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.
Introduction
Gender and geographical inequalities have been widely reported across the biomedical publication process, including the underrepresentation of women and ethnic minorities on editorial boards, authoring research publications, and holding of key authorship positions on manuscripts.123456 Research from higher income countries is also favoured over lower income countries.7
Peer review, pivotal to the publication process, is under increasing pressure and prone to many potential biases,891011 but the extent of these biases has been less investigated than other areas of the publication process as most peer review is done anonymously and reviews are not usually in the public domain.1213 Some studies have analysed the selection of peer reviewers and their response to invitations to review submissions to biomedical journals; however, as this information is confidential, these studies have largely been done within single journals and may not be representative beyond their communities.141516 Analyses of published peer reviews and public acknowledgment statements to named reviewers of biomedical journals have shown gender and geographical bias in the contributions.17181920
The main reason researchers give for declining to review is lack of time.1421 Peer reviewing is not a formally rewarded academic task and is often considered as outside the scope of researchers’ duties and done outside of work hours.822 The covid-19 pandemic and associated lockdowns led to significant and sudden global changes to researchers’ work patterns; many experienced an increase in their professional duties combined with additional family responsibilities.23242526 Women were shown to be more affected than men, particularly in their research activity and production.3232425262728293031 Few studies have evaluated the impact of the pandemic on biomedical peer review activity. Bro et al and Perlis et al compared peer review invitations and agreement patterns in single journals with no focus on gender or geographical inequalities and reported no significant differences in reviewer activity during the pandemic.1532 Hupalo et al found no effect on women’s peer review activity during the pandemic compared with previous years,33 but this was explored in a single journal. However, a large study across 2329 Elsevier health and medicine journals found that women were less involved in peer review, with an agreement rate lower than that of men in the very early phase of the pandemic compared with two previous years; they did not report any differences by geographical areas.23
The objectives of our cohort study were to describe gender and geographical inequalities in invitations to review and the response to these invitations and to assess whether inequalities increased during the early and later stages of the covid-19 pandemic in 21 biomedical journals.
Methods
Participants and data sources
Using ScholarOne databases, we identified all original research manuscripts (including systematic reviews) submitted to one of 21 participating BMJ Publishing Group journals (see supplementary table A) between 1 January 2018 and 31 May 2021. We included all manuscripts that were reviewed by at least one peer reviewer and for which a final decision had been made by 28 February 2022 in the cohort with complete information for the studied variables.
Factors and outcomes
We collected data at three levels: manuscript, journal, and reviewer. At the manuscript level, we recorded manuscript ID; journal name; date of original submission; manuscript title; last authors’ first, middle, and last names, salutation, institutional address, and affiliation (department, institution, city, country); editors’ first and last names, institutional address, and affiliation (department, institution, city, country); first and last editorial decisions and dates; and total numbers of reviewers invited who agreed to review and who completed reviews. At the journal level, we recorded the journal impact factor (JCR year 2019) (categorised as <5, 5-10, and >10) and the type of peer review process (open or anonymised (single, double, triple anonymised)) (supplementary table A). At the reviewer level, we recorded the reviewer’s first, middle, and last names, salutation, institutional address, and affiliation (department, institution, city, country); response to the invitation (“unavailable,” “no response,” “late response,” “conflict of interest,” “decline,” “agreed,” “email problem”); dates of the invitation to review, response to the invitation, and completion of the review where applicable. We excluded invitations to reviewers who were unable to receive the invitation.
Our primary outcome was the reviewer’s agreement to review—that is, whether the response to the review invitation was “agreed” not “declined.” We considered response to peer review invitation as declined if the response to the invitation was “decline,” “conflict of interest,” “unavailable,” or “no response.”
