Analysis of peer reviewers’ response to invitations by gender and geographical region: cohort study of manuscripts reviewed at 21 biomedical journals before and during covid-19 pandemic
BMJ 2023; 381 doi: https://doi.org/10.1136/bmj-2023-075719 (Published 13 June 2023) Cite this as: BMJ 2023;381:e075719Linked Opinion
Unveiling hidden inequalities in diversity and inclusion in medical research
- Khaoula Ben Messaoud
, postdoctoral researcher1 2, - Sara Schroter, senior researcher, honorary assistant professor34,
- Mark Richards, article transfer service manager3,
- Angèle Gayet-Ageron, assistant professor1 2
- 1Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
- 2University of Geneva, School of Medicine, Geneva, Switzerland
- 3BMJ, London, UK
- 4Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Correspondence to: K Ben Messaoud Khaoula.Ben.Messaoud{at}gmail.com (or @MessaoudKhaoula on Twitter)
- Accepted 18 April 2023
Abstract
Objectives To describe gender and geographical inequalities in invitations to review and the response to these invitations and to assess whether inequalities increased during the covid-19 pandemic.
Design Retrospective cohort study.
Setting 19 specialist medical journals and two large general medical journals from BMJ Publishing Group.
Population Reviewers invited to review manuscripts submitted between 1 January 2018 and 31 May 2021. The cohort was followed up to 28 February 2022.
Main outcome measures Reviewer’s agreement to review.
Results A total of 180 092 reviewers were invited (39.0% (70 203/180 092) women), and 67 019 (37.2%) agreed to review. Invited reviewers were mainly (168 291; 93.5%) affiliated with high income countries: Europe (95 616; 53.1%), North America (51 923; 28.8%), Asia (14 240; 7.9%), Oceania (12 678; 7.0%), Africa (3224; 1.8%) and South America (2411; 1.3%). Independent factors associated with agreement to review were gender (odds ratio 0.92, 95% confidence interval 0.89 to 0.95, for women compared with men), geographical affiliation (3.66, 3.29 to 4.08, for Africa; 2.87, 2.72 to 3.04, for Asia; 3.36, 2.98 to 3.79 for South America; 1.05, 1.01 to 1.09, for North America; and 1.34, 1.27 to 1.43, for Oceania compared with Europe), and country income (3.34, 3.09 to 3.60, for upper middle income; 5.22, 4.76 to 5.73, for lower middle income; and 4.76, 3.86 to 5.87, for low income compared with high income country). Agreement was also independently associated with editor’s gender (0.96, 0.93 to 0.99, for women compared with men) and editor’s geographical affiliation (1.16, 1.03 to 1.30, for Oceania compared with Europe), last author’s geographical affiliation (0.82, 0.77 to 0.88, for Africa; 0.80, 0.77 to 0.83 for Asia; 0.95, 0.91 to 0.98, for North America; and 0.89, 0.84 to 0.94 for Oceania compared with Europe), impact factor (1.64, 1.15 to 2.42, for >10 compared with <5), and type of peer review process (0.44, 0.29 to 0.69, for open compared with anonymised). During the first and second phases of the pandemic, agreement was lower than in the pre-pandemic period (P<0.001). The interaction between time periods and covid-19 related topic and reviewer’s gender was non-significant. However, significant interaction was found between time periods and covid-19 related topic and reviewer’s geographical affiliation.
Conclusions To reduce bias and improve diversity, editors need to identify and implement effective strategies and continually evaluate progress against these to ensure that more women and researchers from upper middle income and low income countries are involved in review.
Footnotes
Contributors: KBM, SS, and AGA were involved in the study conception and design. SS was responsible for data collection. KBM was responsible for data management. KBM and MR were involved in the gender determination. AGA was responsible for obtaining research funding. KBM and AGA were involved in data analysis and interpretation. KBM generated figures and tables. KBM, SS, MR, and AGA were involved in drafting the manuscript. KBM, SS, MR and AGA revised the manuscript. All authors approved the final version. AGA is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding: This study was supported by grant 10001A_192374 from the Swiss National Science Foundation (SNSF). The funders had no role in considering the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the article for publication.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the university hospitals of Geneva, Geneva Medical School, and the SNSF for the submitted work; SS and MR are full time employees of BMJ Publishing Group but are not involved in decision making on individual research submissions; no other relationships or activities that could appear to have influenced the submitted work.
The lead author (the manuscript’s guarantor) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Dissemination to participants and related patient and public communities: The results from this study were presented at the 9th International Congress on Peer Review and Scientific Publication in Chicago. Dissemination of results to public communities will take place via media and on social network platforms from the affiliated institutions through press release. Results will also be shared with the respective BMJ journal editors.
Provenance and peer review: Not commissioned; externally peer reviewed.
Data availability statement
Relevant anonymised reviewer level data are available on reasonable request from the corresponding author. The study was conducted under a confidentiality agreement between the BMJ Publishing Group and the medical school of Geneva University, represented by the Department of Health and Community Medicine.
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