Authorship and citation inequities in high-impact emergency medicine journals: a bibliometric analysis

Emergency medicine (EM) is a global discipline; however, marked inequities in authorship representation persist. Disparities between high-income countries (HICs) and lower-and middle-income countries (LMICs) may influence research visibility, access to funding, and scholarly impact. Using recent data, we examined authorship leadership, funding, and citation patterns across national income groups in high-impact EM journals.

We conducted a cross-sectional bibliometric analysis of articles published between 2020 and 2024 in the 20 highest-ranked EM journals according to Google Scholar Metrics. Bibliographic records were retrieved from PubMed and Web of Science, excluding publication types not considered citable scholarly outputs. Country income classification followed the World Bank 2025 schema based on first-author affiliation. Descriptive statistics and χ² tests assessed distributions across income groups. Multivariable logistic regression identified predictors of LMIC first authorship and funding, while linear regression assessed annual citation counts adjusted for study characteristics.

Among 23,379 eligible articles, first authors were predominantly affiliated with HICs (81.6%), followed by upper-middle-income (10.8%), lower-middle-income (7.3%), and low-income (0.3%) countries. LMIC representation did not increase over time. Larger author teams were inversely associated with LMIC first authorship (p < 0.001). In adjusted analyses, LMIC-affiliated first authors accrued fewer annual citations than HIC counterparts (β = -0.79; p < 0.001), whereas funded studies were associated with higher citation rates (p < 0.001). Africa accounted for 0.6% of publications and did not demonstrate lower citation rates once published.

High-impact EM research remains dominated by HIC institutions, with persistent inequities in authorship leadership, funding, and citation visibility. These findings suggest that structural barriers to research leadership and publication may contribute to the observed disparities, rather than differences in scholarly relevance once studies are published. Strengthening LMIC research capacity and promoting equitable collaborations and inclusive publishing policies are essential for a more representative global EM research ecosystem.