Chest. 2025 Feb 22. pii: S0012-3692(25)00185-0. [Epub ahead of print]
BACKGROUND: Double-blind peer review (DBPR, reviewers blinded to author identities and vice-versa) aims to reduce biases. DBPR's effectiveness has not been studied in pulmonary, critical care, and sleep journals.
RESEARCH QUESTION: What was the causal effect on bias of DBPR at CHEST?
STUDY DESIGN AND METHODS: From January 2020 - June 2022, CHEST and Annals of the American Thoracic Society (AATS) used single-blind peer review (reviewers concealed from authors only); in July 2022, CHEST switched to DBPR. We estimated the causal effect of DBPR on manuscript acceptance at CHEST using AATS as a control. Our co-primary exposures were first and last author gender; secondarily, we considered author residence in English fluent countries. To estimate DBPR's differential impact by exposure, we constructed multivariable regression models with triple interaction terms (e.g., author gender X CHEST vs AATS X pre- vs post-DBPR), all component factors (e.g., author gender), paired interactions (e.g., author gender X CHEST vs AATS), and covariables (year, topic).
RESULTS: We included 4,651 manuscripts (CHEST: 3,494; AATS: 1,157) sent for peer-review; 4,645 (99.9%) had identifiable author gender. From 2020-2024, CHEST submissions (compared to AATS) were less frequently authored by women (first: 38.7% vs 45.5%, SMD = 0.14; last: 23.9% vs 31.2% SMD = 0.16) or people from English fluent countries (first: 56.0% vs 77.7%, SMD = 0.47; last: 57.9% vs 79.0%, SMD = 0.47), and acceptance rates were lower (30.7% vs 48.4%, SMD = 0.37). After adjustment, no difference was appreciated in DBPR's impact on acceptance for women vs men authors (first: -7.4 [95% CI: -20.9 - 6.0] percentage points, p=0.28; last: -10.1 [-25.1 - 5.0] percentage points, p=0.19). DBPR negatively impacted first (but not last) authors from English fluent countries (vs non-fluent: -16.8 [-32.1 - -1.6] percentage points, p=0.030).
INTERPRETATION: DBPR did not differentially impact authors by gender but did by presumed English fluency.
Keywords: Bias; Female; Language; Peer Review; Publishing