The predictors assessed in our study were geographical affiliation, wealth of country of affiliation, invitation period, and manuscript topic. Common practice in biomedical research is for the most senior author to go last, and we hypothesised that the last author was likely to be more influential than the first. We extracted geographical affiliations of the last author, editor, and reviewers from the country of their institutional affiliation and classified them into one of six groups (Europe, Africa, Asia, South America, North America, or Oceania). We further classified geographical affiliation by the wealth of the country by using the four levels defined by the World Bank Atlas method according to 2021’s gross national income per capita (low income by annual inhabitant $1045 or less, lower middle income by $1046 to $4095 per inhabitant, upper middle income by $4096 to $12 695, and high income by $12 696 or more).34 We defined three invitation time periods—“pre-pandemic period” (1 January 2018 to 31 December 2019), “first phase of the pandemic” (1 January 2020 to 31 January 2021), and “second phase of the pandemic” (1 February 2021 to 28 February 2022)—to obtain periods of relatively similar duration before and during the pandemic.3 For each manuscript reviewed, we further identified whether covid-19 was the research topic by using a combination of keywords in the title and the abstract, as previously described.3
Gender determination
Editors’ genders were provided by BMJ Publishing Group. We identified the gender of reviewers and the last authors by using the same sequential four step procedure as in a previous study, using an accuracy for gender determination above 80%.3 Where this procedure did not identify gender, we recorded gender as “undetermined.”
Statistical analysis
Our sample size was fixed (28 607 reviewed manuscripts and 180 092 invited reviewers), and the number of events evaluated (primary outcome) provided sufficient power to test several predictors in multivariable models. We described continuous variables as mean (standard deviation) or median (interquartile range) and presented categorical variables as frequencies and relative proportions. We graphically verified the linearity assumption of logit for the continuous variable (impact factor) and, as it was not verified, we further reported associations with a categorical variable. We performed mixed effects logistic regression models with response to the invitation to review as the dependent variable. To account for some clustering in the data at the journal, manuscript, and reviewer levels (several reviewers were invited to review different manuscripts), we included three random factors on the intercept by using the journal, manuscript ID, and reviewer ID variables. We prespecified two interactions: time period and manuscript topic with reviewer’s gender, and time period and manuscript topic with reviewer’s geographical affiliation. We performed this regression model on complete cases, and we report unadjusted and adjusted odds ratios, 95% confidence intervals, and P values from univariate and multivariable models. We used the glmer function from the “lme4” package with convergence optimizer “bobyqa” and a maximum of 200 000 iterations. We did a post hoc sensitivity analysis by using multiple imputation for missing gender determination (for the main model without interactions). Missing gender of last author and reviewer was considered at random and M=5 imputations were applied; adjustment of the imputation model was done for last author’s and reviewer’s geographical affiliation, time periods, and journal. The computations needed between 12 and 30 cores on the Intel Xeon E5 v4 processor family and took between 12 and 96 hours to complete. We used R software (version 4.0.0) for analyses.
Patient and public involvement
We partnered and co-authored with the chair of the BMJ’s LGBTQ+ network (MR). MR contributed to almost every aspect of the study (data collection, gender determination, manuscript revision, and final approval).
Results
Characteristics of reviewed manuscripts
Among the 100 731 manuscripts submitted during the study period, 28 607 (28.4%) were reviewed, eligible for inclusion in our cohort and the analysis. Table 1 shows the characteristics of included manuscripts. The mean difference in the number of invited and agreed reviewers was 5.0. Most reviewed manuscripts were from journals with anonymised peer review (n=16 082; 56.2%) and with impact factors <5 (n=16 483; 57.6%). Reviewed manuscripts more frequently had a man as last author (19 501/28 607; 68.2%) and a last author affiliated with a high income level country (n=23 765; 83.1%)—Europe (n=13 266; 46.4%), Asia (n=6385; 22.3%), or North America (n=5943; 20.8%)—with only a few affiliated to Africa (n=869; 3.0%) or South America (n=419; 1.5%). Most reviewed manuscripts were handled by editors who were men (n=16 833; 58.8%) and by editors with an institutional affiliation in Europe (n=18 814; 65.8%) or North America (n=6290; 22.0%). Only a very small minority were handled by editors with affiliations in Oceania (n=1890; 6.6%), Asia (n=1595; 5.6%), or Africa (n=18; 0.1%), and none by editors affiliated to South America.
