Gastroenterology and hepatology journals should increase women authorship representation: Room for improvement in trends from 2017 to 2024

Women in gastroenterology (GI) and hepatology remain underrepresented in the profession because of a variety of factors, including their higher work-life commitments alongside discrimination in the workplace.1 Studies have noted increasing women representation of GI and hepatology in fellowship positions, scientific publications, editorial boards, and academic positions.2 Trends in first and senior women authorship of scientific publications and among hepatology compared to GI journals have yet to be explored. We aimed to investigate this further by analyzing trends in women authorship among GI and hepatology journals. We selected 12 GI and hepatology journals of varying impact factors (IFs) to collect data from January 2017 to July 2024 through PubMed. Six journals published mostly GI research and 6 mostly hepatology research. Within each subspecialty, 2 journals were considered as first-tier (IF 15+), 2 as second-tier (IF 5–14), and 2 as third-tier (IF <5) based on relative journal IFs (Figure 1).3 Seven journals were based in the United States, and 5 were international. One out of every 3 articles were reviewed at random and categorized as editorials, reviews, primary research articles, letters to the editor, case report or series, and guidelines. We used a validated multinational binary gender database of first names (genderize.io) to identify the genders of first and senior authors with ≥95% confidence.4FIGURE 1: Women authorship trends per year. Women as first (solid line) and senior (dashed line) authorship rates across 2017–2024 for (A) all manuscripts and by (B) GI journal (Gut, Gastroenterology, American Journal of Gastroenterology, Clinical Gastroenterology and Hepatology, Digestive Diseases and Sciences, Gastroenterology and Hepatology) compared to hepatology journal (Hepatology, Journal of Hepatology, Hepatology Communications, Liver International, Clinical Liver Disease, European Journal of Gastroenterology and Hepatology), (C) first-tier (Gut, Gastroenterology, Hepatology, Journal of Hepatology), second-tier (American Journal of Gastroenterology, Clinical Gastroenterology and Hepatology, Hepatology Communications, Liver International), or third-tier (Digestive Diseases and Sciences, Gastroenterology and Hepatology, Clinical Liver Disease, European Journal of Gastroenterology and Hepatology) journal impact, (D) article type for women as first author, and (E) article type for women as senior author. Annual percent change analysis shown in forest plot format (F) for articles included if gender determined with ≥95% confidence, with CIs indicating significance.Annual percent change (APC) analysis was used to characterize trends in women authorship rates over time based on article type, specific journal, journal IF, and the broader fields of hepatology compared to GI. A sensitivity analysis was performed in which articles were included when gender was determined with ≥80% confidence. All research was conducted in accordance with the Declarations of Helsinki and Istanbul. This research and a waiver of written consent were approved by the Montefiore-Einstein Institutional Review Board. A total of 35,037 articles were reviewed. In all, 7868 articles (22%) were excluded as the first author’s gender could not be determined with ≥95% confidence and 7261 (21%) were excluded given the inability to determine the senior author’s gender with ≥95% confidence. Of the remaining articles, 34% had women as first authors (WFA), and 22% had women as senior authors (WSA). Overall, women authorship incidence increased for all articles by 1.85% annually for WFA (p=0.005, 95% CI [0.80%, 2.91%]) and 3.32% for WSA (p=0, 95% CI [2.30%, 4.30%]) (Figure 1A). This trend was driven by increases in review article authorship (APC=4.42% for WFA, p=0.001, 95% CI [2.64%, 6.22%]; APC=7.21% for WSA, p=0.023, 95% CI [1.40%, 13.40%]) (Figures 1D, E). In addition, WSA wrote more editorials annually at a rate of 7.21% (p=0.034, 95% CI [0.70%, 14.10%]). WSA incidence rates significantly increased across all journal tiers, greatest among third-tier journals (APC=4.46%, p=0.026, 95% CI [0.70%, 8.30%]) (Figure 1C). WFA only increased among second-tier journals (APC=2.72%, p=0.002, 95% CI [1.42%, 4.05%]). WFA had higher annual publication rates in GI journals (APC=2.28%, p=0.006, 95% CI [0.91%, 3.66%]) compared to hepatology journals (APC of 1.32%, p=0.02, 95% CI [0.29%, 2.36%]) (Figure 1B). WSA similarly increased more in GI (APC 3.60%, p=0.001, 95% CI [2.20%, 5.00%]) than in hepatology journals (APC 2.98%, p=0, 95% CI [2.00%,3.90%]). Clinical Liver Disease had the highest APC of 5.81% in favor of WFA (p=0.014, 95% CI [1.62%, 10.18%]) followed by American Journal of Gastroenterology, Gastroenterology, and Liver International. All other GI and hepatology journals did not have significant growth in WFA. Clinical Liver Disease also had the highest APC for WSA (7.35% annually, p=0.017, 95% CI [1.80%, 13.20%]), followed by American Journal of Gastroenterology, Gastroenterology, Clinical Gastroenterology and