Despite an ongoing increase in the number of women entering the fields of medicine and science, the proportion of women authors across all article types in major cardiovascular journals remains low, a new study finds. The study of cardiovascular literature from four journals over a 10-year period reveals that women had persistently low contributions to invited papers compared with original research papers. The research team adds that the results underscore the need for targeted interventions to support women in cardiology and provide them with equitable opportunities to advance their careers. “The AAMC [Association of American Medical Colleges] reports a consistent upward trend in the number of women pursuing internal medicine and cardiology during the same period,” said the authors of the paper, led by Ridhima Goel, MD, from the Icahn School Medicine at Mount Sinai, New York. “Despite this positive trajectory, the proportion of women authors on cardiovascular papers has remained stagnant. Therefore, the observed low proportion of female authors on cardiovascular papers is not solely a reflection of the female cardiologist workforce but a broader issue related to the inclusivity and recognition of women within the realm of medical scholarship.” Decade of research The investigation, which was published Monday online and in the June 18 issue of the Journal of the American College of Cardiology, found that of the 18,535 papers with 111,562 authors, 20.6% of the authors were women, and 47.7% of the papers had no women authors. Over 10 years, the proportion of women authors remained low (20.7% in 2010 to 21.4% in 2019), with the lowest proportion in editorial papers (14.8%) and the highest in research papers (21.8%). Further findings revealed that more women as first (34.6%) and last (47.6%) authors were affiliated with institutions in the United States compared with other countries. The researchers also found that the proportion of women middle-order authors was higher on papers with women as first authors (29.4% vs 20.5%) or last authors (30.6% vs 21.3%), compared with papers with men as first or last authors. “The low number of women authors may also be secondary to the higher likelihood of their papers being rejected during the peer-review processes,” the paper’s authors said. “It has been hypothesized that increasing women on editorial boards and as peer reviewers might lead to an increase of women authors. However, women are less likely than men to be invited as peer reviewers.” Lack of change Mary Norine Walsh, MD, from the Ascension St. Vincent Heart Center in Indianapolis, and JoAnn Lindenfeld, MD, from Vanderbilt University Medical Center in Nashville, Tennessee, highlighted the most striking study finding as the complete lack of change in the proportion of women authors over the decade examined. In their accompanying editorial comment, they pointed out that the assumption over the decade would have been a rise in academic authorship to coincide with more women holding a more senior academic rank. “It is not clear that all, or even a majority, of the authors were cardiologists because many nonphysician researchers and trainees were clearly counted in the tallies as well,” they said. “However, regardless of specialty, the expectation would be that of a growth in the numbers of women in all biomedical fields and a concomitant growth in the number of published researchers who are women.” ‘MANuscript’ and ‘manels’ Walsh and Lindenfeld also highlighted the finding that almost one-half of all papers had not a single woman author. “This type of article has been termed a ‘MANuscript,’ in keeping with the all-male conference panel dubbed a ‘manel,’” the experts said. “Although the organizers of many cardiovascular conferences have gone to great lengths to ensure the absence of manels, very few cardiovascular journals have made efforts to ensure diversity in the author block.” Commenting on the analysis’ limitations, the commentators highlighted that only four journals were included and that the cause of the disparity in authorship was not fully explored by the authors. “There is no mention of the role women themselves might play in the lack of growth of women authors over time,” they said. “Do more women refuse invitations to lead steering committees, serve on editorial boards, review manuscripts, and contribute to research and the resultant manuscripts than men? “Or is the gender disparity primarily a result of the lack of invitations and inclusion experienced by women? We need more research in this area to understand the dynamics.” Concluding their remarks, Walsh and Lindenfeld wrote that the solution rests with cardiovascular journals and medical publishing industry, adding that editorial boards could have an “outsized” effect in ensuring that the literature has equitable gender representation. Going forward, they recommended a series of initiatives that include the institution of blinded peer review, increased diversity on journal editorial boards and sending reviewer invitations to a diverse group of potential reviewers, including those who are more junior in the field. Study methodology All papers published from Jan. 1, 2010, to Dec. 31, 2019, in four major cardiovascular journals (Journal of the American College of Cardiology, European Heart Journal, JAMA Cardiology and Nature Reviews Cardiology) were reviewed. Sources: Goel R, Sartori S, Vogel B, et al. Geographic Mapping of Gender Disparities in Authorship of Cardiovascular Literature. J Am Coll Cardiol. 2023;83:2458–2468. Walsh MN, Lindenfeld J. Gender Diversity in Cardiovascular Journal Authorship: So Much Time, So Little Progress. J Am Coll Cardiol. 2023;83:2469–2471. Image Credit: Vitaliy – stock.adobe.com