Characteristics of selected reviewed manuscripts* (n=28 607) submitted to 21 BMJ Publishing Group journals between 1 January 2018 and 31 May 2021 and followed up until 28 February 2022. Values are numbers (percentages) unless stated otherwise
Reviewers’ response to invitations by characteristics of reviewers and time period
Among the total number of 180 092 invitations to review, 37.2% (n=67 019) were agreed. Most (n=58 303; 87.0%) reviewers who agreed to review went on to complete it. Table 2 shows the characteristics of reviewers invited, agreeing, and declining to review. A total of 70 203 (39.0%) women were invited, and women agreed to review manuscripts 7.6% less often than men (P<0.001). More than half of invitations were sent to reviewers affiliated to Europe (53.1%) and around a third to North America (28.8%); only a small proportion of invited reviewers were affiliated to Asia (7.9%), Oceania (7.0%), Africa (1.8%), or South America (1.3%). Agreement to review was highest among invited reviewers affiliated to Asia (52.3%) or Africa (50.3%), followed by South America (50.2%), North America (37.9%), Oceania (35.8%), and Europe (34.0%). More than nine out of 10 (93.5%) invited reviewers were affiliated to a high income country, whereas agreement to review was highest among reviewers affiliated to lower middle, low income, and upper middle income countries compared with high income countries (60.2%, 54.8%, 51.8%, and 36.0%, respectively).
Proportion of review invitations agreed and declined by key characteristics of reviewers (n=180 092 review invitations)
Looking in more detail, more than three times fewer reviewers with an affiliation to Asia were invited than manuscripts reviewed with a last author affiliated to Asia (fig 1, top). Conversely, more invited reviewers were affiliated to Europe and North America than manuscripts reviewed with a last author affiliated to those regions. Similarly, more invitations were sent to reviewers affiliated with high income countries than manuscripts reviewed with a last author affiliated with a high income country (fig 1, bottom).
Distribution of geographical affiliation (top) and income level group of country of affiliation (bottom) for reviewers invited to review versus last author of reviewed manuscripts in cohort (n=180 092 review invitations and n=28 607 reviewed manuscripts)
Of all invitations sent during the pre-pandemic period, the agreement rate was 37.5%. Agreement rates seemed to be higher during the first phase of the pandemic for covid-19 and non-covid-19 related manuscripts (2694/7291 (37.0%) and 20 512/53 674 (38.2%), respectively) compared with the second phase of the pandemic (1465/4520 (32.4%) and 7304/21 230 (34.1%), respectively) (supplementary table B). Reviewers were faster to respond to invitations to review covid-19 related manuscripts in the first phase of the pandemic compared with pre-pandemic. The percentage of agreement to review was higher for men than for women in all time periods, both for covid and non-covid related manuscripts.
Multivariable analysis of response to peer review invitations
Table 3 shows the univariate analyses. The time period and manuscript topic, the reviewer’s gender and geographical affiliation, the last author’s geographical affiliation, the editor’s geographical affiliation, the journal’s impact factor, and the type of peer review process were all significantly associated with agreement to review; these associations all remained significant in the multivariable model in addition to the editor’s gender (table 3, fig 2).
Agreement (n=180 092) to review manuscripts* submitted to 21 BMJ Publishing Group journals between 1 January 2018 and 31 May 2021: univariate†‡ and multivariable models†‡
Response of reviewers invited (n=180 092) to review manuscriptsa submitted to 21 BMJ Publishing Group journals between 1 January 2018 and 31 May 2021. Summary of multivariate model, with reference categories at bottom. Mixed effect logistic regression with manuscript and journal as random effects. Manuscripts with at least one review completed were included. Model is presented in table 3. IF=impact factor
Time period and manuscript topic was significantly associated with agreeing to review a manuscript in the multivariable analysis; all associations were significantly lower compared with pre-pandemic, except for covid-19 related manuscripts during the first phase of the pandemic, for which the association was not significant. We observed a decreasing trend in agreement from pre-pandemic to the second phase of the pandemic.
