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Recent trends and structural patterns in NIH pediatric research funding, 2015-2024
Christopher B Forrest1, Lauren J Koenigsberg2, David C Schwebel3
1Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA. forrestc@chop.edu.
Insights
National Institutes of Health (NIH) pediatric research funding has remained stagnant, comprising about 13% of the budget despite children being 22% of the population. A lack of coordinated strategy hinders prioritization of pediatric and life-course research.
Area of Science:
- Pediatric Research Funding Analysis
- Health Services Research
- Biomedical Research Policy
Background:
- Pediatric research funding from the National Institutes of Health (NIH) has historically not aligned with children's proportion of the US population or disease burden.
- A significant gap exists between the health needs of children and the allocation of research funds.
- The current funding landscape necessitates an examination of NIH's commitment to pediatric health.
Purpose of the Study:
- To analyze trends in NIH pediatric research expenditures from FY2015 to FY2024.
- To investigate the distribution of pediatric research funding across different NIH components.
- To assess the accuracy of the NIH Research, Condition, and Disease Categorization (RCDC) system in identifying pediatric research.
Main Methods:
- A repeated cross-sectional analysis was performed using RCDC, NIH Office of Budget, and NIH RePORTER data (FY2015-2024).
- Expenditures were adjusted for inflation using the Biomedical Research and Development Price Index (BRDPI).
- A random audit of 200 RCDC-categorized pediatric projects evaluated classification accuracy.
Main Results:
- While nominal NIH research expenditures increased, inflation-adjusted growth was only 26%.
- Pediatric research consistently represented approximately 13% of nonadministrative NIH expenditures, falling short of the 22% of the US population under 18.
- A 6% misclassification rate was found in the RCDC system, particularly in maternal health studies lacking pediatric outcomes.
Conclusions:
- NIH pediatric research funding has remained proportionally stagnant, increasing passively with the overall budget rather than through targeted prioritization.
- A coordinated, trans-NIH strategy is needed to effectively prioritize and oversee pediatric and life-course research.
- Current funding mechanisms do not adequately reflect the health burden or population share of children, indicating a need for policy adjustments.
Background:
National Institutes of Health (NIH) pediatric research funding has persistently lagged behind children's share of the US population and disease burden. This study examined trends in NIH pediatric research expenditures, funding distribution across NIH components, and classification accuracy of the NIH Research, Condition, and Disease Categorization (RCDC)'s system for identifying pediatric research.
Methods:
We conducted a repeated cross-sectional analysis of RCDC, NIH Office of Budget, and NIH RePORTER data from fiscal years (FY) 2015-2024. Expenditures were inflation-adjusted using the Biomedical Research and Development Price Index (BRDPI). A stratified random audit of 200 RCDC Pediatric-category projects assessed classification accuracy.
Results:
NIH research expenditures grew 62% nominally (FY2015: $28.5 billion; FY2024: $46.1 billion), but only 26% in inflation-adjusted dollars. Pediatric research consistently comprised approximately 13% of NIH nonadministrative expenditures, despite children <18 years-old constituting 22% of the US population. Five institutes accounted for 57% of pediatric research expenditures. The audit identified a 6% misclassification rate, clustering around maternal health studies lacking pediatric outcomes.
Conclusion:
NIH pediatric research funding remained proportionally stagnant, rising passively with the NIH budget rather than reflecting deliberate prioritization. Strengthening pediatric and life-course research may require more coordinated trans-NIH prioritization.
Impact:
In nominal dollars, pediatric research funding at the NIH rose from $3.5 billion in FY2015 to $6.2 billion in FY2024; however, adjusted for inflation, the level of funding plateaued from FY2020 to FY2024. As a proportion of NIH nonadministrative expenditures, pediatric research accounted for approximately 13% across FY2015-FY2024. Although NICHD devoted 58-60% of its research funding to pediatric studies, it accounted for just 17% of all pediatric research funding. Every NIH component funded some amount of pediatric research, but the NIH lacks a coordinated trans-NIH strategy for pediatric research prioritization and oversight.
