2025/01/28 by Rose Mary Attieh, Karima Wehbe, Wafaa Khaled +5 · 1 voice
Medicine · Social Sciences · #Diversity and Career in Medicine #Health and Medical Research Impacts #Medical Education and Admissions
paper · doi:10.1093/ckj/sfaf019
openalex publication_date 2025/01/28 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/28
To the Editor, Gender inequity remains deeply rooted within the academic medical community, marked by significant female underrepresentation [1, 2]. In the field of nephrology in particular, several organizations worldwide have been founded with the goal of bolstering career development opportunities for women [3]. However, whether these efforts have effectively narrowed the gender gap remains uncertain. We aimed to assess the current state of research leadership among women within nephrology subspecialties by examining vital benchmarks such as authorship of original investigations and the acquisition of extramural funding. Abstracts accepted for oral presentation at the American Society of Nephrology (ASN) Kidney Week meetings 2017–2020 (n = 1401) were reviewed to capture impactful nephrology research. A subset focusing on the subspecialties of glomerular diseases (GN), transplant, and onconephrology was selected (n = 336). These subspecialties were chosen due to their novel nature and the significant amount of growth and cutting-edge research they have witnessed over the past decade, with numerous academic medical centers striving to enhance their expertise in these areas. The gender of the first and the last author was recorded. Abstracts were divided into two groups based on whether either the first or last author (FLA) was female, or whether both authors were male. Public databases were interrogated to find corresponding articles and the number of citations per article was analyzed for academic influence. In addition, we explored gender disparities in the size of National Institutes of Health (NIH) funding for nephrology (2017–2020) using Principal Investigator (PI) database records across the 40 top-funded academic hospitals. Gender was implied by physical appearance from institutional or social media pictures, names, and pronouns. Detailed methods are available in Supplementary Material S1. Most oral abstracts covered GN topics (57.1%), followed by transplant (36.9%) and onconephrology (6%). Most were authored in North America (53.4%), with Europe in second place (25%). 170 abstracts (50.6%) fell in the “male-only FLA” group and 166 abstracts (49.4%) fell in the “at least one female FLA” group. Slightly more of abstracts in the latter group (51.8%) had female first authors but not last authors (Supplementary Table S2). 75.9% of abstracts (n = 129) with male-only FLAs had corresponding published articles, out of which 89.1% (n = 115) retained male-only FLAs on the full manuscript. Conversely, abstracts with at least one female FLA exhibited a higher overall publication rate of 84.9% (n = 140), out of which 91.4% (n = 128) retained at least one female FLA on the full manuscript. The chi-squared contingency test therefore showed a very strong correlation between the FLA gender groups on the abstract and the article (P < .001). We found no significant inter-group difference in any of the following: the average number of abstracts having corresponding articles with FLA of the same gender group (P = .32), average number of abstracts having corresponding articles with FLAs of the opposite gender group (P = .85), and average number of abstracts that did not result in a full manuscript (P = 0.35). The difference between FLA gender groups remained insignificant when abstracts were stratified by sub-specialty (Supplementary Table S3). Importantly, females were first authors in only 50% of the articles falling in the “at least one female FLA” group and last authors in the remaining 50% of cases. There was no difference in the median number of citations per article between the two FLA gender groups [95% confidence interval (CI) (−5;5); P = .97], even when stratified by specialty, geographic location, or year (Table 1). Differences in median number of citations per article between FLA gender groups. Hodges–Lehmann method (a negative difference indicates that the group with at least one female FLA received fewer citations than the male-only FLA group). Mann–Whitney two-sided test. Between 2017 and 2020, the NIH awarded 1472 new grants for research on kidney disease. Among these, 776 grants (52.7%) were allocated to just 40 academic medical centers (Supplementary Material S4). Across these 40 institutions, 475 (61.2%) grants were awarded to male PIs totaling US|$|193 787 257 in funds, while 301 grants (38.8%) were awarded to female PIs, totaling US|$|108 102 109 (Table 2). The disparity in NIH funding size between female and male PIs across all grant types was statistically significant, in favor of male PIs [95% CI: (−89 812; −24 258); P < .001]. However, this disparity was not seen across the 10 most frequently awarded grant types (P > .05 for all). Gender differences in National Institute of Health new grant allocations to PIs for research on kidney disease from 2017 to 2020. Only the 40 highest-funded academic medical centers are considered. Hodges–Lehmann method (a negative median value indicates that women were allocated less funding compared to men). Mann–Whitney two-sided test. Our work is the first to show that male and female researchers in nephrology now exhibit relatively comparable academic performance and influence in terms of publications and citations. These results are encouraging, especially considering the known workforce imbalance favoring males within the field of nephrology in the USA. Furthermore, our research shows that women are last authors on ∼50% of manuscripts when there is “at least one female FLA,” suggesting that they are increasingly assuming the role of senior mentor rather than remaining in the mentee role. This finding is particularly positive given that statistics by the Association of American Medical Colleges clearly indicate that women in medicine are less likely to be promoted to associate or full professor [2]. By contrast, previous studies have shown increased female representation only in first authorship in high-ranking nephrology journals [4] without achieving equity in randomized controlled trials in nephrology [5, 6]. On the other hand, our findings demonstrate persistent imbalances in the size of NIH funding, consistent with previous studies [7]. Addressing disparities in funding allocation based on gender is crucial, as they can exacerbate attrition rates and perpetuate a vicious cycle of inequities in research opportunities and resources. Our research faced several limitations. First, it relies on social perception of gender, rather than self-reported gender, although the two can be different. Additionally, despite best efforts in cohort selection, inherent biases remain as only research presented at ASN was considered, with only three subspecialties included and a limited number of years covered. Therefore, the results may not be generalizable to the entire nephrology community. Other limitations include possible unmeasured confounding factors such as including non-nephrologist authors, missing nephrology grants that are not under the spending category of “kidney disease,” and the absence of information on grant applications that were submitted and rejected. R.M.A. and K.D.J. designed and orchestrated the study. K.W., W.K., D.J., H.M.M., S.B., and K.M. helped and collected all data. R.M.A. wrote first draft and all authors edited the final version. This work was supported by the Li-Li Hsiao Fellow grant awarded by Women in Nephrology to Rose Mary Attieh. R.M.A. is the Galdi fellow in Glomerular Diseases and Onconephrology at Northwell with grant support from Greg and Linda Galdi. K.D.J. reports consultancy agreements with PMV Pharmaceuticals, Secretrome, George Clinicals, Calliditas, Otsuka Pharmaceuticals; reports honoraria from the American Society of Nephrology and Lexicomp; is a paid contributor to UpToDate.com; and is section editor for Onconephrology for Nephrology Dialysis Transplantation; serves on the editorial boards of American Journal of Kidney Diseases, Clinical Journal of the American Society of Nephrology, Clinical Kidney Journal, Frontiers in Nephrology, Journal of Onco-Nephrology, and Kidney International; and serves as the Editor-in-Chief of ASN Kidney News. None of the other authors have anything else to disclose.