Global gender and geographic disparities in leukemia clinical trials authorship

Abstract Introduction: Authorship not only reflects scientific contribution but also serves as metrics for academic recognition and career advancement. Although disparities in author gender and geographic distribution have been reported in different types of cancer, limited data exist on the representation of women and authors from underrepresented regions in leukemia clinical trials (CTs). To fill this gap, we aimed to identify and characterize disparities in gender and geographic representation among lead and senior authors of CTs in leukemia. Methods: We evaluated CTs abstracts from two major 2024 Hematology-Oncology conferences: the American Society of Hematology (ASH) and the European Hematology Association (EHA). We also assessed CTs published as full-text manuscript (PubMed-indexed) in 2024. Data on CTs design, authorship, and scientific output were collected, including presentation modality (plenary, oral, poster, publication-only, or e-poster for abstracts), and journal impact factor (JIF, 2023 Journal Citations Reporting for manuscripts). Full authors names were extracted and gender assigned using institutional websites, culturally accepted gender associations, or the name-to-gender inference tool Genderize.io. Authors with gender certainty below 90% were excluded. Author affiliations were used to determine country of origin, and its socioeconomic indicators, namely Gross Domestic Product [GDP], GDP investment in Research and Development (R&D) and income tier classification. Chi-square or Fisher's exact test were used to compare the groups for categorical variables. A significance set for p< 0.05 was adopted. Results: We reviewed 396 leukemia CT abstracts presented at ASH (n=293) or EHA (n=103) meetings, and 123 PubMed-indexed leukemia CTs. Among 396 abstracts, most lead and senior authors were affiliated with institutions in high-income countries (HIC, lead: 74.5%; senior: 74.2%), while contributions as lead or senior author from lower-middle-income countries were negligible (<1% for both roles). Similar patterns were observed in the full-text manuscripts (95.1% of lead and 94.5% of senior authors were from HIC). Of the 318 abstracts with available lead author gender data, only 103 (32.4%) had female lead authors. Similarly, female senior authors comprised just 21.8% of senior authors overall. Gender parings revealed that only 7.6% of abstracts were authored by female-female teams. In the PubMed cohort, female first authors accounted for 26.0% and senior authors only 14.2% indicating even lower representation than at ASH/EHA. Female lead authors were more frequently based in countries with lower GDP (median: $27T vs. $18.3T; p=0.017) and R&D spending (median: 3.59% vs. 3.41% of GDP, p=0.016) than male counterparts. Despite the low representativity and reduced resources access by female authors, there was not difference in the type of abstract presentation or on the JIF according to the gender (p>0.05). Research output, assessed by abstract presentation format and JIF, revealed significant disparities based on author region and country income. Abstracts presented as plenary or oral sessions were significantly more likely to be led by authors from upper-middle-income countries (UMIC, p<0.001) and by those affiliated with institutions in Asia (p<0.001). When examining full-text publications, JIF varied significantly by continent and income level of the lead and senior authors. Manuscripts with lead authors from Oceania and Europe had higher median JIFs compared to those from Asia (p=0.002), and those from HIC had significantly higher JIFs than those from UMIC (median: 8.90 vs. 5.50; p<0.001). Similar patterns were observed for senior authors: higher JIFs were associated with affiliations in Oceania and Europe compared to Asia (p=0.020), and with authors from HIC compared to UMIC (p<0.001). No statistically significant differences in JIF were found based on author gender (lead: p=0.221; senior: p=0.679). Conclusion: Across both conference and publication settings, female authors remain underrepresented, particularly in senior authorship roles. Scientific impact of contributions by female lead authors were similar to those by male authors highlighting the strength of their contributions despite systemic barriers. The income and investment in research seem to be more important in the impact of the research output.