Global disparities in scientific publications: A 5-year analysis of 10 critical care journals

To evaluate the global distribution of original research articles in intensive care journals, analysing differences by country income level and assessing study characteristics, including type, funding, and accessibility.

A retrospective bibliometric analysis of original research articles published between 2018 and 2022.

The 10 intensive care journals with the highest 2022 Impact Factors, as identified by Clarivate Analytics.

Original research articles (observational studies and randomised controlled trials) in adult intensive care, excluding paediatric and preclinical studies.

Country of affiliation of the corresponding author (classified by World Bank income level), study type, funding source, number of participating centres, open-access status, and thematic category.

Among 12,441 manuscripts reviewed, we included 4982 original research articles. Of these, 4479 (89.9 %) were from high-income countries (HICs), 446 (9.0 %) from upper-middle-income countries (UMICs), 53 (1.1 %) from lower-middle-income countries (LMICs), and 4 (0.1 %) from low-income countries (LICs). Overall, 434 (8.7 %) were randomised controlled trials, with higher proportions in UMICs (13.2 %) and LMIC (20.8 %) studies compared with HICs (8.1 %). Multicenter design was reported in 44.6 % of all studies, but less frequently in UMICs (29.1 %) and LMICs (30.2 %). The median sample size was 228 patients (interquartile range, 76-1052), ranging from 231 in HICs to 211 in UMICs and 100 in LMICs. Funding was reported in 56.9 % of studies, most often from public sources. Public funding supported 28.0 % of UMICs and 9.4 % of LMICs studies, compared with 14.3 % of HIC studies. Open-access articles represented 44.8 % overall and were more common among funded studies.

Publications from UMICs, LMICs, and LICs remain underrepresented in high-impact intensive care journals. Structural barriers, limited funding, and potential publication bias contribute to this imbalance. Addressing these gaps requires greater funding opportunities, equitable collaborations, and stronger editorial commitment to inclusivity.