Abstract
This cross-sectional study evaluates prominent journals’ sex and gender reporting guidelines.
Introduction
The National Academies of Sciences, Engineering, and Medicine recently emphasized the importance of collecting sex and gender data in research, and avoiding conflation of these variables.1 Sex is defined as a biological attribute encompassing chromosomes and reproductive anatomy; gender refers to sociocultural roles and behaviors associated with one’s perception of themselves, including psychological, emotional, and behavioral identity.1,2 For accurate, equitable, and inclusive biomedical research, researchers must understand and distinguish between sex and gender to ensure the intended demographic is studied and reported, as these intricately linked variables uniquely influence health and disease.3,4 We evaluated prominent journals’ sex and gender reporting guidelines.
Methods
Ethics committee approval was not required as all data are publicly available. Cross-sectional analysis adhering to the STROBE guidelines of the 20 journals with the highest 2020 impact factor (IF)5 for each of the 10 largest US medical specialties6 (eTable 1 in the Supplement) was performed to determine if journals: (1) have a sex and/or gender reporting policy; (2) distinguish between or define sex and gender; (3) require researchers to report their methods for determining sex and/or gender; and (4) require collection of both sex and gender.
All-time journal citations, journal founding date, and perceived gender (via online pronouns [he/she/they] or photographs if unavailable) of journal editor-in-chief (EIC) (April 1, 2022) were collected. Two-sided P < .05 was considered statistically significant. Statistical analysis was performed using GraphPad PRISM version 9.2.0 (GraphPad Software). Additional methodological details including statistical analysis are available in eTable 2 in the Supplement.
Results
Author guidelines for 190 journals were analyzed (Table 1).6 Ten journals are among the top 20 for 2 different specialties. Among these 190 journals, 65 (34%) state a policy for reporting sex and/or gender in their author guidelines; 46 (24%) explicitly distinguish between or define the terms gender and sex; 31 (16%) recommend or require researchers to report their methods for determining sex and gender; and 3 (2%) require researchers to report both sex and gender demographics.
Table 1. Characteristics of Analyzed Medical Specialties and Associated Journals.
| Specialty | Total active physicians 2019a | Total EIC positions | Total women EIC, No. (%) | Mean (SD) | |
|---|---|---|---|---|---|
| 2020 IFb | Journal age, y | ||||
| General medicine/internal medicine | 120 171 | 21 | 8 (38.1) | 24.8 (25.6) | 86.2 (72.0) |
| Pediatrics | 60 618 | 22 | 5 (22.7) | 5.7 (3.2) | 48.8 (30.7) |
| Emergency medicine | 45 202 | 22 | 1 (4.5) | 3.2 (1.2) | 30.5 (13.4) |
| Obstetrics and gynecology | 42 720 | 22 | 4 (18.2) | 5.7 (2.8) | 51.9 (35.7) |
| Anesthesiology | 42 267 | 21 | 0 (0) | 5.0 (2.1) | 49.2 (29.8) |
| Psychiatry | 38 792 | 21 | 3 (14.3) | 13.4 (10.2) | 53.3 (47.5) |
| Radiology | 28 025 | 27 | 5 (18.5) | 7.9 (2.3) | 35.9 (20.3) |
| Surgery | 25 564 | 21 | 3 (14.3) | 7.7 (2.6) | 58.8 (43.9) |
| Cardiology | 22 521 | 20 | 2 (10) | 14.9 (8.0) | 32.8 (24.4) |
| Ophthalmology | 19 312 | 23 | 2 (8.7) | 5.7 (4.2) | 61.4 (49.8) |
| Totalc | 445 192 | 209 | 31 (14.8) | 9.5 (11.3) | 51.6 (42.8) |
Among the 10 specialties, obstetrics and gynecology had the largest percentage of top journals with a sex and gender reporting policy (65% [13 of 20]), while ophthalmology had the smallest (25% [5 of 20]). One specialty (general medicine/internal medicine: 45%) had greater than 20% of journals that instructed researchers to report their methods for determining sex and gender in studies.
