Prevalence of Female Authors in Case Reports Published in the Medical Literature

Key Points

Question

How are female authors represented in the production of nonresearch medical information across clinical specialties, and what factors may determine their presence?

Findings

In this cross-sectional study of 20 427 case reports, female first (36%) and last (25%) authors were underrepresented in nonresearch publications, and female first authors were associated with female last authors and academic environments. While female author underrepresentation was largely associated with the sex composition of clinical specialties, several predominantly male specialties, including oncology, ophthalmology, optometry, and radiation oncology, were not associated with any specific author sex.

Meaning

Disparities between male and female authors are pervasive even in nonresearch medical publications independent of information content, geography, and specialty.

Abstract

This cross-sectional study examines the prevalence of female authors of case studies published in medical journals in the United States.

Abstract

Importance

Underrepresentation of female authors in research publications is prevalent, but it is unclear whether this is attributable to sex disparities in research conduct or authorship practices. Case reports are a poorly understood component of the biomedical corpus, and the production of anecdotal observations is not confounded by factors associated with disparities in female representation in research publications. Whether female authorship disparities exist in nonresearch publications of clinical information is unknown.

Objectives

To examine the authorship of case reports and elucidate factors associated with sex disparity.

Design and Setting

Cross-sectional study of all case reports published by US authors in 2014 and 2015 indexed in PubMed performed from July 2015 to July 2018.

Main Outcomes and Measures

The primary outcome measure was the proportion of female first authors. The secondary outcome measures were the proportion of female last authors and female authorship representation among different clinical specialties.

Results

Bibliometric data was abstracted from 20 427 case reports published across 2538 journals. A total of 7252 (36%) and 4825 (25%) case reports had a female first and last author, respectively. In comparison, 44% and 34% of US trainees and physicians, respectively, were female in 2015. Among adult case reports, female authorship was more prevalent in academic environments compared with community settings (34.0% vs 28.2% for female first authors and 23.4% vs 19.7% for female last authors). Across states, the proportions of female first authors and last authors were universally less than the proportions of female trainees and active female physicians, respectively. Female first authorship was associated with larger author teams (odds ratio [OR], 1.02; 95% CI, 1.01-1.03), an academic affiliation (OR, 1.16; 95% CI, 1.06-1.27), and a female last author (OR, 1.58; 95% CI, 1.47-1.70). Relative to general internal medicine, specialties dominated by male clinicians were less frequently associated with female first authors. Several exceptions displaying a relatively equivalent tendency for male and female first authorship included oncology (OR, 0.97; 95% CI, 0.81-1.16), ophthalmology (OR, 0.87; 95% CI, 0.72-1.05), and radiation oncology (OR, 0.94 95% CI, 0.56-1.56).

Conclusions and Relevance

The underrepresentation of women among first and last authors in publications of case reports underscores the pervasiveness of sex disparities in medicine. Collaboration and female mentors may be critical instruments in upsetting longstanding practices associated with sex bias. Not all clinical specialties were associated with lower-than-expected female authorship, and further exploration of specialty-specific norms in publication and mentorship may elucidate specific barriers to female authorship.