Study Unearths Gender Disparities in Twitter Influence

The results should not discourage women from being active on Twitter, especially in cardiology, one expert says.

Study Unearths Gender Disparities in Twitter Influence

Among a population of health policy and health services researchers who use Twitter, women appear to have less influence on the social media platform compared with men as measured by likes and retweets, according to a new study.

“Some have hoped that social media would help level the playing field in academic medicine by giving women an accessible and equitable platform on which to present themselves,” write lead author Jane Zhu, MD, MSHP (Oregon Health and Science University, Portland), and colleagues. “However, our findings—that women’s voices on Twitter appeared to be less influential and have less reach than men’s—suggest that these forums may do little to improve gender parity and may instead reinforce disparities.”

But Sheila Sahni, MD (Hackensack Meridian Health, JFK Medical Center, Edison, NJ), argued that these findings, published online today as a research letter in JAMA Internal Medicine, should not discourage women from involving themselves in social media, especially in the field of cardiology, where there is a vibrant community inclusive of gender among a variety of other factors.

“This is a very small, nongeneralizable form of data that cannot be used as the blanket statement for women when they start to consider or think about the use of social media,” she told TCTMD. “They measured influence by retweets and likes, but professional visibility and the impact that that can have in your career is not limited to retweets and likes. For instance, one tweet could lead to a direct message offline that leads to a speaking engagement.”

Fewer Likes, Retweets for Women

The researchers included 3,148 health services researchers (53% women) who used Twitter and found that while women on average had used the social media service for a fewer number of years compared with men (4.5 vs 5.1; P < 0.001), they sent out a similar mean number of original tweets per year and followed a similar mean number of people. Interestingly, women were more likely to follow other women than were men—54.8% of users followed by women were also women while 42.6% of users followed by men were women.

Professional visibility and the impact that that can have in your career is not limited to retweets and likes. Sheila Sahni

Women had half as many mean followers compared with men (567.5 vs 1,162.3; P < 0.001), and women’s tweets resulted in fewer mean likes (315.6 vs 577.6) and retweets (207.4 vs 399.8) per year.

The gender disparities observed were maintained across all levels of Twitter use and were greatest among those with full professorships.

“Our findings offer some bright spots,” Zhu and colleagues write. “Similar rates of Twitter use between genders suggest that social media offers women opportunities for engagement, perhaps with fewer barriers than may be present in day-to-day academic interactions. Moreover, the differences in influence on Twitter were less pronounced among junior researchers, suggesting greater gender parity among younger cohorts.”

Sahni agreed. “When you look at younger individuals, they were more likely to engage with others regardless of gender, and that's how all communication should be, that's how science should be. It should be gender-neutral in the way that we engage with our peers.”


With the explosion of #cardiotwitter over the past few years that has generated lively discussion and fostered networking opportunities, Sahni said it seems that health services researchers on Twitter could learn from this. “There are effective ways in which you can create engagement,” she said. “We have a community in cardiology and interventional cardiology that is clearly lacking [among health policy and health services researchers studied here]. Social media is a place where you're going to create outreach for what you're saying, but there are important ways in which you can engage a community and you have to use that wisely and purposefully. That's how you can create communication and awareness about what you're talking about.”

Social media in general and Twitter specifically, especially through use of hashtags like #ILookLikeACardiologist, has helped bridge the stark gender divide in cardiology over time, Sahni argued.

“When you remove that physical barrier of being present in front of someone, sometimes you can say more because you're more comfortable and you can engage in a discussion that now makes you recognized,” she said. “It's also a platform where we can say what we have always felt, which is that it's not equal. Less than 5% of women make up interventional cardiologists. . . . Now we have a place where we can share it with each other, and that ‘less than 5%’ have become bigger because of the sense of community that's surrounding it. Now the 95% of men, [many of whom are] on social media, are aware of that. That's what's happened and that's what's created this sense of really rich community surrounding the gender disparity that exists in our field.”

Social media has “allowed women to not only say what they feel, but now people are listening,” she concluded.

  • Zhu JM, Pelullo AP, Hassan S, et al. Gender differences in Twitter use and influence among health policy and health services researchers. JAMA Intern Med. 2019;Epub ahead of print.

  • Zhu and Sahni report no relevant conflicts of interest.