LMIC authorship in global reconstructive surgery: A bibliometric analysis

Abstract

Introduction

Significant publication disparities exist between low- and middle-income countries (LMICs) and high-income countries (HICs) within plastic surgery literature. Among top plastic surgery journals, only 20% of articles originate from LMICs. While international research collaborations may help mitigate these disparities, it is crucial that LMIC authors are fairly included in collaborative publications. This study characterizes LMIC representation in authorship as well as the extent of HIC-LMIC collaboration in the global reconstructive surgery literature. We also evaluate the relationship between LMIC authorship and article reach in the form of citations, impact factor, and open access status.

Methods Global health articles published between January 2014 and April 2021 in plastic surgery journals were extracted from the PubMed database. We created an original Java program to extract title, year, journal, grants, type of publication, author and affiliation information, author countries and regions, and mission trip status. Other article characteristics were manually extracted. LMIC status was defined by the World Bank and determined by the first author's country of affiliation. If authors had multiple affiliations, primary affiliation was determined through manual search of the author. Wilcoxon rank sum tests, Kruskal-Wallis tests, and multivariable logistic regression models were used to assess associations between article characteristics and HIC vs LMIC authorship. Statistical analysis was performed in R. All tests were two-sided and p < 0.05 was considered statistically significant. Results Study characteristics Among the 1,196 articles included in our analysis, 70% of articles included at least one author from a LMIC (n = 838), 64% of articles listed a LMIC first author (n = 763), and 61% of studies listed a LMIC last author (n = 665). The majority (57%) of articles originated from LMICs with no HIC author listed (n = 683), and 30% of papers listed authors exclusively from HICs without inclusion of LMIC authors (n = 358). A total of 13% of articles represented collaborations between HIC and LMIC authors (n = 158). Notably, 50% of collaboration articles listed a LMIC first author (n = 79), while only 25% listed a LMIC last author (n = 40). The highest output countries were China (n = 260), the United States (n = 258), Brazil (n = 125), Turkey (n = 77), and India (n = 59).