Authors of Clinical Practice Guidelines by Gender, Race, and Ethnicity: A Systematic Review and Meta-Analysis

Importance: Clinical practice guidelines (CPGs) play a critical role in shaping medical care and healthcare policies, yet there is growing concern about the lack of diversity in CPG authorship. This systematic review and meta-analysis aim to assess gender, race, and ethnicity representation among authors of CPGs across different medical specialties. Objective: To evaluate the representation of women and individuals from minoritized racial and ethnic groups among authors and contributors of CPGs. Data Sources: A comprehensive literature search was conducted in databases including Ovid MEDLINE, Embase.com , Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov from inception to September 2023. Studies focusing on CPG authorship disparities by gender, race, and ethnicity were selected for review. Study Selection: Eligible studies included those that reported data on gender, racial, and ethnic composition among CPG authors. Out of 2,436 articles screened, 20 studies met the inclusion criteria for full-text review and meta-analysis. Data Extraction and Synthesis: Data extraction was performed independently by two reviewers, with disagreements resolved through consensus, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis was then conducted using a random-effects model. Main Outcomes and Measures: The primary outcome was the proportion of women and individuals from minoritized racial and ethnic groups among CPG authors. The meta-analysis estimated pooled proportions of women's authorship across the different medical specialties. Results: The 20 included studies covered a total of 36,783 author positions. Women's authorship varied widely across specialties, with an overall pooled proportion of 25.7% (95% Confidence Interval (CI): 21.8%–30.1%). Racial and ethnic data were available in only a few studies, with significant gaps in reporting. The findings indicate persistent gender disparities in CPG authorship, particularly in specialties such as cardiology and gastroenterology. Conclusions: This analysis demonstrated that substantial disparities in gender, race, and ethnicity remain in CPGs' authorship. More inclusive representation is essential to ensure diverse perspectives in shaping healthcare guidelines.