Authors of Clinical Practice Guidelines by Gender,Race,and Ethnicity: A Systematic Review and Meta-Analysis

Abstract

Importance:

Clinical practice guidelines (CPGs) play a critical role in shaping medical care and healthcare policies, yet there is growing concern about the lack of diversity in CPG authorship. This systematic review and meta-analysis aim to assess gender, race, and ethnicity representation among authors of CPGs across different medical specialties.

Objective:

To evaluate the representation of women and individuals from minoritized racial and ethnic groups among authors and contributors of CPGs.

Data Sources:

A comprehensive literature search was conducted in databases including Ovid MEDLINE, Embase.com, Web of Science, Cochrane CENTRAL, and ClinicalTrials.gov from inception to September 2023. Studies focusing on CPG authorship disparities by gender, race, and ethnicity were selected for review.

Study Selection:

Eligible studies included those that reported data on gender, racial, and ethnic composition among CPG authors. Out of 2,436 articles screened, 20 studies met the inclusion criteria for full-text review and meta-analysis.

Data Extraction and Synthesis:

Data extraction was performed independently by two reviewers, with disagreements resolved through consensus, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A meta-analysis was then conducted using a random-effects model.

Main Outcomes and Measures:

The primary outcome was the proportion of women and individuals from minoritized racial and ethnic groups among CPG authors. The meta-analysis estimated pooled proportions of women's authorship across the different medical specialties.

Results:

The 20 included studies covered a total of 36,783 author positions. Women's authorship varied widely across specialties, with an overall pooled proportion of 25.7% (95% Confidence Interval (CI): 21.8%–30.1%). Racial and ethnic data were available in only a few studies, with significant gaps in reporting. The findings indicate persistent gender disparities in CPG authorship, particularly in specialties such as cardiology and gastroenterology.

Conclusions:

This analysis demonstrated that substantial disparities in gender, race, and ethnicity remain in CPGs' authorship. More inclusive representation is essential to ensure diverse perspectives in shaping healthcare guidelines.