key: cord-0934636-b5q7m3j1 authors: Hornstein, Paula; Tuyishime, Hubert; Mutebi, Miriam; Lasebikan, Nwamaka; Rubagumya, Fidel; Fadelu, Temidayo title: Authorship Equity and Gender Representation in Global Oncology Publications date: 2022-01-11 journal: JCO Glob Oncol DOI: 10.1200/go.21.00369 sha: 557515d480cc2f10b4c0863a2fae30fb98583271 doc_id: 934636 cord_uid: b5q7m3j1 Authorship gender disparities persist across academic disciplines, including oncology. However, little is known about global variation in authorship gender distribution. METHODS: This retrospective cross-sectional study describes the distribution of author gender as determined from the first name across variables such as authorship position (first, middle, and last), country region, and country income level. The 608 articles with 5,302 authors included in this analysis were published in the Journal of Clinical Oncology Global Oncology, from its inception in October 2015 through March 2020. Primary outcome measure was author gender on the basis of first name probabilities assessed by genderize.io. World Bank classification was used to categorize the country region and income level. Odds ratios were used to describe associations between female last authorship and representation in other authorship positions. RESULTS: Although female authors were in the minority across all authorship positions, they were more under-represented in the last author position with 190 (32.1%) female, compared with 252 (41.4%) female first authors and 1,564 (38.1%) female middle authors. Female authors were most under-represented among authors from low-income countries, where they made up 21.6% of first authors and 9.1% of last authors. Of all the regions, sub-Saharan Africa and South Asia had the lowest percentage of female authors. Compared with articles with male last authors, those with female last authors had odds ratios (95% CI) of 2.2 (1.6 to 3.2) of having female first authors and 1.4 (0.9 to 2.1) of having 50% or more female middle authors. CONCLUSION: There are wide regional variations in author gender distribution in global oncology. Female authors remain markedly under-represented, especially in lower-income countries, sub-Saharan Africa, and South Asia. Future interventions should be tailored to mitigate these disparities. In recent years, there has been increasing recognition of authorship inequity in academic medicine publications. A 2018 study of 54 prestigious scientific journals listed by the Nature Index, across multiple scientific disciplines, observed that 29.8% of all authors in a selection of 293, 557 articles were female. 1 In several medical specialty publications, female authors consistently comprise a minority of first authors and an even smaller percentage of last authors. [2] [3] [4] Although female authorship representation has increased in recent decades, change has been both slow and inconsistent across various scientific disciplines. A 2017 cross-sectional analysis of articles in five premier oncology journals demonstrated that female authors still comprised a minority of both first (36.6%) and last authors (28.5%). 5 Similar gender disparities in academic oncology leadership have also been described across multiple domains including on editorial boards and in cancer center leadership roles. 6 This imbalance in gender representation risks the perpetuation of systemic bias in research priorities. 7 With worldwide expansion of oncology scholarship and the emergence of global oncology as an academic field, we sought to investigate authorship gender representation in global oncology publications. Although there are complex arrays of factors that are associated with female authorship under-representation, the relationship between author gender and the respective country region and economic level has not been previously described. This study describes the variation in authorship gender distribution in global oncology publications across global regions and country economic levels. of its overarching global perspective and its discounted article charge policy, making it relatively more accessible to researchers from lower-resourced settings. 8 A PubMed search was conducted to identify articles published from the journal's inception from October 2015 through March 2020. Of the 645 articles identified, 608 matched the specified article type inclusion criteria representing editorials, commentaries, case reports, special articles, original reports, or reviews. Correspondences, replies, and other miscellaneous articles (n = 37) were excluded. Data were collected for each article using the Research Electronic Data Capture tool. 9,10 Using dual data entry, H.T. and P.H. independently extracted data from 65 (10%) randomly selected articles. The percent discrepancy for dual data entry was 7.5%, under the predetermined threshold of 10% to proceed with single data entry. Data collection and analysis were performed from April 2020 to April 2021. Author gender was categorized as male, female, or indeterminate on the basis of first name probability assessed by genderize.io, a validated and widely used instrument. 11 Gender categorization used a threshold probability of 0.8 on the basis of previous studies. 