S1521 Sex, Race, and Geographic Disparities Are Prevalent Among Authors and Patients in Prospective Studies Published in Major U.S. Gastroenterology Journals Over the Past Decade

Abstract

Introduction: Our team investigated geographic and sex representation among authors in addition to sex and racial representation among patients in prospective cohort and randomized-controlled trials published in the major United States-based (US) gastroenterology and hepatology journals from 2010-2021. Methods: Our librarians retrieved articles published in the American Journal of Gastroenterology (AJG), Gastroenterology, Clinical Gastroenterology and Hepatology (CGH), Hepatology, and Gastrointestinal Endoscopy (GIE) from 1/1/2010 through 12/31/2021 through PubMed, Scopus, and Web of Science. We randomly selected 2,749 articles and excluded all retrospective studies, meta-analyses, cross-sectional studies, translational work, and case series (Figure 1, Table 1). We then excluded 707 RCTs and PCs that were missing patient demographic data (eg, sex, race, etc). Categorical variables were compared using chi-square analysis while t-testing was used for numerical variables. All analysis was done using R. Results: We analyzed 244 RCTs and PCs and found US and Canada-based institutions represented 192/244 of lead authors (78.7%, P < 0.01), while the South comprised 71/192 (38.6%, P = 0.22) of the US-based authors. There were no papers from Africa or South America, and just 12 combined (4.9%) from East or South Asia, and North America apart from the US/Canada. Male lead authors (166/244; 68%) comprised the majority in both RCTs (2.8:1, P = 0.03) and PCs (1.5:1, P = 0.03), and in multi-center studies (3:1, P = 0.02) and single center studies (1.3:1, P = 0.02). Lead authorship was not significantly associated with journal editorial board membership. There were 1,401,292 patients, including 885,255 women (63.2%) and 308,010 non-White (21.9%) patients. The mean number of female to male patients was equivalent in 3 of the 5 journals and just above 2:1 in the other 2 journals (AJG, Gastroenterology). The ratio of White patients was significantly higher than that of non-White patients across all 5 journals (4.7:1 in AJG, 3.9:1 in Gastroenterology, 3.1:1 in GIE, 2.2:1 in Hepatology, and 1.6:1 in CGH; P = 0.04) for RCTs and PCs, whether single-center (2.5:1) or multi-center (5.4:1). Conclusion: There are geographic and sex-based disparities among lead authors, and race-based disparities among patients, particularly in multi-center studies and RCTs, which tend to be the most prestigious in clinical research. Further investigation and effort is needed to help address underrepresentation in these areas.Figure 1.: Flow Chart for Article Selection. Table 1. - Baseline Characteristics for Lead Authors and Study Types Variable Number (Percent); n=244 Journal American Journal of Gastroenterology 38 (15.6) Clinical Gastroenterology and Hepatology 72 (29.5) Gastroenterology 69 (28.3) Gastrointestinal Endoscopy 23 (9.4) Hepatology 42 (17.2) Study Type Prospective Cohort 104 (42.6) Randomized-Controlled Trial 140 (57.4) Number of Sites Single-Center 95 (38.9) Multi-Center 149 (61.1) US Geographic Region Midwest 43 (23.4) Northeast 41 (22.3) South 71 (38.6) West 29 (15.8) World Geographic Region East and South Asia 7 (2.9) Europe 30 (12.3) Middle East 3 (1.2) North America (NOT US/Canada) 2 (0.8) Oceania 10 (4.1) US/Canada 192 (78.7) Lead Author Sex Female 78 (32) Male 166 (68) Lead Author on Editorial Board? No 215 (90.3) Yes 23 (9.7) Article's Main Focus Endoscopic Technique 28 (15.1) Liver Disease 101 (51) Pancreatico-Biliary or Gallbladder Disease 20 (10.8) Inflammatory Bowel Disease 24 (13) GI-Based Cancer 24 (13.3) Motility 11 (6.2) Functional GI Disease 27 (14.6) Other GI Issue Not Otherwise Specified 37 (19.2)