Female first and senior authorship in high-impact critical care journals 2005–2024

Gender disparities persist in medical research. This study assessed gender representation trends in first and senior authorships in the five highest-ranked critical care journals (by impact factor) over a 20-year period. We analyzed author gender distribution from 2005 to 2024. Author gender was determined using NamSor for web-based gender prediction. We assessed trends in female first, senior, and combined first and senior authorships by calculating percentages, and annual changes by linear regression for multiple and single author publications. Among 42,970 articles, 34,743 had multiple authors and 8,227 had a single author. Despite progress over the past two decades, women remain underrepresented in critical care research leadership with 7.8% of publications having both female first and senior authors, compared to 56.7% with both positions held by men. Single authors were female in 23.6%. Linear regression showed increasing female authorships between − 0.1 and + 0.6% points per year depending on the journal, author position, and time period. Sensitivity analyses including only publications with more than 80% probability of correct gender classification yielded congruent results. Despite small but constant growth rates of female representation as first or senior authors in high impact critical care journals over the past 20 years, women remain clearly underrepresented. Given the current rate of change, it will take decades to achieve gender parity. The observed gender disparity in authorships likely reflects underlying gender inequities in critical care career trajectories, highlighting the need for institutional changes.