Elsevier

Surgery

Volume 156, Issue 3, September 2014, Pages 508-516
Surgery

Special Report
Sex bias exists in basic science and translational surgical research

https://doi.org/10.1016/j.surg.2014.07.001Get rights and content

Background

Although the Revitalization Act was passed in 1993 to increase enrollment of women in clinical trials, there has been little focus on sex disparity in basic and translational research. We hypothesize that sex bias exists in surgical biomedical research.

Methods

Manuscripts from Annals of Surgery, American Journal of Surgery, JAMA Surgery, Journal of Surgical Research, and Surgery from 2011 to 2012 were reviewed. Data abstracted included study type, sex of the animal or cell studied, location, and presence of sex-based reporting of data.

Results

Of 2,347 articles reviewed, 618 included animals and/or cells. For animal research, 22% of the publications did not specify the sex of the animals. Of the reports that did specify the sex, 80% of publications included only males, 17% only females, and 3% both sexes. A greater disparity existed in the number of animals studied: 16,152 (84%) male and 3,173 (16%) female (P < .0001). For cell research, 76% of the publications did not specify the sex. Of the papers that did specify the sex, 71% of publications included only males, 21% only females, and 7% both sexes. Only 7 (1%) studies reported sex-based results. For publications on female-prevalent diseases, 44% did not report the sex studied. Of those reports that specified the sex, only 12% studied female animals. More international than national (ie, United States) publications studied only males (85% vs 71%, P = .004), whereas more national publications did not specify the sex (47% vs 20%, P < .0001). A subanalysis of a single journal showed that across three decades, the number of male-only studies and usage of male animals has become more disparate over time.

Conclusion

Sex bias, be it overt, inadvertent, situational, financial, or ignorant, exists in surgical biomedical research. Because biomedical research serves as the foundation for subsequent clinical research and medical decision-making, it is imperative that this disparity be addressed because conclusions derived from such studies may be specific to only one sex.

Section snippets

Data abstraction

All original manuscripts published in the Annals of Surgery, American Journal of Surgery, JAMA Surgery, Journal of Surgical Research, and Surgery from January 1, 2011, to December 31, 2012, were reviewed for inclusion in this study by three abstractors. These journals were selected because of their relevance to the field of surgery. Letters to the Editor, review articles, editorials, and historic manuscripts were excluded. Data from the text, figures, and tables were reviewed for each

Sex disparity exists in biomedical surgical research

A total of 2,347 publications were reviewed from all five surgery journals during the years of 2011 and 2012. Of these, 618 (26%) publications reported the use of animals and/or cells (Fig 1). Of the 618 publications that used animals and/or cells, 199 (32%) publications did not specify the sex of the animals or cells. Of those publications that did specify the sex, 333 (80%) publications studied only males, 71 (17%) only females, and 13 (3%) both sexes (P < .0001).

Publications reporting the use of animals

Of the 618 publications, 531

Discussion

Our study is the first, to our knowledge, to examine the presence of sex bias in basic science and translational research in the surgical arena. The results of our study show that one-third of all publications using animals and cells did not specify the sex studied, and when stated, 80% studied only males. For research on animals, 22% of the publications did not report the sex of the animal; when reported, 80% of the publications studied only males. For research on cells, 76% of the

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