11, 12 Author primary country affiliation was categorized on the basis of World Bank (WB) designations for the 2020 fiscal year. 13 The country region was classified by the standard seven WB regions, and country income level CONTEXT Key Objective Authorship gender equity is imperative to ensure that research conducted reflects diverse perspectives. Imbalance in gender representation risks the perpetuation of systemic bias in research priorities. With the emergence of global oncology as an academic field, we sought to investigate authorship gender representation in global oncology publication and to explore variations in gender representation across global regions and country economic levels. Although female authors were in the minority across all authorship positions, they were most under-represented in the last author position. Female authors were most under-represented among authors from low-income countries, and countries in sub-Saharan Africa and South Asia. There was a trend toward rising proportion of female authors in the first and last authorship positions in the most recent years, particularly among articles published in 2020. However, more studies are needed to better inform targeted mitigating interventions to improve authorship gender equity in the field. Descriptive statistics using percentages and proportions were used to report gender distribution and variations on the basis of the variables of interest. The odds ratio was used to describe the association between female authorship representation in the first and middle author positions with last author gender. Analyses were completed in SAS version 9.4 (SAS Institute, Cary, NC). LICs, low-income countries; LMICs, lower-middle-income countries; UMICs, upper-middle-income countries. Hornstein et al 2016 was 15.8% and 37.8%, respectively, this proportion was notably higher in 2020 at 51.3%. In the last author position, female authors were a minority from 2015 through 2019 with a proportion ranging from 25.5% to 31.9%; however, they made up higher proportion in 2020 compared with male authors (53.8% female v 37.2% male). Overall, the proportion of female middle authors remained relatively stable from year to year, ranging from 35.0% to 41.2%. Figure 5 shows variation in author gender distribution by article type. In the first author position, female first authors were in the minority for original reports (39.0% female v 48.3% male). However, female first authors made up a higher proportion of authors for special articles (55.0% female v 35.0%) and review articles (60.5% female v 32.6% male). In the middle and last author positions, female authors were more consistently in the minority across all article types, except for editorials. Of note, there were only 16 editorials, of which 11 had more than one author and only three had middle authors. We explored the association between having a female last author and overall author composition; after excluding those with indeterminate gender classification, we found that compared with articles with male last authors, those with female last authors had odds ratios (95% CI) of 2.2 (1.6 to 3.2) of having female first authors and 1.4 (0.9 to 2.1) of having 50% or more female middle authors. On average, articles with female last authors had a higher percentage of female middle authors compared to those with male last authors, 42.8% versus 36.7% (Fig 6) . Of note, indeterminate gender classification accounted for 560 (10.6%) of the total authors, with similar proportions in all the author positions (Fig 1) . However, the distribution of indeterminate authors varied by region, with East Asia and Pacific demonstrating almost 25% indeterminate probability. In this study of gender distribution in global oncology publications, in aggregate, female authors were in the minority across all authorship positions, especially in the last author position. However, there was a substantial variation across regions and economic strata. Although female first authors outnumbered male first authors in UMICs and HICs, particularly from Europe and North America, female authors remained markedly under-represented especially in the middle and last author positions across LICs and LMICs. Female first authors were in the minority for original report articles but made up a higher proportion of first authors on review and special articles. In addition, there appears to be a trend toward increasing female authorship representation in the more recent years, with articles in 2020 having the highest proportion of female first and last authors. We also showed that having female last authors, who typically represent the research team leaders, was associated with a higher proportion of female first authors and middle authors. To our knowledge, our report is the first to describe the variation in authorship gender distribution in any medical specialty by region and economic status. Gains in authorship gender parity are occurring in oncology publications and our findings indicate that these gains are largely occurring in UMICs and HICs in North America and Europe, whereas significant disparities persist in many regions. 5 Authorship representation offers a window into the historical systemic issue of female under-representation in academic oncology. For example, although the proportion of US female graduates of hematology and oncology fellowship programs now approaches 50%, female department leaders and full professors remain under 30%. 15, 16 Achieving authorship gender parity will require concerted efforts such as active recruitment of trainees, fostering engagement in research, facilitating mentorship, and supporting advancement up the academic ladder. The trend toward higher female authorship representation in 2020, the most recent year in the study, is encouraging and may be an early indication of the impact of ongoing efforts. This study also highlights the important role of female leadership in fostering greater gender diversity across academic teams. 3 This positive effect, which has been described in other fields, may be related to effective mentorship and sponsorship for women in earlier career stages. 