Is the Future Pink? Transforming Gender Narratives in Endoscopy Authorship Across Six Decades

Aims Gender diversity in scientific authorship is a critical indicator of progress in various medical fields, including gastrointestinal (GI) endoscopy. The representation of women in academia reflects broader changes in professional roles and leadership. This study aims at analyzing trends in gender representation among authors of randomised controlled trials (RCTs) in GI endoscopy from the 1960s to the present, providing insights into the progression of gender equity in academic gastroenterology.

Methods A comprehensive PubMed search using the terms 'digestive endoscopy' and 'gastrointestinal endoscopy' was conducted on April 1st, 2024, resulting in 5944 records after filtering for RCTs. After excluding articles unrelated to endoscopy, non-English studies, and those where the first author’s name could not be identified, a final sample of 4439 RCTs was included in the analysis. Names of first and last authors were extracted, and gender was identified using the Genderize.io platform, with classifications accepted at a certainty score of≥90%. Descriptive and inferential statistical analyses, including chi-squared tests for categorical variables and assessments of linear trends, were conducted to evaluate changes in gender representation over time.

Results In total, there were 967 female first authors (21.7%), 3415 male first authors (77.0%), and 57 unclassified first authors (1.3%). Among 4173 last authors, 637 were female (15.3%), 3203 were male (76.7%), and 333 were unclassified (8.0%) (p<0.001). Female representation among last authors increased from 0% in the 1970s to approximately 20% by 2024, while female first authorship rose from 0% to around 30% (p<0.05 for both trends). Multivariate regression confirmed a more pronounced increase in female first authorship compared to last authorship (p<0.001, R²=0.90). By topic, “non-IBD-related diagnostic lower GI endoscopy” showed the highest representation for female first authors at 25.5%, while “Obesity” and “Artificial Intelligence” had the lowest at 1.4% and 1.7%, respectively. For last authorship, “non-IBD-related diagnostic lower GI endoscopy” led with 22.1%, followed by “Diagnostic upper GI endoscopy” at 14.0%. The lowest percentages among last authors were “Obesity” at 1.4% and “Artificial Intelligence” at 0.6%. Statistical analysis revealed significant differences in gender representation across topics (p<0.0001). Significant regional differences were observed, with a higher prevalence of female first authors in Europe (36.2%) and Asia (31.0%) and female last authors in Europe (34.2%) and North America (30.8%) (p=0.032), highlighting distinct regional gender dynamics in endoscopy research.

Conclusions This study reveals a substantial yet gradual rise in female representation within digestive endoscopy RCTs particularly among first authors. However, persistent gender disparities in senior authorship roles emphasize the urgent need for targeted initiatives to advance gender equity, particularly in leadership positions within academic gastroenterology [1] [2].

Publication History

Article published online:
27 March 2025

• References

• 1 Liu CS. et al. Gender Trends in Authorship of Gastroenterology Randomized Controlled Trial Literature. Am J Gastroenterol 2024; 119 (10): 2103-2106
• 2 Genderize Data Roskilde, Denmark. Genderize.io (last access Nov 1st, 2024)