The Geographical Gap in Leading Medical Journals - a Computational Audit

Background: Auditing geographical representation in medical publishing could help to mitigate possible national and regional disparities. Methods: Using the Web of Science indexing database, we collected bibliometric data of original research articles published between 2010-2019 in The New England Journal of Medicine, Nature Medicine, Journal of the American Medical Association, The BMJ, and The Lancet. We studied the corresponding authors' geolocation in regard to publication and citation count, their temporal evolution, and the journals' and citing organizations' nationality. Results: We identified 10,558 articles. Based on the nationality of the corresponding authors' institutes, only 32 countries published more than 10 publications in 10 years equaling to 98.9% of all publications. English-speaking countries USA (48.2%), UK (15.9%), Canada (5.3%), and Australia (3.2%) were most represented, but with a declining trend in recent years. Normalized to their accumulated citations, 9/32 countries were associated with [≥]10% publication excess, of which USA (n=1,174 publications) and UK (n=410) accounted for 85.7%. Similar findings were replicated at the municipal level where all top 10 most productive cities were located in USA (n=7), UK (n=2), or Canada (n=1), and 21 out of 25 most productive cities published more articles than predicted based on their accumulated citations. Finally, we discovered that both journals published, and researchers cited more commonly research conducted in the same country. Discussion: The audit revealed Anglocentric dominance, domestic preference occurring in both journals and citation selection, and increased geographical representation in recent years in medical publishing.