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Abstract：
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.
To examine the authorship of case reports and elucidate factors associated with sex disparity.
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.
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.
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).
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.
To examine the authorship of case reports and elucidate factors associated with sex disparity.
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.
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.
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).
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.
摘要：
研究出版物中女性作者的代表性不足，但目前尚不清楚这是否归因于研究行为或作者实践中的性别差异。病例报告是生物医学语料库中鲜为人知的组成部分，轶事观察的产生不会受到与研究出版物中女性代表性差异相关的因素的混淆。临床信息的非研究出版物中是否存在女性作者差异尚不清楚。
研究病例报告的作者身份并阐明与性别差异相关的因素。
2015年7月至2018年7月在PubMed中对2014年和2015年美国作者发表的所有病例报告进行横断面研究。
主要结果指标是女性第一作者的比例。次要结果指标是不同临床专业中女性最后作者和女性作者代表的比例。
文献计量数据摘自2538种期刊上发表的20427例病例报告。共有7252例（36％）和4825例（25％）病例报告有女性第一作者和最后作者，分别。相比之下,44%和34%的美国学员和医生，分别,2015年是女性。在成人病例报告中，与社区环境相比,女性作者身份在学术环境中更为普遍(女性第一作者为34.0%vs28.2%,女性最后作者为23.4%vs19.7%).在各州，女性第一作者和最后作者的比例普遍低于女性受训人员和活跃女医生的比例，分别。女性第一作者身份与更大的作者团队相关(赔率比[OR]，1.02；95%CI，1.01-1.03），学术隶属关系(或，1.16；95%CI，1.06-1.27），和最后一位女性作者(或，1.58；95%CI，1.47-1.70）。相对于普通内科，由男性临床医生主导的专业与女性第一作者的相关性较低.显示男性和女性第一作者相对等同倾向的几个例外包括肿瘤学(OR，0.97；95%CI，0.81-1.16），眼科（OR，0.87；95%CI，0.72-1.05），和放射肿瘤学（或，0.9495%CI，0.56-1.56）。
在病例报告的出版物中，女性在第一作者和最后作者中的代表性不足强调了医学中性别差异的普遍性。合作和女性导师可能是破坏与性别偏见相关的长期做法的关键工具。并非所有临床专业都与低于预期的女性作者身份有关，进一步探索出版和指导方面的专业规范可能会阐明女性作者身份的具体障碍。
研究病例报告的作者身份并阐明与性别差异相关的因素。
2015年7月至2018年7月在PubMed中对2014年和2015年美国作者发表的所有病例报告进行横断面研究。
主要结果指标是女性第一作者的比例。次要结果指标是不同临床专业中女性最后作者和女性作者代表的比例。
文献计量数据摘自2538种期刊上发表的20427例病例报告。共有7252例（36％）和4825例（25％）病例报告有女性第一作者和最后作者，分别。相比之下,44%和34%的美国学员和医生，分别,2015年是女性。在成人病例报告中，与社区环境相比,女性作者身份在学术环境中更为普遍(女性第一作者为34.0%vs28.2%,女性最后作者为23.4%vs19.7%).在各州，女性第一作者和最后作者的比例普遍低于女性受训人员和活跃女医生的比例，分别。女性第一作者身份与更大的作者团队相关(赔率比[OR]，1.02；95%CI，1.01-1.03），学术隶属关系(或，1.16；95%CI，1.06-1.27），和最后一位女性作者(或，1.58；95%CI，1.47-1.70）。相对于普通内科，由男性临床医生主导的专业与女性第一作者的相关性较低.显示男性和女性第一作者相对等同倾向的几个例外包括肿瘤学(OR，0.97；95%CI，0.81-1.16），眼科（OR，0.87；95%CI，0.72-1.05），和放射肿瘤学（或，0.9495%CI，0.56-1.56）。
在病例报告的出版物中，女性在第一作者和最后作者中的代表性不足强调了医学中性别差异的普遍性。合作和女性导师可能是破坏与性别偏见相关的长期做法的关键工具。并非所有临床专业都与低于预期的女性作者身份有关，进一步探索出版和指导方面的专业规范可能会阐明女性作者身份的具体障碍。
