Systematic analysis of authorship demographics in global surgery

Abstract

Background: Global surgery has recently gained prominence as an academic discipline within global health. Authorship inequity has been a consistent feature of global health publications, with over-representation of authors from high-income countries (HICs), and disenfranchisement of researchers from low-income and middle-income countries (LMICs). In this study, we investigated authorship demographics within recently published global surgery literature.

Methods: We performed a systematic analysis of author characteristics, including gender, seniority and institutional affiliation, for global surgery studies published between 2016 and 2020 and indexed in the PubMed database. We compared the distribution of author gender and seniority across studies related to different topics; between authors affiliated with HICs and LMICs; and across studies with different authorship networks.

Results: 1240 articles were included for analysis. Most authors were male (60%), affiliated only with HICs (51%) and of high seniority (55% were fully qualified specialist or generalist clinicians, Principal Investigators, or in senior leadership or management roles). The proportion of male authors increased with increasing seniority for last and middle authors. Studies related to Obstetrics and Gynaecology had similar numbers of male and female authors, whereas there were more male authors in studies related to surgery (69% male) and Anaesthesia and Critical care (65% male). Compared with HIC authors, LMIC authors had a lower proportion of female authors at every seniority grade. This gender gap among LMIC middle authors was reduced in studies where all authors were affiliated only with LMICs.

Conclusion: Authorship disparities are evident within global surgery academia. Remedial actions to address the lack of authorship opportunities for LMIC authors and female authors are required.

Keywords: health services research; obstetrics; other study design; surgery.

Figure 1

Country affiliations of first and last authors. World maps depicting the number of first authors and last authors affiliated with a country.

Figure 2

Author demographics for studies related to Surgery, Obstetrics and Gynaecology (O&G), Anaesthesia and Critical care (A&C) and Multiple topics. Percentages of: (A) male and female authors; (B) authors affiliated with only HICs, with only LMICs and with both HICs and LMICs; (C) authors of seniorities 1 (lowest) to 5 (highest). (HIC, high-income country; LMIC, low-income and middle-income country.)

Figure 3

Gender and seniority of authors affiliated with at least 1 HIC (HIC authors) and authors affiliated only with LMICs (LMIC authors). (A, C, E) Percentages of male and female authors at each seniority grade for first (A), last (C) and middle (E) authors. (B, D, F) Male:Female ratio (M:F) (number of male authors/number of female authors) at each seniority grade for first (B), last (D) and middle (F) authors. Seniority 5 represents the highest seniority. (HIC, high-income country; LMIC, low-income and middle-income country.)

Figure 4

Gender and seniority of HIC authors and LMIC authors, separated by overall authorship network. Author demographics are shown for all studies, studies where all authors are affiliated only with HICs (all HIC authors), studies with HIC first and last authors, studies where all authors are affiliated only with LMICs (all LMIC authors) and studies with LMIC first and last authors. Seniority 5 represents the highest seniority. (A, C, E) Percentages of male and female authors at each seniority grade for HIC first (A), last (C) and middle (E) authors. (B, D, F) Percentages of male and female authors at each seniority grade for LMIC first (B), last (D) and middle (F) authors. (G) Male:female ratio (M:F) (number of male authors/number of female authors) at each seniority grade for HIC and LMIC middle authors. (HIC, high-income country; LMIC, low-income and middle-income country.)