More work needed to “untangle reasons” for gender gap in cardiovascular research

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David Ouyang

Writing in Circulation: Cardiovascular Quality and Outcomes, David Ouyang (Stanford University, Falk Research Center, Palo Alto, USA) and others report that while the number of female first and senior authors of cardiovascular research papers has increased over the past four decades, women continue to be poorly represented as first authors, senior authors, and in the number of publications. They say further work is needed to understand why there continues to be a gender gap in cardiovascular research.

The investigators comment that despite the growth of female medical students (in the USA, >50% of graduating medical studies are female), there is still a lag of female representation in both training and practice. In particular, they note that, in the USA, only 13% of the cardiology workforce are female and only 8.4% of interventional cardiologists are female. Furthermore, according to Ouyang et al, only 10% of medical school deans, 11% of department chairs, and 14% of full professors in medical schools are women. “The under-representation of women in senior roles has been thought to be multifactorial—attributable in part to fewer research and promotion opportunities,” they write.

According to the investigators, an important measure of research productivity is the number of peer-reviewed publications and they note “in consideration for promotion, the number and impact of publications is explicitly evaluated”. Therefore, the authors sought to “determine trends in authorship of cardiology-related publications in three high-impact general cardiology journals over the past 40 years”. The hypothesis of the study was that women would be less likely to be first or senior authors in high-impact published research but the gap between men and women would have decreased over time. The journals reviewed were: Circulation, Journal of the American College of Cardiology, and the European Heart Journal.

From 55,085 articles identified, 257,328 authors could be matched for gender; of these, 71,345 were unique authors. Ouyang et al write: “In total, 23,629 (33.1%) authors were female. Only 44,434 (26.7%) of 16,613 first authors were female (p<0.001). There was a smaller proportion of female authors in senior authorships, accounting for 2,193 (19.7%) of 11,160 senior authors (p<0.001).” Additionally, both research papers with a first female author and those with a senior female author had a higher mean number of additional middle female authors than did papers with male first or senior authors. Furthermore, articles with a female senior author more frequently had a female first author (0.37 vs. 0.18 for papers with a male senior author; p<0.001).

However, the number of female authors increased from over time: 9.5% with a female first author and 5.9% with a female senior author between 1980 and 1990 vs. 26.2% and 17.4%, respectively, between 2010 and 2017. Ouyang et al comment: “Our analysis showed a persistent, though narrowing, gap in female representation in research on all levels, as an author in general, as a first author, and as a senior author.”

“More work is needed to untangle the reasons behind these disparities and to develop strategies to increase female representation in cardiovascular research,” Ouyang et al conclude.

Ouyang told Cardiac Rhythm News: “Our study gives further support for the need to support female early faculty members as well as trainees during medical school, residency, and fellowship. Previous studies have shown that the earliest years in an academic career have a big impact on career trajectory and longevity—our study shows that progress in proportion of female senior authors track but lag behind the proportion of female first authors. I would encourage senior researchers to actively recruit and engage female trainees and junior faculty in research projects.”

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