Article Text

Authorship representation in global emergency medicine: a bibliometric analysis from 2016 to 2020
  1. Stephanie Chow Garbern1,
  2. Gimbo Hyuha2,3,
  3. Catalina González Marqués4,
  4. Noor Baig5,
  5. Jennifer L Chan6,7,
  6. Sanjukta Dutta8,
  7. Masuma A Gulamhussein2,3,
  8. Gloria Paulina López Terán9,10,
  9. Hussein Karim Manji3,11,
  10. Winnie K Mdundo2,3,
  11. Rachel T Moresky12,13,
  12. Raya Yusuph Mussa3,
  13. Erin E Noste14,
  14. Mulinda Nyirenda15,16,
  15. Maxwell Osei-Ampofo17,18,
  16. Sindhya Rajeev19,
  17. Hendry R Sawe3,
  18. Alphonce Nsabi Simbila2,3,
  19. M.C. Kaushila Thilakasiri20,
  20. Nikkole Turgeon21,
  21. Benjamin W Wachira22,
  22. Rebecca S Yang23,
  23. Amne Yussuf2,3,
  24. Raina Zhang24,
  25. Alishia Zyer25,
  26. Chris A Rees26,27
  1. 1Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
  2. 2Emergency Medicine Department, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
  3. 3Emergency Medicine Department, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
  4. 4Division of Global Emergency Medicine and Humanitarian Studies, Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
  5. 5Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
  6. 6Department of Emergency Medicine, Northwestern University, Chicago, Illinois, USA
  7. 7CrisisReady, Boston, Massachusetts, USA
  8. 8Department of Emergency Medicine, Fortis Hospital, Kolkata, India
  9. 9Servicio de Emergencia, Hospital Santa Inés de Ambato, Ambato, Ecuador
  10. 10Servicio de Emergencia, Hospital General Ambato, Ambato, Ecuador
  11. 11Accident and Emergency Department, Aga Khan Hospital, Dar es Salaam, United Republic of Tanzania
  12. 12Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, USA
  13. 13Department of Emergency Medicine, Columbia University Medical Center, New York, New York, USA
  14. 14Department of Emergency Medicine, University of California San Diego, San Diego, California, USA
  15. 15Adult Emergency and Trauma Centre, Queen Elizabeth Central Hospital, Ministry of Health - Malawi, Blantyre, Malawi
  16. 16Emergency Medicine Unit, Department of Internal Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
  17. 17Emergency Medical Services, Ghana National Ambulance Service, Accra, Ghana
  18. 18Department of Internal Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana
  19. 19Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
  20. 20Postgraduate Institute of Medicine, University of Colombo, Colombo, Sri Lanka
  21. 21University of Vermont College of Medicine, Burlington, Vermont, USA
  22. 22Accident & Emergency Department, The Aga Khan University, Nairobi, Kenya
  23. 23Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  24. 24Alpert Medical School of Brown University, Providence, Rhode Island, USA
  25. 25Bryant University, Smithfield, Rhode Island, USA
  26. 26Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
  27. 27Department of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
  1. Correspondence to Dr Stephanie Chow Garbern; sgarbern{at}


Introduction High-income country (HIC) authors are disproportionately represented in authorship bylines compared with those affiliated with low and middle-income countries (LMICs) in global health research. An assessment of authorship representation in the global emergency medicine (GEM) literature is lacking but may inform equitable academic collaborations in this relatively new field.

Methods We conducted a bibliometric analysis of original research articles reporting studies conducted in LMICs from the annual GEM Literature Review from 2016 to 2020. Data extracted included study topic, journal, study country(s) and region, country income classification, author order, country(s) of authors’ affiliations and funding sources. We compared the proportion of authors affiliated with each income bracket using Χ2 analysis. We conducted logistic regression to identify factors associated with first or last authorship affiliated with the study country.

Results There were 14 113 authors in 1751 articles. Nearly half (45.5%) of the articles reported work conducted in lower middle-income countries (MICs), 23.6% in upper MICs, 22.5% in low-income countries (LICs). Authors affiliated with HICs were most represented (40.7%); 26.4% were affiliated with lower MICs, 17.4% with upper MICs, 10.3% with LICs and 5.1% with mixed affiliations. Among single-country studies, those without any local authors (8.7%) were most common among those conducted in LICs (14.4%). Only 31.0% of first authors and 21.3% of last authors were affiliated with LIC study countries. Studies in upper MICs (adjusted OR (aOR) 3.6, 95% CI 2.46 to 5.26) and those funded by the study country (aOR 2.94, 95% CI 2.05 to 4.20) had greater odds of having a local first author.

Conclusions There were significant disparities in authorship representation. Authors affiliated with HICs more commonly occupied the most prominent authorship positions. Recognising and addressing power imbalances in international, collaborative emergency medicine (EM) research is warranted. Innovative methods are needed to increase funding opportunities and other support for EM researchers in LMICs, particularly in LICs.

  • other study design
  • health policies and all other topics

Data availability statement

Data are available upon reasonable request. Data are available for free on reasonable request from the corresponding author.

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Data availability statement

Data are available upon reasonable request. Data are available for free on reasonable request from the corresponding author.

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  • SCG and GH are joint first authors.

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  • Contributors Author contributions are detailed in the authors reflexivity statement in online supplemental file S9. SCG and CR are responsible for the overall content as guarantors. All authors approved the version of the manuscript to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

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  • Competing interests None declared.

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