Gender equity analysis of nontrainee hemostasis and thrombosis recognition award recipients

TO THE EDITOR:

Recognition award conferral advances academic careers^1-4 by influencing research funding, prestige, notoriety, academic promotion, connections, and financial compensation. Unfortunately, women continue to be underrepresented among award recipients,^4-8 including in hematology and oncology,⁷ and blood banking and transfusion medicine.⁸ Although informative for the respective specialties, prior studies assessing inequities in hematology and transfusion medicine did not specifically address awards dedicated to hemostasis and thrombosis, which cross numerous medical fields, including hematology and oncology, blood banking and transfusion medicine, cardiology, cardiovascular surgery, and anesthesiology, as well as basic sciences such as physiology and pharmacology. Therefore, we sought to evaluate whether gender inequities exist among hemostasis and thrombosis recognition awards and whether there has been any change over time.

We examined recipients of 22 hemostasis and thrombosis awards (Table 1) from 4 societies (1972-2021): (1) ISTH, (2) HTRS, (3) American Heart Association’s Council on ATVB, and (4) THSNA. Detailed membership data (eg, sex, gender, race, ethnicity, sexual orientation, terminal/professional degree, etc) were unavailable.

We stratified awards by their availability to trainees, and excluded awards for trainees because: (1) trainee gender is often unable to be determined owing to the lack of available online biographies or faculty profiles, resulting in a significant amount of missing data, and (2) to reduce confounding and biasing of the data by the identity of the trainee’s mentor(s) and/or recommender(s). All awards from THSNA were available to trainees and therefore excluded from the analysis. We excluded awards given for best papers, as contributions from the award recipient and coauthors could not be assessed. Award recipient’s gender was determined independently by 2 authors using previously described methods,^1,4-7,9,10 via online review of pronouns in 3 categories (he/she/they). If unavailable, an individual’s photograph and name (17 individuals) or a web-based gender identification application¹¹ were utilized (4 individuals).

The perceived gender of award recipients overall and predefined subgroup analyses for physician (ie, MD/DO/MBBS degree) award recipients and award categories (achievement, research/innovation, leadership, service, named lectureship) were performed. Temporal analysis of award conferral rates was performed (1972-1989; 1990-1999; 2000-2009; 2010-2021). Notably, the award year for 25 individuals who received an ISTH award was unavailable. Descriptive statistical analyses were conducted using GraphPad PRISM version 9.2.0 (GraphPad Software, LLC San Diego, CA, USA). 95% confidence intervals (CI) were calculated for all analyses. A P value <.05 was considered significant.

Twenty-two recognition awards have been presented 565 times to 398 unique individuals since 1972 (Table 2). Of these, 17 are exclusive to nontrainees.

A total of 460 awards have been presented to 302 nontrainees (physicians and nonphysicians combined). Of these, significantly more have been conferred to men compared with women (391/460, 85.0%; 95% CI, 81.4-88.0 vs 69/460, 15.0%; 95% CI, 12.0-18.6; P < .001). Among the 302 unique award recipients, significantly more men received an award compared with women (249/302, 82.5%; 95% CI, 77.7-86.3 vs 53/302, 17.5%; 95% CI, 13.7-22.3; P < .001). A total of 89 unique individuals have received more than 1 award, 88.8% (79/89; 95% CI, 80.4-94.0) of whom have been men, significantly more than multiple award-winning women (10/89, 11.2%; 95% CI, 6.0-19.6; P < .001). Among awards conferred to physicians, a greater proportion of men (160/188, 85.1%; 95% CI, 79.3-89.5) received awards compared with women (28/188, 14.9%; 95% CI, 10.5-20.7; P < .001). Similarly, among awards conferred to nonphysicians, a greater proportion of men (89/114, 78.1%; 95% CI, 69.6-84.7) received awards compared with women (25/114, 21.9%; 95% CI, 15.3-30.4; P < .001).

Among all award recipients, significantly more men have received awards for achievement (172/210, 81.9%; 95% CI, 76.1-86.6 vs 38/210, 18.1%; 95% CI, 13.5-23.9; P < .001), research/innovation (113/126, 89.7%; 95% CI, 83.0-94.0 vs 13/126, 10.3%; 95% CI, 6.0-17.0; P < .001), leadership (20/25, 80.0%; 95% CI, 60.4-91.6 vs 5/25, 20.0%; 95% CI, 8.4-39.6; P = .005), and named lectureships (79/88, 89.8%; 95% CI, 81.5-94.7 vs 9/88, 10.2%; 95% CI, 5.3-18.5; P < .001), whereas a similar proportion of men and women have received awards for service (7/11, 63.6%; 95% CI, 35.2-85.0 vs 4/11, 36.3%; 95% CI, 15.0-64.8; P = .545) (Table 2).

