Gender, race, and economic factors influencing screening practices in hidradenitis suppurativa: a cross-sectional analysis.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that significantly impacts patients' quality of life. Despite its substantial burden, HS remains underdiagnosed and undertreated, particularly among marginalized populations. This study aimed to elucidate the primary social determinants of health (SDOH) and structural determinants of health (StDOH) influencing rates and patterns of screening for patients diagnosed with HS. Using data from the All of Us Research Program database, participants with HS were identified using ICD-10 codes and stratified based on various sociodemographic factors, including race, gender, and income. The primary outcome variables were participation in viral screening and disease screening among HS patients. Statistical analyses were performed to assess the relationship between sociodemographic factors and screening practices. Income and gender had significant impacts on screening practices. Higher-income patients were more likely to receive necessary disease screening and less likely to receive unnecessary disease screening compared to lower-income patients. Non-male patients had significantly higher rates of unnecessary disease and viral screening than male patients. While differences in screening practices within each income level were significant, there were no significant differences across different income brackets or racial groups. These findings suggest that subjectivity associated with individual physicians' recommendations may contribute to disparities in screening outcomes, especially in lower-income and non-male HS patients. The study highlights the need for more clearly delineated screening guidelines and continued research on the role of SDOH in improving patient health outcomes.

Fairness in AI-Driven Oncology: Investigating Racial and Gender Biases in Large Language Models.

INTRODUCTION: Large language model (LLM) chatbots have many applications in medical settings. However, these tools can potentially perpetuate racial and gender biases through their responses, worsening disparities in healthcare. With the ongoing discussion of LLM chatbots in oncology and the widespread goal of addressing cancer disparities, this study focuses on biases propagated by LLM chatbots in oncology. METHODS: Chat Generative Pre-trained Transformer (Chat GPT; OpenAI, San Francisco, CA, USA) was asked to determine what occupation a generic description of "assesses cancer patients" would correspond to for different demographics. Chat GPT, Gemini (Alphabet Inc., Mountain View, CA, USA), and Bing Chat (Microsoft Corp., Redmond, WA, USA) were prompted to provide oncologist recommendations in the top U.S. cities and demographic information (race, gender) of recommendations was compared against national distributions. Chat GPT was also asked to generate a job description for oncologists with different demographic backgrounds. Finally, Chat GPT, Gemini, and Bing Chat were asked to generate hypothetical cancer patients with race, smoking, and drinking histories. RESULTS: LLM chatbots are about two times more likely to predict Blacks and Native Americans as oncology nurses than oncologists, compared to Asians (p < 0.01 and < 0.001, respectively). Similarly, they are also significantly more likely to predict females than males as oncology nurses (p < 0.001). Chat GPT's real-world oncologist recommendations overrepresent Asians by almost double and underrepresent Blacks by double and Hispanics by seven times. Chatbots also generate different job descriptions based on demographics, including cultural competency and advocacy and excluding treatment administration for underrepresented backgrounds. AI-generated cancer cases are not fully representative of real-world demographic distributions and encode stereotypes on substance abuse, such as Hispanics having a greater proportion of smokers than Whites by about 20% in Chat GPT breast cancer cases. CONCLUSION: To our knowledge, this is the first study of its kind to investigate racial and gender biases of such a diverse set of AI chatbots, and that too, within oncology. The methodology presented in this study provides a framework for targeted bias evaluation of LLMs in various fields across medicine.

Intraoperative Communication Among Men and Women Surgeons With Nursing and Anesthesia Providers.

