Background/Purpose Gender equity remains an elusive goal across many specialist medical fields. The Coalition for Health and Gender Equity (CHANGE) conducted a comprehensive global survey assessing gender equity within the international rheumatology workforce. Methods A cross-sectional online survey of rheumatologists and allied health professionals was conducted between January 2023 and May 2024. The 38-item survey covered demographics, gender discrimination, sexual harassment, work-family interface, and career advancement. It was translated into eight languages and disseminated through professional organisations, mailing lists and social media channels in 105 countries. Analyses included descriptive statistics and comparative tests, with gender differences evaluated after adjustment for years of work experience. Subgroup analyses included country Human Development Index (HDI), professional roles, and caregiving responsibilities, with statistical significance set at p<0.05. Results Among 1,945 respondents (66.4% female), pronounced gender-based disparities were observed. Male professionals demonstrated higher rates of full-time employment, leadership positions, and clinical experience. Female rheumatology professionals more frequently encountered career barriers, including tasks below their expertise, hostility from colleagues, lacking leadership training opportunities, lower remuneration, and difficulties securing research funding. Women reported greater domestic responsibilities (47.5% vs 36.2%, p<0.001) and higher work-family conflict, with nearly four times the odds of experiencing sexual harassment and double the odds of experiencing bullying. Perceived experiences were more pronounced among respondents from high-HDI countries and those with caregiving responsibilities, but did not differ by professional role. Conclusion This global survey provides compelling evidence of gender disparities in rheumatology, necessitating coordinated, evidence-based interventions to address structural barriers and promote inclusive cultures.
Introduction Diffuse idiopathic skeletal hyperostosis (DISH) has been associated with lower lung volumes and function, but it is unknown whether this is due to structural lung disease. This study aimed to investigate DISH and reduced lung function and volume in relation to structural lung disease in individuals with long-term smoking history. Methods Participants were included from the NELSON lung cancer screening trial. Structural lung abnormalities were automatically quantified (emphysema, airway wall thickness, and air trapping), or visually assessed (interstitial lung abnormalities, bronchiectasis, centrolobular emphysema) by two chest radiologists. Multivariate linear regression analyses were performed with adjustment for participant factors and structural lung disease. Results Among 3514 subjects (100% male, mean age 60.4 years), DISH was present in 241 (6.7%). Individuals with DISH had lower prevalence of Respiratory Bronchiolitis Interstitial Lung Disease (5%vs. 10.4%, p = 0.04) and of centrilobular emphysema (3.3%vs. 7.6%, p = 0.009), but greater airway wall thickness (2.6 vs. 2.4 mm, p < 0.001). In multivariate linear regression analyses, DISH subjects had a 4.4% lower FEV1 (95%CI: -7.1% to -1.7%), 150 ml lower FEV1 (95%CI: -160, -140 ml), 4.0% lower predicted FVC (95%CI: -6.2%, -1.7%), 170 ml lower FVC (95%CI: -280, -70 ml) and 210 ml lower CT measured lung volume (95%CI: -40, -1 ml), compared to subjects without DISH. Conclusion In long-term smokers, DISH was associated with lower lung function and volumes, not explained by structural lung abnormalities on CT. These findings suggest that DISH may be an extrinsic factor contributing to reduced lung function as a result of thoracic cage stiffening.
