Assessment of gender and geographical bias in the editorial decision-making process of biomedical journals: A Case-Control study

Abstract Objectives To assess whether the gender (primary) and geographical affiliation (post hoc) of the first and/or last authors of manuscripts is associated with publication decisions after controlling for known confounders. Design Case-control (1:1) study. Setting Two large general medical journals and 20 specialist journals. Participants Original peer reviewed research manuscripts submitted between January 1, 2012, and December 31, 2019. Main outcomes measures and predictor Manuscripts accepted (cases) and rejected (controls) were compared between women and men first authors (main predictor), and between women and men last authors (secondary predictor). Results Of 7,000 included manuscripts 6,724 (96.1%) first and 6,768 (96.7%) last authors’ gender were identified; 3,056 (43.7%) and 2,214 (32.7%) were women, respectively. The proportion of women first and last authors were respectively 46.7% (n=1,571) and 32.3% (n=1,093) among cases and 44.2% (n=1,485) and 33.1% (n=1,121) among controls. In univariate analysis, being a woman first author increased the likelihood of acceptance for publication (odds ratio 1.11; 95% confidence interval 1.00 to 1.22). After adjustment for study attributes, then post-hoc variables, the association between the first author’s gender and acceptance for publication became non-significant 1.04 (0.94 to 1.16). The likelihood of acceptance for publication was significantly lower for first authors affiliated to Asia 0.58 (0.48 to 0.70) compared to Europe, and for first author affiliated to upper middle income 0.61 (0.47 to 0.78) and lower middle and low-income 0.65 (0.45 to 0.93) compared to high income countries. Compared to papers where both first and last authors were from the same country, acceptance for publication was significantly higher when both authors were affiliated to different countries from the same geographical and income groups 1.39 (1.09 to 1.77), to different countries, different geographical but same income groups 1.45 (1.14 to 1.84), or to different income groups 1.59 (1.20 to 2.11). The study attributes (design, and funding) were also independently associated with acceptance for publication. Conclusions The absence of gender inequalities during the editorial decision-making process is reassuring. However, the underrepresentation of first authors affiliated to Asia and low-income countries in manuscripts accepted for publication indicates poor representation of global scientists’ opinion and supports growing demands for improving diversity in biomedical research. Summary boxes What is already known on this topic? Published studies have revealed gender inequalities in academia, attainment of leadership positions, successful grant funding and in biomedical research production (including reported research contributions, attainment of key authorship positions in submitted and published manuscripts, membership of editorial boards, and participation in peer review). Geographical inequalities have been reported in biomedical research production, including membership of editorial boards, participation in peer review, and attainment of key authorship positions in submitted and published articles. Diversity in science is associated with better research quality and improved representation of global scientists’ opinions. What this study adds? Gender inequality toward the first author of original research manuscripts disappeared after adjusting for other important factors related to authorship (first authors’ geographical affiliation and income group), and the study attributes (funding and medical specialty). First authors affiliated to Asia compared to Europe and from low-income compared to high-income countries had a lower chance of being accepted for publication. Geographical and income diverse teams represented by the first and the last authors’ affiliations had a greater chance of being accepted for publication.