Reviewer’s gender and geographical affiliation—Agreement to review a manuscript was significantly lower among women compared with men (adjusted odds ratio 0.92, 95% confidence interval 0.89 to 0.95). Compared with Europe, the adjusted odds ratio was significantly higher for all regions (table 3). When high income was the reference (supplementary table C; supplementary figure A), the odds ratio was drastically higher for reviewers affiliated to upper middle income (3.34, 3.09 to 3.60), lower middle income (5.22, 4.76 to 5.73), and low income countries (4.76, 3.86 to 5.87).
Editor’s gender and geographical affiliation—Agreement to review was significantly lower if the editor was a woman (adjusted odds ratio 0.96, 0.93 to 0.99) (table 3). The editor’s geographical affiliation was associated with reviewer’s agreement (adjusted odds ratio 1.16, 1.03 to 1.30 for Oceania compared with Europe), but the income level of the editor’s country of affiliation was not associated with agreement (supplementary table C).
Journal impact factor and type of peer review process—Agreement to review was significantly associated with impact factor (higher agreement to review for journals with impact factors >10 compared with <5). The type of peer review process was also independently associated with agreement to review: lower for journals with open peer review compared with anonymised peer review (table 3,fig 2).
We confirmed similar findings when we used multiple imputation, except that the odds ratios for the associations with the reviewer’s geographical affiliation were slightly lower (supplementary table D).
Reviewers’ response to invitations by geographical affiliation and gender during and before the pandemic
The interaction between the reviewer’s gender and the time period and topic was not significant (P=0.08; supplementary table E). Women agreed to review less often than did men, with no difference across the time periods.
The interaction between the reviewer’s geographical affiliation and the time period and topic was significant (P=0.005; supplementary table F). Reviewers affiliated with Asia and Oceania agreed to review less often for covid-19 and non-covid-19 related manuscripts in the first and second phases of the pandemic compared with pre-pandemic. Reviewers affiliated to Africa agreed to review covid-19 related manuscripts in the first phase and the second phases of the pandemic more than in the pre-pandemic. Reviewers affiliated to South America agreed to review covid-19 and non-covid-19 related manuscripts less in the first phase of the pandemic compared with pre-pandemic.
Discussion
We found wide inequalities in the gender and geographical affiliation of researchers invited to peer review, and also in their response to the invitations. Similarly to other studies,81516 just over a third of all invited reviewers were women, but we also found that women were less likely to agree to review than men. Overall agreement to review fell as the pandemic unfolded, but gender inequalities did not widen. The vast majority of invited reviewers were affiliated to high income countries and, similarly to other studies, some regions were underrepresented in invitations to peer review despite being large contributors as last authors on the same cohort of submissions and having high review agreement rates.815 Factors associated with higher agreement to review were invitations to reviewers affiliated to upper middle income, lower middle income, or low income countries (compared with high income countries); invitations to reviewers affiliated to Africa, Asia, South America, or Oceania (compared with Europe); journals with higher impact factors (>10 compared with <5); and journals using an anonymised peer review process (compared with open). Factors associated with lower agreement to review were invitation to review sent during the pandemic (except for covid-19 related manuscripts during the first phase), reviewer being a woman, editor being a woman, last authors’ geographical affiliation (Africa, Asia, North America, or Oceania compared with Europe), and last authors’ country income level (low or lower middle income or upper middle income compared with high income).