INTRODUCTION: Gender bias has been reported by women surgeons, but its impact on communication in the operating room (OR) is unclear. OR communication is critical to understand, as it directly impacts patient outcomes. The current study evaluates potential gender bias in the type and quality of communication between surgeons and OR nursing and anesthesia providers. METHODS: We developed a novel intraoperative communication assessment tool, Operating Room Communication Quality assessment tool (OComm), which was adapted from previously validated teamwork assessment tools. Independent coders recorded the instances of conversation and categorized them into clinical or casual communication. After the operation, the participants were assigned a score from the OComm tool. Participants were then given the same OComm measure to assess their self-perceived communication quality and collect demographic information. RESULTS: For both genders, surgeons' median self-perceived OComm scores was 3.47/4, but surgeons observed OComm score was 2.91/4. Anesthesia providers noted the highest median self-perceived OComm score of 3.65/4 but the lowest observed OComm median score of 2.29/4. From both surgeon to nurse and surgeon to anesthesia provider, there was no association between the gender and frequency of casual conversation (P = 1 > 0.025). CONCLUSIONS: There was no gender difference in the degree to which women and men surgeons engaged in casual conversation with nursing and anesthesia providers. Surgeons, both men and women, were also more likely to rate their quality of communication lower than the nurses and anesthesia providers, while independent coders were more likely to rate surgeons' quality of communication higher than that of nurses and anesthesia providers.

Social media stethoscope: unraveling how doctors' social media behavior affects patient adherence and treatment outcome.

Objective: The exposure of the content posted by doctors on social media has the potential to influence how patients perceive and judge doctors. It is necessary to further investigate whether and how the content posted by doctors affects patients' health behaviors and outcomes, as well as to identify the factors that may influence this mechanism. Methods: Multi-respondent survey data was collected from 35 doctors and 322 patients in China, and structural equation modeling (SEM) was used to test the hypothesis model. Results: The findings revealed that doctors posting professional knowledge content on social media positively impacted patient adherence and treatment effectiveness. Conversely, doctors sharing personal life-related content on social media were associated with lower patient adherence and poorer treatment outcome. Moreover, doctor gender and doctor humor moderate the relationship between social media behavior of doctors and patient adherence. Conclusion: Doctors sharing professional knowledge on social media not only fosters trust in physicians but also closely correlates with patient adherence and treatment effectiveness.

Rooting for Their Own Gender: Preschoolers' Selective Preference for Winners.

Children's social preferences are influenced by the relative status of other individuals, but also by their social identity and the degree to which those individuals are like them. Previous studies have investigated these aspects separately and showed that in some circumstances children prefer high-status individuals and own-gender individuals. Gender is a particularly interesting case to study because it is a strong dimension of social identity, but also one of the most prevalent forms of social hierarchy, with males conceptualised as superior to females, by adults and children alike. Here we directly asked how children's social preferences are influenced by status (winner or loser of a zero-sum conflict) and winner gender (female or male) in different scenarios (same or mixed-gender). In Experiment 1, children saw same-gender conflicts between two females or two males and they displayed an overall preference for winners. In Experiment 2, participants watched two mixed-gender conflicts, one where the female prevailed and one where the male prevailed. In this case, children chose the winner, but only when they had the same gender as themselves. Experiment 3 confirmed that children preferred own-gender individuals in the absence of conflict or status. Overall, children are sensitive to the relative status of other individuals and use this information to make social decisions. However, preschoolers do not prefer just any individual who wins access to a resource. They preferred dominant individuals, but only when they were of their own gender. This suggests that children's dominance evaluations are modulated by children's social identity.

Gender bias of antisocial and borderline personality disorders among psychiatrists.

PURPOSE: Antisocial Personality Disorder (ASPD) and Borderline Personality Disorder (BPD) challenge mental health professionals with similar maladaptive behaviors. However, these two disorders differ regarding available evidence-based treatments. The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been criticized as being gender-biased diagnostic construct. The present study aimed to determine the gender bias of ASPD and BPD among Turkish psychiatrists. METHODS: Three case vignettes were randomly presented as male or female to the psychiatrists online. The first case was a patient with schizophrenia case to confirm the participant's ability to diagnose. The second case was a patient with ASPD, and the third one was a patient with BPD. RESULTS: Two hundred fifty participants diagnosed the first case correctly (n = 250). The results with statistical significance demonstrated that a female case with ASPD was 5.1 times more likely to get misdiagnosed than a male case with ASPD (p˂0.0001). CONCLUSIONS: Categorical classification of personality disorders in DSM leads to gender bias in in the diagnosis of ASPD and BPD. The present study shows that female cases with ASPD are misdiagnosed as BPD which may result in treatment attempts without evidence.

