Rates of Female Leadership of Phase 3 Dermatologic Clinical Trials
Increasing attention has been given to ensuring that women are represented in leadership roles within dermatology. Women make up roughly 50% of academic dermatology faculty in the USA but more frequently occupy junior positions (i.e., clinical instructor or assistant professor) than senior positions (including department chair).1,2 To further assess female leadership roles in academic dermatology, we examined the representation of women among corresponding authors for phase 3 clinical trials in dermatology, because this type of leadership affects career opportunities and prominence in the field. We analyzed trial-related factors associated with female corresponding authorship, as well as trends in the proportion of female-led phase 3 trials over time.
ClinicalTrials.gov was queried on March 4, 2019, using the following search strategy: term, “dermatology”; study type, “all studies”; status, excluded “not yet recruiting”; phase, “Phase 3”; and study results: “with results.” The resulting 210 trials were then screened for dermatological phase 3 studies with results published in the peer-reviewed literature. The earliest publication of a trial’s primary end point results served as the primary publication. Pearson’s chi-square tests were used to compare rates of female corresponding authorship by disease type, country, and region, and a weighted linear regression model was used to examine rates of female authorship over time (SPSS, Version 24).
Among the 210 studies identified, 34 were excluded for not being dermatology specific, 22 were excluded for not being phase 3, and 62 were excluded for lacking published results. Thus, 92 trials met inclusion criteria. These trials were initiated between 2004 and 2017. The overall rate of female corresponding authorship was 23.9% (22/92). Comparing lead female authorship by disease, there were more women leading trials studying malignancy/premalignancy (50.0%) and fewer women leading trials studying interventions in psoriasis (14.5%), acne (12.5%), and skin infections (14.3%; P = 0.04) (Table 1). The rate of female corresponding authorship was also correlated with the region of the world in which the lead author’s affiliated institution was located: 35.4% of American-based corresponding authors were women compared to 11.4% of non-American corresponding authors (P = 0.007) (Table 1). Finally, a weighted linear regression analysis by trial initiation year revealed an increasing rate in female corresponding authorship over time (P = 0.001, r = 0.33), with an estimated annual increase in female corresponding authorship of +2.5% (95% confidence interval, +1.0 to +4.0%). The average rate increased from 9.1% in the early years of our study (2004–2007) to 36.4% in the later years (2014–2017).
Table 1.
Factors associated with female corresponding authorship
| Trial/author characteristic | Female corresponding author/total |
P value | ||
|---|---|---|---|---|
| Number | Percentage | |||
| Disease type | Psoriasis | 7/48 | 14.5% | 0.04 |
| Malignancy/premalignancy | 4/8 | 50.0% | ||
| Acne | 1/8 | 12.5% | ||
| Atopic dermatitis | 2/7 | 28.6% | ||
| Infection | 1/7 | 14.3% | ||
| Othera | 7/14 | 50.0% | ||
| Country/world region of corresponding author | USA | 17/31 | 35.4% | 0.099 |
| Canada | 1/11 | 8.3% | ||
| Europe | 3/22 | 13.6% | ||
| Australia | 0/4 | 0.0% | ||
| Asia | 1/6 | 16.7% | ||
| USA | 17/31 | 35.4% | 0.007 | |
| Non-USA | 5/44 | 11.4% | ||
| Industry funding of trial | Yes | 21/91 | 23.1% | 0.07 |
| No | 1/1 | 100.0% | ||
Urticaria, alopecia, rosacea, hyperhidrosis, cosmetics, hemangioma, systemic sclerosis, wound care.
The gap between rates of lead female authors and total female academic dermatologists has narrowed over time.2,3 However, the overall rate of female authorship, though increasing, is still much lower than the proportion of academic dermatologists who are women (roughly 50%). Though this gender imbalance is evident in dermatology publications overall,4 it is especially pronounced in these high-impact phase 3 studies. The reason for this gender imbalance is likely multifactorial; unintended or overt bias, unequal pressures to carry out familial responsibilities, and lack of appropriate mentorship have all been suggested as possible contributory factors.5 Through demonstration of the continued gender imbalances in our field, we hope to spur the dermatological community to redouble efforts to better understand and address these issues.
—Walker Mainwaring, MD
Lankenau Medical Center, Wynnewood, Pennsylvania
—Ethan B. Ludmir, MD
The University of Texas MD Anderson Cancer Center
Houston, Texas
—Soo Jung Kim, MD, PhD
Baylor College of Medicine, Houston, Texas
soojung.kim@bcm.edu
References
- 1.Association of American Medical Colleges . The State of Women in Academic Medicine: The Pipeline and Pathways to Leadership, 2015–2016. Washington, DC: Association of American Medical Colleges ; 2015. https://www.aamc.org/download/481182/data/2015table3.pdf.
- 2.Shinohara M. The gender gap in dermatology: where are we now? Pract Dermatol. 2019. https://practicaldermatology.com/articles/2019-jan/the-gender-gap-in-dermatology-where-are-we-now.
- 3.Stratman H, Stratman EJ.. Assessment of percentage of women in the dermatology workforce presenting at American Academy of Dermatology annual meetings, 1992–2017. JAMA Dermatol. 2019;155:384–386. doi: 10.1001/jamadermatol.2018.5481. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Bendels MHK, Dietz MC, Brüggmann D, Oremek GM, Schöffel N, Groneberg DA.. Gender disparities in high-quality dermatology research: a descriptive bibliometric study on scientific authorships. BMJ Open. 2018;8:e020089. doi: 10.1136/bmjopen-2017-020089. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Holliday EB, Siker M, Chapman CH, et al. Achieving gender equity in the radiation oncology physician workforce. Adv Radiat Oncol. 2018;3:478–483. doi: 10.1016/j.adro.2018.09.003. [DOI] [PMC free article] [PubMed] [Google Scholar]