Among all award recipients, significantly more men than women have received awards from the ISTH (316/357, 88.5%; 95% CI, 84.8-91.5 vs 41/357, 11.5%; 95% CI, 8.6-15.2; P < .001) and the ATVB (60/81, 74.1%; 95% CI, 63.5-82.4 vs 21/81, 25.9%; 95% CI, 17.6-36.5; P < .001), whereas there was no significant difference in HTRS (15/22, 68.2%; 95% CI, 47.2-83.8 vs 7/22, 31.8%; 95% CI, 16.2-52.9; P = .088) award recipients’ gender (Table 2). All analyzed awards from THSNA were available to trainees.

The most recent decade of awards (2011-2021) saw a significant increase in the proportion of women award recipients compared with the 4 previous decades (29/131, 22.1%; 95% CI, 15.8-30.0 vs 33/304, 10.9%; 95% CI, 7.8-14.9; P = .001), and the proportion of women award recipients has steadily increased since the 1970s (Table 1). However, despite this increase, women remain significantly underrepresented among award recipients, even in the most recent decade. Notably, the award year for 25 award recipients from the ISTH (20 men, 5 women) was not available.

Women have been underrepresented among hemostasis and thrombosis recognition award recipients, receiving only 15% of the 460 nontrainee awards since 1972. Although a lack of candidates has been suggested to contribute to gender discrepancies within awards, one-third of US hematology providers are women,¹² and over 60% of Canadian hematologists are women.¹³ Moreover, since 2010, over 50% of all life science doctoral degrees¹⁴ and slightly more than one-third of all National Institutes of Health (NIH) grants have been awarded to women.¹⁵ These data suggest that low numbers of awardees within hemostasis and thrombosis likely stand in contrast to the increasing number of women within the academic pipeline, as women have comprised only 22% of recognition award recipients in the last decade, despite the increasing prominence of diversity, equity, and inclusion research publications and initiatives to promote women in hemostasis and thrombosis.^16-19 

Women were underrepresented among research/innovation and named lectureship awards but not among service awards. These findings are consistent with the literature demonstrating that women are often excluded from research awards and instead are more likely to receive service or humanistic awards.^2,7,8 Furthermore, of the 11 eponymous awards analyzed in this study, 7 are named after men, with no research or achievement award named after a woman. These results recapitulate recent study findings demonstrating women are more likely to win awards not named after men.²⁰ Nevertheless, given recent diversity, equity, and inclusion advocacy efforts,^16-19 we are encouraged by our findings that, although still underrepresented, the proportion of women recognition award recipients increased significantly over the last decade compared with the previous 4 decades.

This study is not designed to assess all variables that may influence award recipient choice or determine causality. Instead, we simply highlight gender disparities among recognition award recipients in broad fields of study encompassing multiple basic science and medical subspecialties.

To elucidate the underlying contributors to these disparities and advance equity, we suggest the award nomination process must be transparent. Specifically, we propose that the criteria for both recognition award recipients and selection committee members be publicly available. As the demographics of the nomination and selection committees are currently unavailable, our ability to ensure these committees themselves are diverse, equitable, and representative of the individuals in the field is inhibited.

We acknowledge limitations to this study, particularly regarding the lack of availability of both society membership data and award nomination data, which precludes evaluation as to whether women are being nominated at equitable rates and how this might influence the number and proportion of women award recipients. If women are not nominated for these awards, then they will be underrepresented among award recipients. Therefore, we believe that anonymized membership and nomination demographics should be made public to ensure organizations are both nominating and selecting individuals at equitable rates. We also acknowledge that we assessed award recipients’ perceived gender, which may not necessarily correlate with an individual’s true gender identity. Furthermore, we recognize that gender is a spectrum and is one of many social categories that contribute to diversity. Finally, additional study limitations include the frequent absence of award recognition criteria, exclusion of trainee awards and the finding that not all years of awards were available for analysis.

This study illustrates the presence of gender inequities among hemostasis and thrombosis award recipients. Although improvements have occurred in the last decade, further work is required to address this issue. We call on researchers and professional societies to engage in discussions and work to ensure equity among individuals based on, but not limited to, gender, race, ethnicity, and sexual orientation.

Acknowledgment: No funding was received for this research.

Contribution: J.W.J. designed the manuscript, analyzed the data, performed statistical analysis, drafted the manuscript, and approved the final version; B.D.A. drafted the manuscript, interpreted the data, revised the manuscript, and approved the final version; A.P.W. interpreted the data, revised the manuscript, and approved the final version; J.C.Y. interpreted the data, revised the manuscript, and approved the final version; and G.S.B. analyzed the data, revised the manuscript, supervised the project, and approved the final version for submission.

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Correspondence: Jeremy W. Jacobs, 55 Park St, New Haven, CT 06511; e-mail: Jeremy.jacobs@yale.edu.