Hepatology, and Hepatology. Over the study period, Hepatology Communications had stagnant WFA (APC=-0.42%, p=0.79, 95% CI [−3.96%, 3.26%]), though trended toward increased WSA (APC=4.59%, p=0.065, 95% CI [−0.40, 9.80]). When examining rates of women and men as first authors working with senior authors of the same or different gender, 23,665 articles were included with ≥95% confidence in both genders. A chi-square analysis was performed. WSA were more likely to work with WFA (32%) than men as first authors (17%). WFA were still more likely to publish with men as senior authors (68%) (p<0.001). Men as first authors working together with men as senior authors compiled 83% of articles published (p<0.001). The 80% sensitivity analysis showed that the percentage of WFA and WSA did not differ compared to the main analysis. APC analysis as well as rates of WFA working with WSA compared to men as first authors yielded similar trends. Our analysis of article authorship in 12 GI and hepatology journals over a 7.5-year period demonstrates more women are increasingly publishing in GI and hepatology journals. This trend is more evident among senior authors than first authors. Bhatia et al2 observed an increasing incidence of WFA among GI journals between 1997 and 2017. The increasing incidence of WSA in this bibliometric analysis may reflect the transition of these prior first authors to now senior authors. WFA publication rates in GI and hepatology journals only changed by 4% (33%– 37%) from 2017 to 2024. Yet, the presence of women trainees in GI and transplant hepatology fellowships has increased more significantly over the same time period.5 Women represented 40.1% of GI fellowships by 2022 (7% more than in 2017) and 60.4% of transplant hepatology fellowships (10.4% more than in 2017).5 WFA publication rates lagging behind women fellowship entry rates may be a result of several factors that remain unclear at this time. Research is more heavily encouraged in academic settings and not all fellowships are affiliated with research and academic centers. Furthermore, women GI and hepatology trainees and early-career attendings may face different work-life commitments than their more senior counterparts. Finally, men as senior authors still prefer to work with men as first authors, which has a significant impact when there are more men as senior authors publishing in general. Review and editorial articles had more prominent rises in women authorship, whereas all other article types, including original research papers, remained stagnant over the study period. These article types may not require the same level of resources often required of original research papers. We hypothesize the difference in resources might include dedicated research time, access to research teams and networks, and grant funding. Ultimately, mentorship is one of the most essential factors in research and career development. Rabinowitz et al6 showed that women prefer women mentors but face difficulty establishing relationships with one. Women mentees are less likely to have a mentor who encouraged their scholarly pursuits. This becomes especially important in academia where publications are factored into career advancement, and women gastroenterologists and hepatologists in every stage of their careers may be at a disadvantage. Besides supporting more women in leadership positions, we need to re-evaluate how we provide mentorship to women to avoid unconscious biases. Mentors should seek to encourage women trainees and early-career attendings to not only pursue research endeavors but also become mentors for others. In so doing, an academic mentorship cascade can develop and have an exponential effect within the fields of GI and hepatology. This may be especially prudent for hepatology given the lagging women authorship rates compared to GI despite the greater representation of women among fellowship positions.5Hepatology Communications has the opportunity to become a leader in supporting this, especially with its emphasis on original research, large research presence, and novel approaches to promoting research within the community. Limitations of this study include the inability to account for authors’ race or ethnicity and analyze the intersectionality of disparities experienced among underrepresented minority women authors, potential incorrect categorization of gender by the validated multinational binary gender database, and analysis of articles over a limited time period. Further investigation is needed to understand the perspectives of both genders in overcoming authorship challenges. Additional studies analyzing data over a longer time frame would also be helpful in determining potential inflection points in the trends. Several GI societies and organizations have initiatives to begin addressing gender disparities in the profession, although more must be done at institutional and grant-funding levels, especially for underrepresented minority women. While representation of women is slowly improving, achieving gender equality in the academic environment will require active engagement from gastroenterologists, hepatologists, and respective societies.