Unfit or disliked: How descriptive and prescriptive gender stereotypes lead to discrimination against women.

Decades of research attest to the role of gender stereotypes in the emergence of gender-based discrimination. Placing a focus on recent studies, we provide evidence that gender stereotypes continue to negatively affect women's career outcomes in jobs and fields that are seen as male in gender-type. We identify two pathways through which gender stereotypes bring about discrimination: Whereas descriptive gender stereotypes lead to gender discrimination through negative performance expectations produced by lack-of-fit perceptions, prescriptive gender stereotypes lead to gender discrimination through social penalties elicited by perceived stereotype violation. We end by discussing how characteristics of women and those evaluating them may amplify or ameliorate discriminatory behavior, and by considering how organizations and policymakers can leverage research to promote gender equality.

The Impact of Mentoring on Academic Career Success in Surgical Subspecialties: A Systematic Review.

INTRODUCTION: As of 2019, women comprise 52.4% of medical school matriculants, make up more than one-third of the active physician workforce, and nearly half of residents and fellows. Although the number of women physicians continues to increase, many surgical subspecialities, including orthopaedic surgery, have not seen a substantial increase in the percentage of women physicians. This may be due to a lack of mentorship. Efforts within the medical community to decrease the burden of gender bias on women include attempts to increase access to mentorship opportunities. Effective mentoring is a critical aspect of any resident physician's training. The purpose of this study was to analyze the most important aspects of mentorship in the academic advancement of female surgical subspecialists. METHODS: A systematic review of the literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in July 2022 using the electronic databases PubMed, EMBASE, Cochrane Database, Scopus, and Web of Science.10 Search terms can be found in Appendix 1. An initial abstract screen of each article was conducted by 3 authors. Studies were included if they focused on mentorship of women in academic surgery, were published from 2000-2023, were peer-reviewed articles in the English language, and conducted in the United States. Two reviewers screened each article based on the criteria; the remaining studies were then reviewed in full text. After the full text screen, the eligible articles underwent data extraction and quality assessment using AXIS tool or CASP checklist. The results were then analyzed and synthesized. Additionally, risk of bias was assessed using the 2018 version of the Mixed Methods Appraisal Tool (MMAT). RESULTS: Several common themes among the 10 studies were identified. Six (60%) studies discussed the impact of mentorship on career success. One of the most important ways that mentors assist mentees is by serving as positive role models. Two (20%) studies noted that goal-setting assistance is one of the most helpful ways mentors can provide guidance. Guidance with academic politics (such as funding and research priorities) was identified as a major contribution by mentors in two (20%) studies. The second most common theme was female mentors (6; 60%). Most studies (9; 90%) agree that it's important for women surgeons to have female mentors. The importance of multiple mentors was explored in 4 (40%) papers. Three (30%) studies addressed the issue of balancing work and life responsibilities among female surgeons. CONCLUSION: This review suggests that female surgical subspecialists value mentorship in regard to career development, managing work-life balance, and academic productivity. Although many studies found that female physicians were more likely to express the desire for a same-sex mentor, these female subspecialists were also more likely to report not only a lack of mentorship but a lack of available female mentors. Effective mentoring from multiple mentors, preferably some of whom identify as female, may improve career advancement in female surgical subspecialists and promote gender equality in these fields. More research is needed to establish a baseline of knowledge on how mentoring specifically affects quantitative aspects of career development, such as research productivity and promotions, to continue to equilibrate these historically male-dominated subspecialities.

Girls play basketball too? A study of the mechanisms of traditional social gender consciousness on female participation in contact leisure sports.

