some may believe that diversity and equity are niceties that cannot be considered during times of crisis, abundant literature reveals the importance of diverse teams for solving complex problems like those related to COVID-19 (Nielsen et al., 2018 (Nielsen et al., , 2017 Phillips et al., 2014; Woolley et al., 2010) . If societal constraints limit the talent pool who may contribute to research informing the crisis response, the consequences will be profound indeed. Policies to support full inclusion of diverse scholars and transformation of norms for dividing labor appear to be urgent priorities.

On May 9 th 2020, we searched PubMed Medline for papers including "COVID-19" or "SARS-CoV2" in the title or abstract, to identify publications most likely generated after pandemic-related societal changes developed. This resulted in 9,054 articles, of which only 4 were published prior to 2020. We extracted journal information and matched the 2020 papers [treatment] to 2019 papers [control] from the same journals (N = 193,098) . Only journals with at least 5 papers on COVID-19 were included in the analysis (443 of 1,823 journals (24.3%), 6,734 of 9,050 papers (74.4%)). We extracted author names for both treatment and control, and used these to determine author gender as in prior work (Andersen et al., 2019) .

Gender was reliably estimated for 81.9% of the entire sample. For the papers with at least one US author, gender could be established for 89.4% of first authors and 90.5% of last authors. Only papers with gender reliably identified for first and last authors were included. Limiting the sample further to papers with at least one author with a US address, with gender determined for authors, gives us a treatment group of 1,179 papers (13.0%) and a control group of 37,531 papers (19.4%). The treatment group is relatively smaller, because proportionally more COVID-19 research has been done by researchers outside the US, especially those in China and Italy.

As a robustness check, we selected a random sample of 300 publications from the treatment group and looked up information supplied by the publishers on submission and publication dates. Far from all publishers offer this information and to our knowledge there are no databases gathering this information consistently. Thus, we were able to find submission dates for 153 (51.0%) of the 300 publications. Of these, 129 (84.3%) were submitted after March 15 th , 2020, and 276 of the 300 (92.0%) were published after this date.

We calculated the general proportion of women per author group (f_share) for all papers included in the analysis. If we could not determine the gender of one or more authors, these were left out of the equation, so as to not skew the average share towards one gender. f_share values range from 0 to 1, with values closer to 1 indicating a higher proportion of women in the paper's byline.

We used mixed logit and tobit models to estimate women's share of authorships Covid-19 papers (treatment) and papers published in the same journals in 2019 (control). We included scientific journal as random effect parameter to adjust for variations in COVID-related research activities across scientific journals.

The mixed tobit regression was used to estimate the relationship between the dichotomous intervention variable (2019 sample=0, COVID-19 sample=1) and women's overall representation per article (f_share).

The tobit model was specified with a left-censoring at 0 and a right-censoring at 1, and computed with robust standard errors. We used multilevel logistic regressions to estimate the relationship between the intervention variable and women's share of first authorships (outcome variable: man=0, woman=1) and last authorships (outcome variable: man=0, woman=1). The statistical analyses were conducted in STATA 16

and R version 4.0.0. For the multilevel tobit and logit regressions, we used the "metobit" and "melogit" mixed effects routines in STATA. To produce the figures, we used the R package ggplot2 v. 3.3.0.

The relative differences in observed and adjusted proportions were calculated with six decimals. 

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