Comparison with other studies
Previous works on publicly available datasets have also shown gender and geographical bias in peer review.717181920 Our dataset enabled us to look at both invitations and responses to these same invitations, and we found that women were not only less frequently invited to review but also agreed less often than men, compounding this gender inequality. Although some gender inequality in peer review activity has been reported in the early pandemic period,23 other studies found no difference in overall patterns of review activity and women’s peer review activity.153233 To the best of our knowledge, our study was the first to look at invitations and responses to invitations by gender in the later stages of the pandemic compared with pre-pandemic. We did not find a significant change in women’s agreement to review covid-19 or non-covid-19 related manuscripts in either pandemic time period compared with pre-pandemic. This is not in line with our previous study of women’s authorship in the same group of journals and other studies of reduced research productivity during the pandemic.3232425262728293031 We can only speculate that this might be because peer review is less onerous than other aspects of research productivity that were affected in the pandemic.
We found several factors that were associated with agreement to review at manuscript, journal, and reviewer level. We did not identify other studies exploring factors associated with agreement to review. However, our finding that reviewers with North American/European affiliations had lower rates of agreement compared with reviewers affiliated with Africa, Asia, South America, or Oceania has previously been reported.15 Reviewers also seem to be more motivated to agree to invitations from journals with high impact factors; others have found that review reports are longer and completed more quickly for journals with higher impact factors.8
Strengths and limitations of study
We included more than 100 000 submitted research manuscripts and 250 000 responses to peer review invitations from 21 biomedical journals in a range of specialties attracting submissions and worldwide reviewers. This unique dataset gave us the opportunity to explore some hypotheses on the factors associated with agreement to review and to include all review invitations (including those that were declined—the hidden part of the peer review process, which has been explored little until now). This is the first study to explore gender and geographical diversity in invitations to review and responses to these invitations and to consider factors associated with this agreement at several levels (journals, manuscripts, reviewers, and editors). We included all review invitations at multiple journals, whereas other studies have been limited to online peer review reports of published manuscripts, focused on a single journal, or used aggregated metadata.1415161718192023323335 We explored geographical diversity by using multivariable analyses with both geographical affiliation and the income level of the country, which increases the understanding of the identified associations. Other researchers have investigated geographical diversity, but they provided only a descriptive analysis.8 Undetermined reviewers’ and last authors’ genders had no effect on our results, as multiple imputation resulted in similar findings. Future studies should go one step further and investigate the role of ethnicity and seniority of reviewers and their association with the different steps of the peer review process.
Our study has some limitations. In the absence of self-identified data from authors and reviewers, we determined gender as binary by using software based on first name and country of affiliation. Although we found that open peer review was associated with lower agreement than anonymised review, most (87%) open review invitations were from one journal (BMJ Open) and we should be cautious in our interpretation of the generalisability of this result.
Policy implications
Lack of gender and geographical diversity in the peer review process has important implications. Involvement in peer review is important, as it not only exposes researchers to current and new research ideas but can also help with career progression through the development of writing and critical appraisal skills and foster relationships with other research networks.36 Non-inclusive practice in invitations to review thus has the potential to exacerbate existing gender and geographical bias. Relying on a narrow pool of reviewers may lead to the opinion of the most productive researchers being overrepresented.83738 Lack of diversity in peer review also has the potential to imbalance scientific knowledge with an underrepresentation of opinion from women and non-high income countries, which could impair global health policies delivered to implement research findings. Also, gender and geographical inequalities in peer review may deprive the scientific community of more innovative research,3940 as we already know that collaboration in gender diverse teams leads to more innovative and high impact scientific ideas.41 Bibliographic evidence also shows that papers with more ethnically diverse authorship teams generate more citations and can outperform teams made up of similar people.3942
Journals need to improve diversity when recruiting and inviting reviewers and monitor the success of their approaches across time to highlight barriers and propose new effective methods for improving inclusion. For example, a policy whereby underrepresented groups are oversampled to account for their lower level of agreement might be considered for reviewer invitations. Our finding that women were not only invited to review less often than men but also declined more often needs further attention. We need to better understand the reasons why women are less likely to agree to review to find ways to support them to become more active peer reviewers. The counter argument to this is that men might agree to review manuscripts more often than is appropriate. Men have been shown to be more confident; they more positively frame their own research findings,43 and they might approach invitations to review differently than women. Fixing the systems that support bias should be the focus.44 Academic institutions need to better support women involved in research to increase their overall productivity, which has been shown by others to have fallen in the pandemic, and avoid a backslide in gender equality.2445 More equal sharing out of pastoral and teaching roles that deprive women of time to commit to other scholarly activities,45 including peer review, could help to redress some of the imbalance.