Background: With the development of women's sports, the mechanism of barriers to women's leisure sports participation has attracted extensive attention from the academic community. Despite its significant impact, there are few empirical studies on intra-personal barriers. Consequently, a structural equation model was established to examine the relationships between traditional social gender awareness, gender bias, gender stereotypes, and barriers to participation in leisure sports. Methods: In this study, a total of 508 questionnaires were collected and analyzed using AMOS 24.0 software for structural equation modeling. After model testing, the relationships between the variables were examined. Results: The results of the statistical analyses indicated that traditional gender awareness could serve as an antecedent variable for barriers to participation in leisure sports, and that gender stereotypes mediated the relationship between traditional gender awareness and barriers to participation in leisure sports. The study also concluded that gender bias could not mediate the relationship between traditional gender awareness and participation barriers in leisure sports, but gender bias and gender stereotypes could act as chain mediators in the process of the influence of traditional gender awareness on barriers to contact leisure sports. Discussion: This study emphasizes the need for women to break down the traditional social gender awareness, gender bias, gender stereotypes, and other intra-personal barriers when engaging in leisure sport participation. According to this study, the promotion of sustained and healthy development of women's sport requires the breaking down of traditional social gender awareness education and the creation of more gender-inclusive sports policies and environments. The significance of the study is that by proposing and confirming the internal participation barriers to women's participation in contact leisure sports, it will lead to the ideological liberation of women's gender perspectives, so that they can break down the participation barriers to contact leisure sports, participate in sports activities, and enjoy the right to play sports on an equal footing.

Association of Double-Blind Reviews With Increases in Women as First Authors: An Initial Report From the Journal of Cardiac Failure.

INTRODUCTION: Women continue to remain under-represented in academic publishing in the field of cardiology. Some evidence suggests that double-blind peer reviews may mitigate the impact of gender bias. In July 2021, the Journal of Cardiac Failure implemented a process for the conduct of double-blind reviews after previously using single-blind reviews, with the aim of improving author diversity. The purpose of the current study was to examine the association between changes in authorship characteristics and implementation of double-blind reviews. METHODS: Manuscripts were stratified into 3 Eras: March-September 2021 (Era 1: prior to double-blind reviews); March-September 2022 (Era 2); and March-September 2023 (Era 3). All article types except invited editorials were included. Data were abstracted, including names, genders, ranks, and disciplines of the first and senior authors. RESULTS: A total of 310 manuscripts were included in the analysis. The proportion of women first authors increased from 24% in Era 1 to 34% in Era 2 to 39% in Era 3, while the percentage of women authors serving in a senior authorship role remained fairly stable over time-around 21%-22%. Even after adjusting for region, article type, first-author discipline, and last-author gender, there was an increase in female first authors over time (P = 0.015). Manuscripts with a female senior author were significantly more likely to have a female first author. CONCLUSIONS: Our findings suggest that double-blind peer review may contribute to increased gender diversity of first authors and may highlight areas for future improvement by the Journal and academic publishing in general.

Gender Bias in AI's Perception of Cardiovascular Risk.

The study investigated gender bias in GPT-4's assessment of coronary artery disease risk by presenting identical clinical vignettes of men and women with and without psychiatric comorbidities. Results suggest that psychiatric conditions may influence GPT-4's coronary artery disease risk assessment among men and women.

Amplifying Their Voice: Inclusive Healthcare Provider Perspectives to Improve Advancement, Resilience, and Retention.

