Female Authors in Top Orthopedic Journals Across Different Regions: An Analysis of Authorship Rates and Publication Trends from 2019 to 2023

Background Orthopedic surgery remains male-dominated in research publications. This trend is documented in American journals but has not been compared with foreign journals. This study aimed to analyze the rates of female first authors, senior authors, and overall female authors in top orthopedic journals from the United States, United Kingdom (UK), Germany, and East Asia between 2019 and 2023. Methods A retrospective bibliometric review of articles published from 2019 to 2023 in orthopedic journals was conducted using the application Genderize. We determined the genders of first and last authors for each article. ANOVA and chi squared tests were used to assess continuous and categorical variables. Posthoc tests made specific comparisons between groups, and multivariate regression identified factors influencing female authorship. Results The United Kingdom had the highest rates of female authors(p<0.001). It also had the highest average and percentage of female authors per manuscript (p<0.001). The UK (OR:2.02;95%CI[1.80,2.27];p<0.001) and East Asia (OR:1.33;95%CI[1.10,1.60] p<0.001) had significantly higher odds of female first authors compared to the US. Germany had lower odds of female first and last authors compared to the US (OR 0.65;95%CI[0.50,0.82];p<0.001). All regions showed increased odds of female first authorship when paired with a female senior author(p<0.001). Conclusions The UK excels in promoting female authorship with the highest rates of female authors. This indicates greater inclusion of women. Other countries could reduce gender disparity by studying the UK's culture and initiatives. All regions experience increased female first authorship under female senior leadership, highlighting the impact of women's leadership role.