An article featuring IDOR’s participation highlights how global economic disparity impacts research production in critical care worldwide

In a recent publication in the journal Intensive Care Medicine, an article revealed data on scientific inequality between developed and developing countries, with a focus on studies related to critical care. The research was conducted by Brazilian doctors from the Instituto D’Or de Pesquisa e Ensino (IDOR), A. C. Camargo Cancer Center, and Hospital Mater Dei Porto Dias.

Economic inequality is a significant social challenge for various nations and across nations. Income and resource disparities directly impact education, social indicators, and the health of populations. While it’s common knowledge to point out the various consequences of these asymmetries, quantified data on these global discrepancies, particularly regarding scientific production, remains scarce.

Quantifying Scientific Inequality in Intensive Care

Considering this gap, the authors sought to examine differences in scientific output in intensive care, a highly relevant topic given that other global pandemics, such as the one in 2020, may become increasingly frequent.

To collect the information, researchers classified all countries into different income brackets, defined according to the World Bank, and correlated the scientific output in critical care with each country’s gross domestic product (GDP). The data collection period was from 2018 to 2022, and scientists also gathered information on each country’s population, GDP, and GDP per capita for 2022.

Differences in Publication Volume Between Countries

The results indicated that high-income countries published 68.3% of general medical articles and 77.9% of intensive care articles over the five years analyzed. This discrepancy becomes more apparent considering that 75% of the global population lives in middle-income countries (MIC).

According to the study, as a country’s GDP per capita increases, so does its publication output. In middle-income countries, those with larger populations are also the most prolific publishers, such as India, China, and Brazil.

Dr. Antonio Paulo Nassar Junior, a researcher at IDOR who led the study, reveals that Brazil ranks 15th in terms of article production, contributing 1.9% of the global output in 2022. Over the analyzed years, this value ranged from 1.7% in 2018, increased to 2.2% in 2019, remained at 2.1% in 2020 and 2021, and dropped to 1.9% in 2022.

Regionally, North America and Europe lead in global publications, but the authors note that in the five years analyzed, low- and middle-income countries achieved a 5% increase in their scientific output.

Why Do Rich Countries Publish More?

According to researchers, the disparity is not solely due to richer countries having a higher GDP per capita but also because they allocate a larger percentage of their GDP to health, education, research, and development. These investments translate into more funding, greater resources, and better research infrastructure.

They also point out that the higher number of publications in Global North countries may be partly due to publication bias, as journals might prioritize submissions from prestigious institutions and authors in high-income countries. Additionally, although many journals waive processing fees for low-income countries, these fees still pose a barrier for emerging middle-income countries due to significant differences in researchers’ purchasing power.

Importance of the Study

Dr. Nassar Junior comments, “The study is important as it shows that inequalities in scientific production in intensive care—a field that proved vital during the pandemic—are greater than those occurring merely due to socioeconomic differences.”

He emphasizes that reducing the asymmetry in scientific production and medical care among the world’s inhabitants is essential, as these disparities lead to problems for the global population. “We live in a globalized reality where pandemics are a threat that knows no borders,” he notes.

Understanding the origins of this inequality in all its aspects, including economic, is an effort that can bring benefits and aid in implementing global public policies focused on science and medical care worldwide.

Written by Maria Eduarda Ledo de Abreu.