Authorship diversity in hematology-related Cochrane systematic reviews: Inequities in global representation.

RESEARCH LETTER

The need for promoting diversity and equitable authorship representation in academics faces increasing recognition, with some articles pointing out the lack of diversity in specific fields. Currently, there are no such articles scrutinizing the author diversity in the field of hematology. Cochrane systematic reviews are perceived worldwide to be among the highest quality of evidence available, thereby its conclusions often impact policy and practice globally. However, little is known about the current state of authorship diversity in hematology‐related Cochrane reviews. This study sought to determine the gender and country diversity in authorship representation in the authorship of Cochrane systematic reviews related to hematology.

Data were collected from the Cochrane Library on 20 May 2022, using the keyword “hematology” in advanced search under the subheading “Cochrane Group.” All the articles were extracted that included published reviews, protocols, and withdrawn publications. The temporal distribution of the articles ranged from 2003 to 2022. A total of 139 articles were found (97 Cochrane reviews and 42 Cochrane protocols). The date of publication, the title of the article, DOI (digital object identifier), complete author list, and the email address for correspondence were collected.

The designation of the first author and corresponding author was based on the author list order and correspondence provided. Those authors who did not provide a complete name were queried on public search engines such as Google and other publications on databases (PubMed, Research gate, Scopus, Embase, Hinari, etc.), and institutional pages. Genders (female/male) were assigned to each author based on an online search, attempting to capture at least one web page demonstrating it (such as LinkedIn, Research gate, institutional websites, etc.). For those authors whose gender could not be ascertained by these methods, attempts were made to contact the corresponding author to determine their gender and that of their coauthors. The identification of gender solely based on the name or appearance was deferred until confirmation was obtained by the corresponding author. Authors whose gender could not be ascertained were categorized into an “unknown” group. We treated a collaborative author group belonging to a single country (e.g., MRC Clinical Trials Unit [UK]) as a single author. A second investigator independently cross‐verified the extracted data.

A Google sheet was created to collect and store the data. The collected data were presented as frequency (percentage, %) and ratios as appropriate. For graphical representation of the global diversity, we used a choropleth‐style map.

One hundred and thirty‐nine publications with a total of 940 authors were included in the current study for the country‐based analysis. The leading five represented nations (Figure 1) in authorship were Germany (n = 396, 42.1%), United Kingdom (n = 167, 17.7%), China (n = 65, 6.9%), United States of America (n = 57, 6.06%), and Israel (n = 48, 5.1%). First authors were mostly represented by Germany (n = 58, 41.7%), followed by the United Kingdom (n = 22, 15.8%), China (n = 14, 10%), United States of America (n = 8, 5.7%), and Israel (n = 8, 5.7%). Only 21 (2.23%) authors from low and low‐middle‐income countries had authorship representation.

FIGURE 1

Choropleth‐style map showing nation wise author contribution in hematology‐related Cochrane systematic reviews.

Of the 940 authors, gender could not be ascertained for three (0.32%) authors from China. Male (n = 438, 46.6%) to female (n = 499, 53.1%) ratio in this study was 1:1.13 (Figure 2). There were 63 (45.3%) male and 76 (54.7%) female first authors. Women (n = 80) constituted 57.5% of all the corresponding authors. Fifty‐two (37.4%) studies did not have female representation in any lead author (corresponding or first author) positions. Twelve (8.6%) studies did not have any female authors at all.

FIGURE 2

Bar chart demonstrating gender representation in authorship.

Authors from high‐income countries continue to be the largest contributors to Cochrane systematic reviews in hematology, source of one of the highest quality evidence. There is extremely poor representation of authors from low and low‐middle‐income countries. Despite the fact that only less than 40% of practicing hematologists are female, an overwhelming representation of women was noted in the overall as well as lead authorship (first author and corresponding author).

Gender bias is very evident in the leadership positions. Over the past 50 years, only four female presidents were elected for both the American Society of Hematology (ASH) and the International Society of Thrombosis and Haemostasis (ISTH). In an insightful study by Shruthi et al., women were found to receive lesser recognition than males for clinical academia. This included awards and formal recognition for contributions to research, education, and clinical practice. A study by King et al. identified that men had more lead‐authored publications than women, and almost twice as many total publications in the American Society of Hematology, Clinical Research Training Institute. Another study by Siddiqui et al. showed that in investigating gender inequality in the National Institutes of Health funding for hematologic malignancies and cellular therapies, only 29% of the total grant was allocated to women principal investigators. However, our study found that the representation of women in Cochrane reviews was significantly higher compared with other existing literature. This may be because Cochrane reviews do not necessarily require independent funding and the gender gaps are likely to be higher for women trying to get funding for interventional studies.

Taskforces like Women in Hematology Working of the ASH are developing strategies to limit this imbalance by providing career development opportunities for women in hematology. A similar initiative was taken by the editorial board of Research and Practice in Thrombosis and Haemostasis, a journal of the ISTH, where more women editors and editorial board members were appointed to minimize the gender gap in academic publishing. These bold efforts resulted in increased gender representation of women. Active capacity‐building efforts are needed in several countries for advancing authorship diversity among academic hematologists involved with Cochrane.

AUTHOR CONTRIBUTIONS

J.B. and A.D. wrote the manuscript. C.D., J.B., and R.B.R. performed data collection. A.D. conceptualized the manuscript.

RELATIONSHIP DISCLOSURE

Nil.