Trends in gender of first and senior authors of articles published in JMIRO

Despite progress of women in science and medicine, women remain underrepresented in academic publication. The aim of this study was to evaluate potential gender differences in women authorship in the Journal of Medical Imaging and Radiation Oncology (JMIRO).


Introduction
Academic publications serve as an important measure of academic productivity, leadership and achievement. 1 Disappointingly, women continue to be underrepresented in scientific leadership and publications. 2,3 While the proportion of women researchers is increasing worldwide, they publish significantly fewer research papers on average than men. 4 In 2018, researchers from the University of Melbourne reported that it will take 16 years before equal numbers of men and women publish scientific papers, but in some disciplines like computer science and physics, it will be hundreds of years before gender parity is achieved. 5 Depending on the discipline, the rate of increase in women authors is estimated to be 0-1% per year. 5 While there is literature addressing gender differences in authorship in major radiology and radiation oncology journals, [6][7][8][9][10] there has been no previous assessment of potential gender differences in the authorship of scientific publications in the Journal of Medical Imaging and Radiation Oncology (JMIRO). JMIRO is the official journal of The Royal Australian and New Zealand College of Radiologists (RANZCR), publishing articles of scientific excellence in both medical imaging and radiation oncology. This journal attracts submissions from around the world and all articles are peer-reviewed.
This study aimed to examine the authorship teams of articles published in JMIRO, to determine if there were gender differences in the first and senior authorship, and if so determine whether they were reflective of the local clinical radiology and radiation oncology workforces. We also aimed to identify any trends in the gender distribution of first and senior authorship over time.

Study design and data collection
A retrospective review of all articles published in JMIRO over a 10-year period between 2012 and 2021 was conducted. For each article, the following was recorded: year of publication, article specialty (Medical Imaging (MI); Radiation Oncology (RO); Combined (MI/RO)), article title, article type (original article, review article, technical note, pictorial essay, case series, letter to editor/viewpoint, editorial, guidelines), and first and senior (last listed) authors' name. It should be noted that the combined (MI/RO) article specialty was introduced in the February 2013 issue; therefore, for the first year of this study period (2012), no combined MI/RO articles were recorded. For articles with only a single author, that author was considered a first author and no senior author was recorded.

Binary gender inference
For each article, the names of the first and senior author were used to assign binary gender. The authors' first names were entered on the genderize.io online database (https://genderize.io/) to infer the gender of authors based on the name. The genderize.io database contains over 200,000 distinct first names and gender self-report data from approximately 80 countries. The database has been used and validated in previous studies identifying gender gaps. 5,11 The database returns the most likely gender for each given name, along with a probability of the most common gender given that name. Each author's first name was inspected to check the accuracy of genderize.io. For names that were not found in the database, or that were found but had a probability <0.95, Google searches were used for publicly available information such as conference biographies and images to infer the gender of the individual. If the gender could not be identified through the database or internet searches, the author's gender was listed as indeterminate.

Statistical analysis
Descriptive statistics were used to describe the distribution of first and senior authorship by year and article type. Changes over time and differences among groups were compared using the chi-square test.

Results
A total 1,138 articles were available for review ( Fig. 1). Of these, 60 articles had a single author. The names of 12 first authors and 12 senior authors could not be inferred and were assigned the 'indeterminate' category. The proportion of women as first author was 30%, 41% and 36% for MI, RO and MI/RO articles respectively. This was statistically significant when compared with proportion of men as first authors in all three specialties (P = 0.0012). Similarly, the proportion of women as senior author was lower than men at 22%, 32% and 23% for MI, RO and MI/RO articles respectively (significantly different to men, P = 0.0011). Overall, women were first and senior authors on 34% and 25% of all articles respectively.
Authorship gender frequency based on article type is detailed in Figure 2. Women did not outnumber men as first and senior authors for any article type. The highest proportion of women as first author was for original article (38%), review (37%) and editorial (36%). For senior authorship, the highest proportion of women authors was noted for review (37%), original article (27%) and pictorial essay (25%).
The proportion of women first and senior authorship over time is highlighted in Figure 3. There was no statistically significant difference in the frequency of women authorship over time for first author (P = 0.89). However, a statistically significant difference over time was noted in the frequency of women authorship for senior author (P = 0.019). Women first authorship over the study period remained stable from 2014 (36%) to 2020 (38%); however it decreased dramatically in 2021 to 28%. There was a trend of increasing women senior authorship from 2013 (15%) to 2017 (35%). However, this decreased to 23% in 2021.