17 Although earlier studies have described that women in academic medicine noted less access to career mentorship, the development of formal mentorship programs has been shown to be associated with increased career satisfaction. [17] [18] [19] The higher proportion of female first authors in HICs and UMICs provides hope that progress toward equitable representation in academic research is possible. There are emerging programs in LICs and LMICs focused on academic research mentorship of women; one such example is a recent initiative by the Pan-African Women's Association of Surgeons that targets female surgeons across Africa for mentorship in research methodology and project management. 20 Such initiatives hold the potential to increase the pipeline of female researchers and the scope of scholarly output by female authors from these regions. Further study is needed to better understand the various barriers that women face in pursing academic medical careers. These factors may include societal contextual factors, such as perceptions of the role of women in leadership and expectations of family responsibilities. These studies will help inform the design and evaluation of future tailored interventions to improve academic engagement and authorship participation of women in regions with the most profound under-representation. In addition, systematic collection and reporting of selfreported gender identity by oncology journals will be important to measure future progress and promote accountability toward gender parity. This study has some limitations. There is potential for gender misclassification using first name probabilities for ascertainment. To limit this bias, we used a stringent probability threshold of 80%, which resulted in 10.5% of the authors being classified as indeterminate. However, given variation in naming practices and the use of gender-neutral names around the globe, the proportion of indeterminate genders was not evenly distributed across regions. The higher proportion of indeterminate gender in East Asia and Pacific, and South Asia may limit the generalizability of the findings. It is also important to acknowledge the fluidity of gender identification, which is not fully reflected using male or female binary. Another limitation is that the study involves publications from one journal, in which North American and European authors are over-represented. Hence, the reported findings may not represent authorship distribution in other oncology journals. Finally, the study was conceived before the COVID-19 pandemic and only includes articles published up to March 2020. Therefore, the results do not reflect the potential differential impact of the COVID-19 pandemic on academic productivity. Future studies should explore changes in productivity and academic engagement of clinicians and researchers in the COVID-19 era and beyond and explore the impact on authorship equity. In conclusion, our analysis shows that authorship gender inequities persist in global oncology publications. Female authors from lower-income countries and regions in sub-Saharan Africa and South Asia remain markedly underrepresented. Moreover, the higher proportions of female first authors in HICs and UMICs are promising signs of progress toward more equitable representation. Future investigation and interventions should be tailored especially to regions with the greatest disparities. Gender Equity and Representation Global Oncology Publications Gender disparities in high-quality research revealed by Nature Index journals The "gender gap" in authorship of academic medical literature-A 35-year perspective Trends in proportion of women as authors of medical journal articles Trends and comparison of female first authorship in high impact medical journals: Observational study Mind the gap: Gendered publication trends in oncology Women's leadership in academic medicine: A systematic review of extent, condition and interventions Women and academic medicine: A review of the evidence on female representation The REDCap consortium: Building an international community of software platform partners Research electronic data capture (REDCap)-A metadata-driven methodology and workflow process for providing translational research informatics support Comparison and benchmark of name-to-gender inference services Gender trends in gynecologic oncology authorship: Implications for the critical evaluation of gender distribution in academic rank and leadership positions World Bank Country and Lending Groups Strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies Diversity by race, hispanic ethnicity, and sex of the United States medical oncology physician workforce over the past quarter century Gender differences in faculty rank and leadership positions among hematologists and oncologists in the United States Mentorship of women in academic medicine: A systematic review Junior faculty members' mentoring relationships and their professional development in U.S. medical schools Keys to career satisfaction: Insights from a survey of women pediatric surgeons Conception and design: Paula Hornstein, Hubert Tuyishime, Miriam Mutebi, Nwamaka Lasebikan, Temidayo Fadelu Administrative support: Hubert Tuyishime, Temidayo Fadelu Collection and assembly of data: Paula Hornstein, Hubert Tuyishime, Temidayo Fadelu Data analysis and interpretation: All authors Manuscript writing: All authors Final approval of manuscript: All authors Accountable for all aspects of the work: All authors The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/go/authors/author-center. Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments). This author is a member of the JCO Global Oncology Editorial Board. Journal policy recused the author from having any role in the peer review of this manuscript. Research Funding: Celgene (Inst), Cepheid (Inst)No other potential conflicts of interest were reported.