Abstract
IMPORTANCE: Underrepresentation of women and racial and ethnic minority individuals among reviewers and funded investigators in health research has been widely reported. It is unknown whether such underrepresentation exists in the Veterans Health Administration (VHA). OBJECTIVE: To describe gender and racial and ethnic makeup of VHA Health Services Research and Development (HSR&D) study sections and funding awardees and to explore the associations between gender and racial and ethnic makeup of study sections and awardees who were women and racial and ethnic minority individuals. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study at the VHA evaluated study section members and funding awardees from 5 review cycles from March 13, 2018, through March 6, 2020, identified via the HSR&D and National Institutes of Health websites. MAIN OUTCOMES AND MEASURES: Univariable and multivariable logistic regression models were used to determine the likelihood of an awardee being a woman or a racial or ethnic minority individual based on the gender and racial and ethnic makeup of study sections, respectively. Separate models were conducted for investigator-initiated research proposals only. RESULTS: Thirty-six study sections comprised 664 reviewers, including 381 women (57.4%) and 81 racial and ethnic minority individuals (12.2%). Of the 146 funded proposals, 77 (52.7%) were awarded to women and 25 (17.1%) to racial and ethnic minority investigators; 29 (19.9%) were reviewed by study sections with no racial and ethnic minority reviewers. The odds of a woman awardee were more than 5 times greater for proposals reviewed by study sections comprising the highest proportion of women (fourth quartile; >58.3%) than the lowest proportion of women (first quartile; ≤50.0%) (adjusted odds ratio [aOR], 5.24 [95% CI, 1.70-16.13]). Similarly, the odds of a racial or ethnic minority awardee were 3 times greater for proposals reviewed by study sections in the top 50th percentile for proportion of racial and ethnic minority individuals (>7.3%) than the bottom 50th percentile (aOR, 3.08 [95% CI, 1.18-8.09]). Secondary analyses limited to investigator-initiated research proposals identified similar associations. CONCLUSIONS AND RELEVANCE: In this cross-sectional study of VHA HSR&D-funded research, racial and ethnic minority individuals were underrepresented among investigators and reviewers. More women and racial and ethnic minority reviewers on study sections were associated with women and racial and ethnic minority individuals awarded funding.