Female under-representation in sepsis studies: a bibliometric analysis of systematic reviews and guidelines

J Clin Epidemiol. 2020 Oct:126:26-36. doi: 10.1016/j.jclinepi.2020.06.014. Epub 2020 Jun 17.


Objectives: The objective of the study was to assess female representation in primary studies underpinning recommendations from clinical guidelines and systematic reviews for sepsis treatment in adults.

Study design and setting: We conducted a bibliometric study. We removed studies pertaining to sex-specific diseases and included quasirandomized, randomized clinical trials (RCTs), and observational studies. We analyzed the female participation-to-prevalence ratio (PPR).

Results: We included 277 studies published between 1973 and 2017. For the 246 studies for which sex data were available, the share of female participation was 40%. Females overall were under-represented relative to their share of the sepsis population (PPR 0.78). Disaggregated results were reported by sex in 57 studies. In univariate analyses, non-intensive care unit setting and consideration of other social health determinants were significantly associated with greater female participation (P < 0.001 and P = 0.023, respectively). In regression models, studies published in 1996 or later were likely to report sex, while RCTs were unlikely to do so (P = 0.019 and P < 0.001, respectively).

Conclusion: Our study points to female underenrollment in sepsis studies. Primary studies underpinning recommendations for sepsis have poorly reported their findings by sex.

Keywords: Clinical guidelines; Gender; Participation-to-prevalence ratio; Sepsis; Sex; Sex-related reporting; Systematic reviews.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bibliometrics*
  • Data Analysis
  • Female
  • Humans
  • Observational Studies as Topic / statistics & numerical data
  • Patient Participation / statistics & numerical data*
  • Patient Participation / trends
  • Patient Selection
  • Practice Guidelines as Topic
  • Publications / trends
  • Randomized Controlled Trials as Topic
  • Sepsis / epidemiology
  • Sepsis / therapy*
  • Sex Factors
  • Systematic Reviews as Topic
  • Women