BACKGROUND AND OBJECTIVES:  Addressing the issues of workplace advancement, resilience, and retention within medicine is crucial for creating a culture of equity, respect, and inclusivity especially towards women and nonbinary (WNB) providers including advanced practice providers (APPs), most notably those from marginalized groups. This also directly impacts healthcare quality, patient outcomes, and overall patient and employee satisfaction. The purpose of this study was to amplify the voices on challenges faced by WNB providers within a pediatric academic healthcare organization, to rank workplace interventions addressing advancement, resilience, and retention highlighting urgency towards addressing these issues, and, lastly, to provide suggestions on how to improve inclusivity. METHODS:  Participants were self-identified WNB providers employed by a pediatric healthcare organization and its affiliated medical university. An eligibility screener was completed by 150 qualified respondents, and 40 WNBs actually participated in study interviews. Interviews were conducted using a semi-structured interview guide to rank interventions targeted at improving equity, with time allotted for interviewees to discuss their personal lives and how individual circumstances impacted their professional experiences. RESULTS:  WNB providers called for efficient workflows and reducing uncompensated job demands. Support for family responsibilities, flexible financial/compensation models, and improved job resources all were endorsed similarly. Participants ranked direct supervisor and leader support substantially lower than other interventions.  Conclusions: Career mentorship and academic support for WNB individuals are recognized interventions for advancement and retention but were not ranked as top priorities. Respondents focused on personal supports as they relate to family, job resources, and flexible compensation models. Future studies should focus on implementing realistic expectations and structures that support whole lives including professional ambitions, time with family, personal pursuits, and self-care.

Sex differences in dementia diagnosis: a fourteen-year retrospective analysis of cases using the Registry of Dementia of Girona.

OBJECTIVE: To evaluate the impact of sociodemographic and clinical sex/gender-associated factors on dementia severity at the time of diagnosis. METHODS: Retrospective, cross-sectional study using 2007-2020 data from the Registry of Dementia of Girona (ReDeGi), collecting information from new dementia diagnoses in the seven hospitals of the Health Region of Girona (Northeast region of Catalonia, Spain). Sociodemographic and clinical variables were compared by sex and dementia severity at diagnosis. A multivariate analysis stratified by sex evaluated the risk of having a moderate/severe dementia diagnosis. RESULTS: Of 9614 new dementia cases, 6040 (62.8%) were women, and 3574 (37.2%) were men. Women and men aged 75-85 years had 27.9% (p = .003) and 43.1% (p < .001) less risk of moderate/severe diagnosis, respectively, than those >85. Being institutionalized increased the risk of moderate/severe diagnosis more in women (159.9%; p < .001) than in men (114.8%; p = .030). Being single and having a higher education increased the risk of moderate/severe diagnosis by 76.2% (p = .039) and 69.8% (p = .021), respectively, only in women. CONCLUSIONS: Age, education level, marital status, and place of residence were differentially associated with moderate/severe dementia at the time of diagnosis in women and men, indicating sex/gender differences in dementia severity at diagnosis, with an increased impact on women.

Unveiling Gender Disparity: A Closer Look at Speaker Representation at International Aesthetic Medicine Conferences.

Introduction: Despite some recent progress, gender disparity is a well-documented and persistent problem at medical professional conferences, with women being consistently underrepresented.1 This study examines the representation of speakers at international aesthetic medicine conferences, an area previously unexplored in the literature. Methodology: An analysis of speaker composition was conducted of three international aesthetic medicine conferences over the past three years: the Aesthetics & Anti-Aging Medicine World Congress (AMWC), the International Master Course on Aging Science (IMCAS) World Congress, and the Facial Aesthetic Conference and Exhibition (FACE). Results: Of the 5,993 clinical lectures amongst 189 sessions over three years, 66.34 percent were given by male speakers and 33.66 percent by female speakers. The gender disparity remained consistent over the three-year period reviewed, with no upward trend. Symposiums with all-male panels consisted of 26.4 percent of the total sessions. Conclusion: The study highlights an ongoing gender imbalance at international aesthetic medicine conferences. These disparities have broad and significant implications in terms of inequalities in employment and earnings as well as the perpetuated societal inequalities faced by women. The aesthetic medicine community should therefore consider it a priority to acknowledge and address this issue by supporting improved representation of women at key events and congresses amongst other initiatives to drive positive change.

The gender gap in fair earnings increases with age due to higher age premium for men.

This study explores how gender and age interact in shaping beliefs about fair pay through a factorial survey experiment conducted with German employees. Respondents evaluated hypothetical worker descriptions varying in age, gender, and earnings. While no gender gap in fair earnings was found for the youngest hypothetical workers, a significant gap favoring men emerged with increasing age. This suggests that male workers receive a higher age premium on fair earnings than female workers. The findings highlight the need to understand how gender interacts with other characteristics to legitimize workplace inequalities.