Discussion
This study demonstrates a gender imbalance in first and senior authorship for articles published in JMIRO over the 10-year period between 2012 and 2021. We found that only 34% of first authors were women, and only 25% of senior authors were women. The findings of this study suggest that the gender inequity in academic publications in JMIRO is similar to those reported in other radiology and radiation oncology journals as listed in Table 1. [6][7][8][9][10] Similar findings were also reported in other oncology specialties including surgical oncology and clinical oncology in 2017 where the representation of women as first and senior authors was 37% and 29% respectively. 12 The results of this study showed that the proportion of women as first author was 30% and 41% MI and RO articles respectively. This may reflect the underrepresentation of women radiologists and radiation oncologists in Australia and New Zealand. According to the 2021 RANZCR (Faculty of Clinical Radiology) workforce survey, only 31% of consultant radiologists are women. 13 For radiation oncology, the representation of women in the workforce was better at 40% in 2018. 14 Given the gender imbalance in the workforce, the proportion of women authors in JMIRO is aligned with the local workforce. It should be noted that authors may also be non RANZCR members including trainees, radiation therapists, medical physicists, radiographers, medical students or other researchers who are not formally considered as active contributors to MI or RO workforce.
The proportion of women first authorship in our study remained consistent from 2014 to 2020 but dropped by 10% in 2021. The COVID-19 pandemic has potentially exacerbated any pre-existing gender imbalances in manuscript submissions and publications. Women may have been disproportionately responsible for additional duties such as child care and home schooling and more likely to have been primary caregivers in a household. 15 These coupled with disruptions to clinical work practices may have resulted in a drop in their ability to take on tasks related to conducting, writing and publishing their research. Our study also showed that the proportion of women senior authorship decreased by 9% from 2020 to 2021. This finding was in line with another recent study which investigated the impact of COVID-19 on gender equality and found that the proportion of women last (senior) authors was statistically significantly lower in the second quarter of 2020 compared to 2019 (30% vs.  50%, P = 0.017). 16 They concluded that given that the last authorship is often associated with a supervisory role/status in the research reported in the manuscript, this decrease in women senior/last author representation could reflect a decreased availability and capacity of women academics to supervise research. 16 Other studies have also reported that submissions of scholarly papers to the medical literature by women decreased, whereas for men, they increased. 17,18 Similarly, within the MI and RO fields, the pandemic has had a disproportionate effect on academic publishing of women researchers. [19][20][21] The disproportion of COVID-19's impact on women may have a longer term impact on the careers of women in research and the resultant gender imbalance in publishing. 22 Evidence suggests that women academics may face hurdles in their professional work that men authors do not face to the same extent, which may impact on the academic output of women in research. Many factors that prevent women's full participation and contributions in the scientific field may pertain to broader issues in academia including, career development, gender bias in funding assessment and success rates in attracting competitive grant funding. 23 The role of mentoring in career development for academics is well recognised. However, it has been reported that women perceived greater difficulty finding a mentor than men. 24 The change needed to reach the goal of gender parity in academia is substantial, structural and system-wide. 25,26 Data from radiation oncologists show a systematic gender association with fewer women achieving senior faculty rank. 27 The academic, clinical and funding environments must vastly transform and address any issues of bias in their systems and the same applies to academic journals if they are to address diversity. 28 While this manuscript has focussed on gender, there are several other sociodemographic aspects of diversity that must be considered and addressed. To create lasting change and to  prevent the current focus on diversity and inclusion from becoming another ineffectual trend in management, it is important to firstly recognise and understand the disparities, secondly, to educate the wider academic community on the importance of diversity in academia in order to ensure diversity in thought leadership, research ideas and innovation and finally to ensure that efforts to address the disparities are not tokenistic but instead are evidence based. 29 In December 2017, The Lancet announced the #Lan-cetWomen project as an active step towards solving the problem of gender inequities in publishing. 28 Lancet's internal processes were reviewed to provide a baseline for improvement, and to report to readers in the interest of transparency. While women represent 79% of the editorial staff across 14 journals in The Lancet group, only 28% of The Lancet's subject-matter reviewers were women, and only 29% of authors were women. 28 As a result of this audit, The Lancet developed strategies to improve women's participation including developing a diversity pledge. Similarly in the field of radiation oncology, the International Journal of Radiation Oncology, Biology and Physics (Red Journal) moved to a more selective, merit-based system in 2011 and played a critical role in advancing the status of women in radiation oncology. 30 The 2021 Red Journal editorial board women representation included the deputy editor, 50% of senior editors, 42% of editorial board members and 27% of other editors, for a total women representation of 41%. 30 In 2022, the deputy editor became the editor in chief, the first woman editor in chief of the Red Journal. In Australia, the Medical Journal of Australia (MJA) published a themed issue on gender and sexuality in recognition of the key role medical journals play in protecting and advancing the rights and well-being of women, gender diverse and sexually diverse individuals. 31 In keeping with the theme of the issue, the MJA reflected on the role the journal plays in gender equity and how to promote positive change. The journal made a commitment to move towards ensuring gender balance in author invited to write commissioned articles and to strengthen the peer-review process through improved engagement with women in medicine and research, as well as achieving parity within MJA's editorial advisory group. 31 An important limitation to our study was the binary gender attribution adopted based on author names. We acknowledge that gender is a spectrum and that people define their own gender identity. Therefore, our inferences may have been inaccurate in some cases. Future demographic information collected by academic journals regarding authorship teams would ideally include selfreports of gender identities. Limitation of the online database used to infer gender (genderize.io) is that the database performs better for western names compared to non-western names. 11 The names of 12 first authors and 12 senior authors that could not be inferred in this study were all non-western names. We also acknowledge the potential impact of the unblinded review process used by JMIRO. However, double-blind peer review, which has potential to reduce bias in academic publishing, has been associated with mixed results in terms of improving women authorship. 12,[32][33][34] Indeed, a previous report in the Red Journal suggests that double-blinded reviews may not do enough to conceal an author's gender and reduce bias. 35 In conclusion, this study has highlighted gender differences in the authors of JMIRO publications. Over the past 10 years of publications, one in three first authors were women and only one in four last authors were women. While the proportion of women first authorship is reflective of the current workforce, the gender imbalance in senior authorship could be improved. The COVID 19 pandemic appears to have further negatively impacted on first and last author representation by women in 2021. The acknowledgement of this imbalance is the first step to pave the way to addressing underlying systemic issues and disparities in gender and other inequities.