The favourable trend toward gender parity that has been seen within neurology faculty over the past decade “has not translated” to the leadership of stroke-related clinical trials, as per a recent analysis published in the journal Stroke.
“The results of our study show that gender disparity in the leadership of stroke-related clinical trials has persisted over the last decade with no favourable trend toward parity,” the authors—Sandeep Kumar (Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA) and colleagues—write.
“However, the proportion of women leading clinical trials funded by the NIH [National Institutes of Health] or other federal agencies has fared significantly better relative to the overall proportion of women PIs [principal investigators] of clinical trials registered on Clinicaltrials.gov.
“Our findings merit further investigation into this area and a re-examination of efforts, specifically toward inclusion of women as leaders of clinical trials in the field of stroke research.”
Kumar and colleagues begin by noting that, despite the fact that gender disparities among clinical trial PIs can have implications regarding the areas of investigation, methods, conduct, trial enrolment, and interpretation of results, an estimation of the gender gap in the leadership of stroke-related clinical trials from North America has not been undertaken to date.
To investigate this further, they extracted information about stroke-related clinical trials between 2011 and 2020 from Clinicaltrials.gov and PubMed, and examined gender distribution according to academic credentials and trial type. Further information was obtained from Association of American Medical Colleges and Accreditation Council for Graduate Medical Education data resource books on the gender composition of full-time neurology faculty, neurology residents and vascular neurology fellows.
Across 821 trials registered on Clinicaltrials.gov and 110 studies published on PubMed, Kumar and colleagues found that gender disparity among PIs, as well as first and last authors, have persisted over the past decade, “without any significant trend toward parity”.
On examining the gender distribution according to academic credentials, they found that men (78.1%) were “over-represented” in the subgroup of PIs with a medical degree, as compared to women (21.9%). A similar trend was seen regarding trial type, with a significantly greater proportion of acute stroke trials being led by men (86%) versus women (14%).
Discussing their findings, Kumar and colleagues reiterate the favourable trend seen in the proportion of women holding a full-time neurology faculty appointment in the USA over the past decade, and state that, “considering the expected time-lag between starting in a junior role to becoming a Pl, we expected to see a trend toward greater gender parity at least over the last five years”.
“Its absence may indicate persistent hurdles women face in leading clinical trials and/or publishing on their trial experience,” they add. “Further, our finding that the proportion of women holding an MD degree has been lower than the overall proportion of women leading clinical trials is suggestive of other systematic barriers that MD degree holders face when it comes to leading a clinical trial.
“These findings reveal some of the inadequacies of the pipeline theory, which postulates that recruiting a greater proportion of women in junior positions would automatically translate to a greater representation of women in leadership roles over time.
“However, our analysis also reveals that there has been a greater representation of women in leadership roles of NIH and federally funded clinical trials compared [to] all stroke-related clinical trials—regardless of funding status—registered in Clinicaltrials.gov. Additionally, our analysis also shows greater proportion of women among non-MD degree holders leading clinical trials, which is in line with the higher proportion of women in non-MD healthcare professions.”
The authors go on to state that, in spite of attempts to close the gender gap, “numerous barriers” remain for women in science, and their findings warrant “a more comprehensive, multifaceted and inclusive effort”. They also highlight the fact that the creation of flexible policies that cater to some of the disproportionate challenges women face—such as access to childcare support, allowing for re-entry and re-integration into the academic sphere; flexibility in promotion tracks; and efforts to retain women in academic leadership roles—may all hold value.
“Our findings warrant further investigation into this area and calls for efforts to improve gender diversity in the leadership of clinical trials,” Kumar and colleagues conclude.
