(A140) Persistent Disparities in Global Otolaryngology Research: A 30-Year Analysis of Authorship Representation

Introduction: Despite the disproportionate burden of otolaryngologic disease in low- and middle-income countries (LMICs), research from these regions remains severely underrepresented. Local expertise is essential for addressing region-specific health challenges, yet authorship disparities persist. This study examines trends in LMIC first-author (FA) representation and evaluates the quality and impact of LMIC-led research in otolaryngology over the past three decades.

Methods: Employing a PubMed search algorithm, we reviewed all articles with abstracts published in the 27 otolaryngology journals with the highest h-5 index over the past 30 years. We extracted data on FA country affiliation, study design, and citation impact. Multivariable regression models assessed trends over time and estimated associations between LMIC FA status, study design, and citation impact.

Results: Between 1990 and 2023, 102,186 articles were analyzed. The highest-represented journals were Int J Pediatr Otorhinolaryngol (12.8%), The Laryngoscope (12.9%), and Otolaryngol Head Neck Surg (7.5%). Among 115 contributing countries, most FAs were from high-income countries (82.5%), followed by upper-middle-income (15%) and LMICs (2.6%). The most common affiliations were the US (35.6%), Japan (6.8%), and the UK (5.4%).

Over time, LMIC representation increased marginally (0.10% per year, 95% CI 0.09–0.11%). Compared to non-LMIC studies, LMIC-led research was more likely to be prospective (aOR 2.71, 95% CI 2.35–3.12) but received fewer citations (aIRR 0.69, 95% CI 0.66–0.72; LMIC: 17 vs. non-LMIC: 25 citations/article) after adjusting for journal and publication year.

Conclusions: LMIC first authorship in otolaryngology remains severely underrepresented, with minimal improvement over 30 years. Despite producing proportionally more prospective studies, LMIC-led research receives fewer citations, exacerbating disparities in global scholarship. Addressing this imbalance requires targeted interventions to enhance LMIC research visibility, foster collaboration, and promote equitable authorship representation.