Our finding that overall agreement was lower when the editor was a woman compared with a man is intriguing, and we need more data to understand, interpret, and make inferences from it. Studies have suggested that the inclusion of editors who are women and those from low and middle income countries may improve the representation of women and these regions in future authorship of publications.464748 Editors seem to invite reviewers with similar characteristics to their own in terms of gender, specialty, and geographical origin.8141749 Improving diversity among journal editors alone would not be sufficient to reduce inequalities in peer review, but it is a step forward.
Overall reduction in the agreement to peer review during the pandemic will have had an undesirable effect, but the widening of geographical inequalities during the pandemic is of particular concern, especially as reviewers from some underrepresented regions were more likely to accept invitations to review. Researchers from these regions were not given the opportunity to contribute to scientific debate as the pandemic unfolded, despite the fact that some of these regions were the most affected by the pandemic. Researchers from minority ethnic groups have also faced further challenges to academic work during the pandemic, and these need to be tackled.45 Editors can help to correct imbalances in reviewer invitations going forward, but this will not influence the identified bias of reviewers not agreeing to review manuscripts with last authors from underrepresented regions. These findings could be interpreted as a disinterest in research conducted in Asia and more globally for the research conducted in low and middle incomes countries. To overcome potential bias related to the name and/or affiliation of authors, journals might consider removing author information from the reviewer’s invitation email. However, anonymising reviewers is often not effective,11 and it could detract from moves towards greater transparency in peer review.
Conclusions
Calls for increased diversity and inclusion in editorial boards of journals have been issued,18424750 but they are not enough. Editors need to identify and implement effective peer review strategies and continually evaluate these over time to ensure that more women and researchers from middle income and low income countries are involved in peer review and that global opinion is better represented in research.
What is already known on this topic
Gender and geographical disparities have been reported in editorial processes, among editorial boards, and in key authorship positions of submitted and published biomedical research
Surveys and studies based on samples of published reviewers’ reports or reviewers’ names have shown lower participation of women and researchers from emerging countries
In the early pandemic period, gender inequalities widened for attainment of key authorship positions
What this study adds
Gender inequality among invitations to peer review is compounded by fewer women agreeing to peer review invitations, and this persisted during the pandemic
Reviewers with African, Asian and South American affiliations and those from low and middle income countries are underrepresented, even when they were more likely to agree to review
These geographical inequalities widened during the pandemic
Ethics statements
Ethical approval
This cohort study is ancillary to the ATHENA study, a broader research project funded by the SNSF, which is assessing whether gender bias exists during the editorial decision making process. The ATHENA project received ethical approval from the Institutional Review Board of the Geneva Canton on 16 April 2018 (2019-00540). All studies are being conducted under a confidentiality agreement between BMJ Publishing Group and the medical school of Geneva University represented by the Department of Health and Community Medicine.
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.
Acknowledgments
We thank the editors of the participating journals for giving us access to the data. We thank the Swiss Academy of Human and Social Sciences (ASSH) for their support for KBM’s participation at the 9th International Congress on Peer Review and Scientific Publication. We thank Cyril Jaksic and Christophe Combescure, at Division of Clinical Epidemiology, University Hospitals of Geneva, Switzerland, for their valuable help on R. We thank Christophe Charpilloz from SciCoS, University of Geneva, for his support in scientific computing.
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.
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