Gender bias in surgery: A systematic review of qualitative studies.

BACKGROUND: In order to gain a comprehensive understanding of gender bias in the field of surgery, a systematic review was conducted to assess relevant perceptions. METHODS: We searched PubMed, Embase, and LILACS for qualitative studies on how students, trainees, and surgeons recognize gender aspects concerning surgery. Data was thematically synthesized according to Thomas and Harden's methodology. RESULTS: Eighteen articles were included, comprising 892 participants, between males and females. Twenty-four codes were generated, and two major themes were identified: gender bias and discrimination, and parenting. Bias were commonly implicit and associated with microaggressions. It involved discouragement, struggles with traditional gender norms, harassment, and lifestyle. CONCLUSIONS: We highlight the complexity of the barriers towards gender equality in surgery, addressing the lack of representativity and the persistence of bias. Understanding the obstacles and finding ways to overcome them can help to change the current situation.

Female-dominated disciplines have lower evaluated research quality and funding success rates, for men and women.

We use data from 30 countries and find that the more women in a discipline, the lower quality the research in that discipline is evaluated to be and the lower the funding success rate is. This affects men and women, and is robust to age, number of research outputs, and bibliometric measures where such data are available. Our work builds on others' findings that women's work is valued less, regardless of who performs that work.

There have been growing concerns around sexism in science. Studies have found that women in science are often paid less, are less likely to get credit for their work and receive fewer and smaller grants than men at similar stages in their careers. This can make it harder for women to advance in their careers, resulting in less women than men taking up positions of leadership. There are also gender imbalances between scientific disciplines, with a higher proportion of women working in some fields compared to others. Here, James et al. set out to find whether having more women working in a discipline leads to biases in how the research is evaluated. The team examined four datasets which included information on the research evaluations and funding success of thousands of researchers across 30 different countries. The analysis suggested that scientists working in women-dominated disciplines were less likely to succeed in their grant applications. Their research was also often evaluated as being lower quality compared to researchers working in fields dominated by men. These biases applied to both men and women working in these disciplines. There were not sufficient data to analyse patterns faced by non-binary individuals. The study by James et al. cannot pinpoint a specific cause for these outcomes. However, it suggests that funding organisations should analyse the pattern of successful applications across disciplines and consider taking steps to ensure all disciplines have similar success rates. James et al. also propose that when hiring or making promotions, scientific institutions should take care when comparing researchers across disciplines and ensure there is no built-in assumption that fields dominated by men are intrinsically better.

Gender bias in assessing narcissistic personality: Exploring the utility of the ICD-11 dimensional model.

OBJECTIVES: Narcissistic personality disorder as captured in categorical diagnostic systems (e.g., DSM-5) emphasizes grandiose features more associated with masculine norms and under-emphasizes vulnerable features more associated with femininity. This poses significant implications in diagnostic outcome and clinical treatment in women with narcissistic preoccupations. Research finds that clinicians using the DSM-5 categorical system tend to diagnose vulnerable narcissism in women as other 'feminized' personality disorders (e.g., borderline), but no research has explored gender differences in narcissism using the new ICD-11 dimensional framework for personality disorders. This study investigated the clinical utility of the ICD-11 approach in capturing gender differences in narcissistic presentations. METHODS: Adopting an online vignette-based study, mental health clinicians (N = 157; 71.3% female) completed ratings of ICD-11 personality disorder severity and trait domains for two cases reflecting 'grandiose' and 'vulnerable' narcissism in hypothetical male or female patients. RESULTS: The results showed that ratings of core impairments in personality functioning and overall severity were consistent irrespective of patient or clinician gender, contrasting prior research using categorical models. CONCLUSION: While some differences were observed in trait domain (e.g., negative affectivity) between patient gender, these results suggest the clinical utility of the ICD-11 model as emphasizing elements of personality functioning in the process of assessment and diagnosis, therefore potentially being less susceptible to influences of gender stereotype in aiding clinical conceptualization.

