Evaluation of Sex Specific Representation and Sex Disaggregated Reporting in European Society for Vascular Surgery Clinical Practice Guidelines on the Management of Peripheral Arterial Disease and Chronic Limb Threatening Ischaemia.

Abstract

The aim of this study was evaluate the extent to which women are represented and reported within the scientific evidence supporting the clinical practice guidelines on peripheral arterial disease (PAD) and chronic limb threatening ischaemia (CLTI). 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 PAD and the 2019 global vascular guidelines on the management of CLTI, including study type, journal impact factor, year of publication, country, sex of authors, participant sex, use of a sex stratified main outcome, and sex disaggregated reporting. The protocol was registered with PROSPERO (CRD42024559537) and conducted in accordance with PRISMA-Equity guidelines. Analyses were performed using RStudio. Under enrolment was defined as a participation prevalence ratio (PPR) < 0.8. Binary logistic regression evaluated factors associated with reporting sex stratified outcomes; weighted linear regression assessed factors linked to increased PPR. Of 89 PAD and 113 CLTI recommendations, 213 and 116 unique studies were analysed. The remaining references were consensus documents or were excluded due to reasons such as single sex populations. Only 21% and ∼10% of the studies reported sex disaggregated data, while only 10% and 2% reported sex stratified outcomes in PAD and CLTI, respectively. Participants' sex was unreported in ∼42% (PAD) and ∼39% (CLTI). Women were under enrolled in ∼63% (PAD) and ∼55% (CLTI) of studies. Multinational studies, higher proportion of women authors, and stronger evidence levels were associated with better women's enrolment. Women first authorship was associated with increased odds of sex stratified reporting. Other factors that influenced sex stratified reporting included more women participants, a higher proportion of women authors, and recent publication year. Women are under represented and under reported in the evidence underpinning ESVS PAD and CLTI guidelines. Future societal guidelines should be based on research with balanced inclusion and consistent sex specific reporting.