Evaluation of Sex Specific Representation and Sex Disaggregated Reporting in European Society for Vascular Surgery 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms.

Abstract

Objective: To evaluate the extent to which women are reported and represented within evidence supporting best practice recommendations for abdominal aortic aneurysms (AAAs).

Data sources: Data were extracted from all studies supporting recommendation statements within the European Society for Vascular Surgery (ESVS) 2024 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms (AAAs), including study type, journal, year of publication, country, funding, gender of authors, participant sex, demographics, use of a sex stratified main outcome, and sex disaggregated reporting.

Review methods: This was a PRISMA equity analysis (Prospero registration: CRD42024559537). Prevalence adjusted estimates (e.g., participation prevalence ratio [PPR]) were derived by dividing the proportion of women enrolled by the proportion of women expected in the disease population. Under-enrolment of women was defined as a PPR < 0.8. Binary logistic regression was used to evaluate factors associated with reporting of a sex stratified main outcome. Weighted linear regression was used to evaluate factors associated with an increased PPR for women.

Results: Of 160 guideline recommendations, 32 were consensus statements. The remaining 128 recommendations used evidence from 419 published studies, 30% (126/419) of which did not specify the overall number of women and men. Only 7% (31/419) reported a sex stratified main outcome and 11% (46/419) of studies presented sex disaggregated data. The odds of sex stratified reporting increased with a woman first author and with an increased PPR for women. Nearly 50% (141/293) of studies demonstrated under-enrolment of women. A higher journal impact factor, woman first author, more recent studies, and North American studies were associated with increased enrolment of women, while multinational studies, aortic specific studies, and woman last author were associated with decreased enrolment.

Conclusion: Women are under reported and under represented in the evidence supporting ESVS AAA guideline statements. In depth evaluation is needed regarding best practice guidance for women and proportionate enrolment of women in AAA research should be encouraged.