Sex and gender bias in chronic coronary syndromes research: analysis of studies used to inform the 2019 European Society of Cardiology guidelines.

Background: Sex and gender inequalities in ischemic heart diseases persist. Although ischemic heart disease is less common in women, they experience worse clinical outcomes and are less likely to receive guideline-recommended treatments. The primary scientific literature from which clinical guideline recommendations are derived may not have considered potential sex- and gender biases. This study aims to determine whether the literature cited in recent cardiovascular guidelines' clinical recommendations contain sex and gender biases. Methods: We analysed publications cited in the 2019 European Society of Cardiology (ESC) guideline recommendations on chronic coronary syndromes, using a checklist to guide data extraction and evaluate the individual studies for sex- and gender-related aspects, such as inclusion/exclusion criteria, outcome measures, and demographic data reporting. To assess representation over time, the proportion of women participants in each study was computed and analysed using a beta regression model. We also examined the associations between women's representation, journal impact factor and author gender. Findings: Among the 20 ESC recommendations on chronic coronary syndromes, four contained sex-related statements; we did not identify any gender-specific suggestions. The referenced literature upon which these recommendations were based consisted of 108 articles published between 1991 and 2019, encompassing more than 1.6 million study participants (26.8%; 432,284 women). Only three studies incorporated sex-sensitive designs; none were gender-specific. The term "gender" did not occur in 84% (n = 91/108) of the publications; when used, it was exclusively to denote biological sex. The proportion of women (assumed by investigators) among study participants fluctuated over time. Having a woman as first (odds ratio (OR) = 1.68, 95% CI: 1.19-2.39) or last author (OR = 2.28, 95% CI: 1.31-3.97), was significantly associated with having more women participants in the study. Interpretation: The data underlying ESC guideline recommendations largely lack reporting of possible sex- and gender-specific aspects, and women are distinctly underrepresented. To what extent these recommendations apply to members of specific population groups who are not well-represented in the underlying evidence base remains unknown. Funding: This study is part of the Gender and Health Inequalities (GENDHI) project, ERC-2019-SyG. This project has received funding from the European Research Council (ERC).

Sex, Age, and Patient Experience in Cardiologist Reviews: A Large-Scale Artificial Intelligence-Enabled Analysis.

Background: Patients are increasingly using online reviews to evaluate cardiologists. Online reviews can provide insights into factors driving patient satisfaction. Little is known about the effects of age and sex on the patient experience with cardiologists. Objectives: The purpose of this study was to apply natural language processing techniques on online reviews to determine the factors underlying positive and negative patient experiences and the effects of age and sex on the patient experience with cardiologists. Methods: Mixed effects logistic regression and sentiment analysis were applied to online cardiologist reviews from Healthgrades between 1998 and 2023. The results were then analyzed by sex and age to show trends with respect to rating statistics, sentiment analysis, and frequency of 2-word phrases. Results: There were 100,334 online reviews of 9,461 cardiologists. Female cardiologists received lower average ratings compared to male cardiologists and were 34.5% less likely to receive a positive review (OR: 0.655; 95% CI: 0.481-0.893; P = 0.015). Older cardiologists received lower average ratings compared to younger cardiologists (4.145 ± 0.908 vs 4.348 ± 0.795; P < 0.01). Positive reviews were associated with time spent with patients (OR: 1.383; 95% CI: 1.251-1.528; P < 0.01), answering questions (OR: 2.622; 95% CI: 2.324-2.959; P < 0.01), and patients feeling they could trust their providers' decisions (OR: 2.285; 95% CI: 2.053-2.543; P < 0.01). Conclusions: Positive reviews were associated with cardiologists being comprehensive and patients feeling a sense of trust in the relationship. There was a difference in ratings based on age and sex with female and older cardiologists receiving lower ratings.