There was no significant difference in mean IF, mean journal age, or EIC perceived gender between journals that have a sex and/or gender reporting policy and those that do not (Table 2). Similarly, there was no difference in journal IF, mean journal age, or EIC perceived gender and the presence of sex and gender definitions in author guidelines. Conversely, journals that require reporting of methods used to determine sex and/or gender have a significantly higher IF (15.7 [95% CI, 9.5-21.9] vs 8.3 [95% CI, 6.9-9.7]) and a significantly greater proportion of EIC positions held by women (29.4% [95% CI, 16.7%-46.3%] vs 12.0% [95% CI, 7.9%-17.7%]; P = .02) than those that do not require methods reporting.
Table 2. Association Between Sex and Gender Reporting Policies and Journal Characteristics.
| Criteria | Stated sex and/or gender reporting policy | Distinguish between or define sex and gender | Require reporting of methods used to determine sex and/or gender | Require collection of both sex and gender | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Yesa | No | Mean difference (95% CI) | Yesa | No | Mean difference (95% CI) | Yesa | No | Mean difference (95% CI) | Yesa | No | Mean difference (95% CI) | |
| 2020 IF,b mean (SD) | 10.8 (13.1) | 8.8 (10.3) | 2.0 (−1.4 to 5.5) | 12.1 (15.4) | 8.7 (9.6) | 3.4 (−0.4 to 7.2) | 15.7 (17.7) | 8.3 (9.2) | 7.4 (3.1 to 11.7) | 15.7 (12.4) | 9.4 (11.3) | 6.3 (−6.7 to 19.3) |
| Journal age, mean (SD), y | 50.5 (46.1) | 52.2 (41.2) | 1.7 (−11.3 to 14.7) | 46.6 (46.8) | 53.3 (41.5) | 6.7 (−7.6 to 21.0 | 47.6 (51.8) | 52.4 (41.0) | 4.8 (−11.8 to 21.4) | 32.3 (8.4) | 52.0 (43.1) | 19.7 (−29.5 to 68.9) |
| Women EIC, No./No. (%) | 15/70 (21.4) | 16/139 (11.5) | P = .07 | 11/50 (22) | 20/159 (12.6) | P = .11 | 10/34 (29.4) | 21/175 (12) | P = .02 | 1/3 (33.3) | 30/206 (14.6) | P = .38 |
Abbreviations: EIC, editor-in-chief; IF, impact factor.
Includes journals that have an external link to a policy.
Data from Journal Citation Reports.5
Discussion
There is a paucity of policies outlining appropriate collection and reporting of sex and gender variables, even among the most influential biomedical journals. Despite guidance from organizations that explicitly defines and differentiates these demographics,2 few journals distinguish between them, and even fewer recommend or require authors to report their methods for determining sex and gender.
This study’s limitations included the inability to account for the entirety of the gender spectrum. Although researchers must be held accountable for appropriate study design and reporting of sex and gender variables, one cannot assume unequivocal adherence to expectations when journals themselves do not have best practice guidelines for study design and reporting. Without these, future research risks inaccurate results, reduced applicability, and exclusion of groups of historically marginalized individuals from research.
eTable 1. Journals Analyzed in the Included Research Study
eTable 2. Methodological Details for Variable Analysis of Journals
References
- 1.National Academies of Sciences, Engineering, and Medicine 2022. Measuring Sex, Gender Identity, and Sexual Orientation. Washington, DC: The National Academies Press. doi: 10.17226/26424 [DOI] [PubMed]
- 2.Advancing Health Equity . A guide to language, narrative and concepts. Accessed April 5, 2022. https://www.ama-assn.org/system/files/ama-aamc-equity-guide.pdf
- 3.Clayton JA, Tannenbaum C. Reporting sex, gender, or both in clinical research? JAMA. 2016;316(18):1863-1864. doi: 10.1001/jama.2016.16405 [DOI] [PubMed] [Google Scholar]
- 4.Jacobs JW, Gisriel SD, Bouza SJ, Adkins BD. Sex and gender reporting in high impact haematology journals. Lancet Haematol. 2022;9(6):e392-e394. doi: 10.1016/S2352-3026(22)00114-4 [DOI] [PubMed] [Google Scholar]
- 5.Journal Citation Reports, Clarivate Analytics. Journal impact factor—journal citation reports. Accessed March 31, 2022. https://clarivate.com/webofsciencegroup/solutions/journal-citation-reports/
- 6.AAMC. Physician specialty data report. active physicians in the largest specialties, 2019. Accessed March 31, 2022. https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-largest-specialties-2019
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
eTable 1. Journals Analyzed in the Included Research Study
eTable 2. Methodological Details for Variable Analysis of Journals
