Gender Representation Trends and Senior Authorships in High Impact Critical Care Journals

• In ICU
• Fri, 26 Sep 2025

Gender disparities remain entrenched in medical academia, particularly in authorship positions linked to seniority and prestige. Women are underrepresented as first and senior authors, transition more slowly to senior authorship, and face greater gaps in high-impact journals and randomised controlled trials. Wealthy countries often show fewer female authors than lower-resource settings. This underrepresentation persists despite evidence that gender-diverse research teams produce higher-quality, more clinically relevant science, and despite guidelines like the Sex and Gender Equity in Research (SAGER) emphasising the importance of sex- and gender-based analysis.

In critical care research, women account for about 30% of first authors and 16–20% of senior authors, with disparities worsening during the COVID-19 pandemic. Investigator-initiated consortia show more balanced representation, but overall gaps remain. 

To date, no studies have comprehensively assessed trends in author gender representation across top-ranked critical care journals over the past two decades, including the pandemic period. A recent meta-epidemiological study aimed to fill that gap by analysing first, senior, and combined authorships over 20 years.

The study examined author gender distribution in publications from 2005 to 2024 using NamSor for gender prediction. Female representation in first, senior, and combined authorships was analysed through percentage calculations, with annual trends assessed via linear regression across both single- and multi-author publications.

This 20-year analysis of the five highest-impact critical care journals found improvements in female authorship but persistent underrepresentation, especially in senior roles. Among 42,970 articles analysed, women remained underrepresented in critical care research leadership. Only 7.8% had both female first and senior authors, versus 56.7% with both roles held by men, while 23.6% of single-author publications were female. Mixed-gender authorships accounted for about 35%, and single female authorship rose to ~30% by 2024. Annual increases in female authorship remained modest (<1 percentage point).

Despite gender parity among medical school graduates, women’s representation in authorship, leadership, societies, editorial boards, and conferences remains stagnant, with critical care among the least gender-diverse specialties. Structural barriers, including implicit bias, mentorship gaps, work-life balance challenges, and limited access to funding, slow women’s progression to senior authorship and leadership. This underrepresentation restricts diversity of research perspectives, potentially undermining patient care and scientific integrity.

Collaborative research networks and paediatric intensive care publications show narrower gaps when equity is actively prioritised. Evidence-based interventions, including visible role models, targets for representation, transparent selection, sponsorship, flexible work environments, and bias training, have shown measurable success when implemented in multifaceted programmes. Broader institutional and societal action is needed to accelerate progress and dismantle systemic barriers.

Overall, despite modest gains, female first and senior authors remain underrepresented in critical care literature, with current trends too slow to reach parity within decades. Accelerated progress will require urgent, systematic, and multi-layered institutional interventions to ensure equity and fully leverage scientific talent for improved patient care.

Source: Critical Care
Image Credit: iStock 

References:

Bruns N, Brensing P, Greve S et al. (2025) Female first and senior authorship in high-impact critical care journals 2005–2024. Crit Care. 29, 395.