Abstract
IMPORTANCE: Women are under-represented in senior roles within academic medicine, including as authors in high-impact journals. OBJECTIVE: To examine trends and predictors of female authorship in the Canadian Medical Association Journal (CMAJ) as the only high-impact Canadian journal over a 10-year period to understand gender balances in Canadian academic publishing. DESIGN: This cross-sectional study analysed trends and predictors of female authorship in articles published in CMAJ from 1 January 2013 to 31 December 2023. SETTING: Data were extracted from PubMed for CMAJ, the only high-impact Canadian medical journal (impact factor ≥10). Data extraction used the RISmed package in R Studio. PARTICIPANTS: The study included articles published in CMAJ within the specified period. Author gender was predicted using the validated Genderize.io software. Articles where the gender of the authors could not be predicted were excluded from analysis. MAIN OUTCOMES AND MEASURES: The co-primary outcomes were proportions of female first and last authors. Statistical analyses included χ(2) tests comparing proportions, Jonckheere and linear regression models to evaluate trends. Among multiauthor articles, multivariable logistic regression models assessed predictors of female first and last authorship. RESULTS: From 5805 included articles, women comprised 47% of first authors and 43% of last authors (p<0.001), both significantly lower than men (p<0.001). Female first authorship increased by 17.7% and female last authorship by 10.5% over the study period (both p<0.05 for trend), reaching a majority (58%) and near parity (48%) in 2023, respectively. Female editor-in-chief and higher proportion of female coauthors were associated with higher odds of female first and last authors; female last authors were additionally associated with higher odds of female first authors. INTERPRETATION: Women were under-represented in authorship overall, though female first and last authorship increased over time, with first authorship exceeding parity in recent years and last authorship nearing equal representation. Female editors-in-chief and a higher proportion of female coauthors were associated with greater female first and last authorship, while female last authorship was additionally associated with higher odds of female first authorship. These findings provide insight into authorship trends in a high-impact Canadian medical journal and may inform future efforts to support gender equity in academic publishing.