Résumé
Studies have shown an underrepresentation of women in critical care research, but little is known about trends over time. Objectives: this study aimed to investigate the evolution and the independent factors associated with the proportion of women in the authorship of high-impact critical care randomized controlled trials (RCTs) over 25 years. Methods: this meta-epidemiological study screened adult critical care RCTs published between 1999 and 2023 in the six highest-impact general and critical care journals. Sex was assessed with the combination of authors’ biographies, available photographs, the gender R package, and a native Chinese speaker’s assistance. The primary outcome was the proportion of women in the authors. Unadjusted and adjusted generalized linear mixed models were performed. Measurements and main results: of 1,203 RCTs, the sex of all authors was determined in 1,199 (99.7%). Overall, 4,335 out of 16,057 authors (27%) were women. Women were less frequently first (247/1,199 [21%], p<0.001) or senior authors (174/1,199 [15%], p<0.001) than at other positions. The proportion of women among authors increased by a change rate of 0.7% per year ([0.5%-0.9%]) from 18% in 1999 to 32% in 2023. In multivariate analysis, the proportion of women increased significantly with the year of publication and the sample size, and decreased significantly in European RCTs, ventilation as topic, mortality as primary outcome, and with endorsement by a study group. Conclusions: although the proportion of women in authorship has risen over 25 years, women are still widely underrepresented in the authors of high-impact RCTs, especially as first and senior authors.