Gender and racial differences in first and senior authorship of high-impact critical care randomized controlled trial...

Females and ethnic minorities are underrepresented in the first and senior authorships positions of academic publications. This stems from various structural and systemic inequalities and discrimination in the journal peer-review process, as well as educational, institutional, and organizational cultures.

A retrospective bibliometric study design was used to investigate the representation of gender and racial/ethnic groups in the authorship of critical care randomized controlled trials in 12 high-impact journals from 2000 to 2022.

In the 1398 randomized controlled trials included in this study, only 24.61% of the first authors and 16.6% of the senior authors were female. Although female authorship increased during the study period, authorship was significantly higher for males throughout (Chi-square for trend, p < 0.0001). The educational attainment [χ²(4) = 99.2, p < 0.0001] and the country of the author's affiliated institution [χ²(42) = 70.3, p = 0.0029] were significantly associated with gender. Male authorship was significantly more prevalent in 10 out of 12 journals analyzed in this study [χ²(11) = 110.1, p < 0.0001]. The most common race/ethnic group in our study population was White (85.1% women, 85.4% males), followed by Asians (14.3% females, 14.3% males). Although there was a significant increase in the number of non-White authors between 2000 and 2022 [χ²(22) = 77.3, p < 0.0001], the trend was driven by an increase in non-White male and not non-White female authors. Race/ethnicity was significantly associated with the country of the author's affiliated institution [χ²(41) = 1107, p < 0.0001] but not with gender or educational attainment.

Persistent gender and racial disparities in high-impact medical and critical care journals underscore the need to revise policies and strategies to encourage greater diversity in critical care research.