Leadership of stroke-related clinical trials still is weighted more heavily toward men, despite women making gains in neurology faculty over the last decade, new study results show.
Bharat Rawlley, MBBS, of the State University of New York Upstate Medical University, Syracuse, and colleagues, reported these findings in a manuscript published Monday online and in a special issue of Stroke focused on cerebrovascular diseases in women, published in conjunction with the American Heart Association’s Go Red for Women initiative.
Studies show differences in stroke rate and consequences between men and women, and both sex and gender can influence clinical treatment of stroke. While efforts have been made to recruit more female patients into clinical trials, the presence of a gender cap in stroke-related clinical trial leadership in North America had not previously been reported.
The authors, therefore, examined gender disparity in stroke-related clinical trial leadership from 2011 to 2020 by analyzing the gender of trial principal investigators and authors.
Rawlley and colleagues analyzed 821 clinical trials registered on ClinicalTrials.gov and 110 published on PubMed. Their analysis showed that the gender disparity among principal investigators and first and last authors of manuscripts was maintained throughout the 2010s and that there was not a significant trend toward parity.
Men were overrepresented among principal investigators (78.11% vs. 21.87%; p<0.01) as well as leaders of trials studying acute stroke (86.04% vs. 13.89%; p<0.01). The study also showed that a lower proportion of female neurology residents pursued vascular neurology fellowships during the decade (33.5% vs. 42.5%; p<0.05). This was despite the percentage of women in neurology faculty rising from 34.6% in 2011 to 42.56% in 2020.
The authors noted that the persistent gender gap in clinical trial leadership is “not exclusive to the stroke field and represents broader, interacting, and social cultural factors that have been barriers against women in science,” which were reported by the National Academies of Science, Engineering, and Medicine in 2007.
Despite this, Rawlley and colleagues noted that the proportion of women leading stroke-related clinical trials that were funded by the National Institutes of Health or other federal agencies fared better than that of overall stroke-related trials, which they said, “is likely reflective of the initiatives taken towards supporting the advancement of women faculty and increasing their academic productivity.”
The authors said their findings show “a more comprehensive, multifaceted and inclusive effort” to increase access to funding for women and underrepresented minorities is warranted. Such an effort should include 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 that it should be supplemented by mentorship, additional training “and identifying diverse candidates when opportunities for promotion and speaking engagements arise,” Rawlley and colleagues wrote.
Rawlley B, Marchina S, Cappucci SP, et al. Investigation on Gender Differences in Leadership of Stroke-Related Clinical Trials. Stroke 2023 Jan 23. (Article in press)
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