• epidemiology
• outcome and process assessment
• health Care
• health services research

We read the correspondence by Colunga-Pedraza et al to our letter about the gender gap in the American College of Rheumatology (ACR) annual conference with great interest.1 2 The authors provide data on the first authors of oral presentations in the Mexican College of Rheumatology (MCR) annual meetings from 2011 to 2018. Out of 153 oral presentations, 79 (51.6%) had women as first authors. While the overall percentage of oral presentations given by female authors surpassed the 42.1% reported as the total number of female rheumatologists in Mexico up to 2017, they found that there were fluctuations based on the year. If the data were available, an additionally valuable insight would be whether these fluctuations were correlated with the proportion of women among new rheumatologists entering the workforce in those years.

We have previously commented on the value of looking at both first and senior authors when responding to the work of Adami et al.1 3 The representation of women among the first authors of original research in high impact general medical journals was significantly higher overall in 2014 compared with 1994, in a study by Filardo et al.4 These authors also noted differences in gender representation that varied across journals, as well as plateauing or declining trends in some cases. An older study by Jagsi et al evaluated the percentage of both first and senior authors in high-impact medical journals5 and found significantly increases over time for both. Looking at both authorship positions, whether it is for oral abstract presentations or publications, would provide some information on trends over time, as the last authorship position is usually reserved for a more senior researcher. It would also be helpful to note whether the selection process for these abstracts involves a double-blind peer review, as this tends to favour increased representation of female authors.6 7

In summary, Colunga-Pedraza et al present more data to support improved gender representation in rheumatology—but also the fact that we still have improvements left to make.