Global Authorship Representation in Otolaryngology Clinical Trials

Objective: To investigate global authorship representation in clinical trials published in major general otolaryngology journals over the past two decades. Methods: We conducted a bibliometric analysis of clinical trials published in four major general otolaryngology journals between 2000 and 2020. The affiliated nationalities of authors in leading positions (first, senior, corresponding) were reviewed for each trial. Countries were classified by World Bank income group. The temporal trajectory of representation was estimated in multivariable logistic regression models, adjusting for publication environment and study design. The academic impact of trials across income groups was also compared. Results: Among 1432 trials, the leading authors for most were affiliated with non-USA nations (57%) and high-income countries (HIC) (87%). Trials led by authors from upper-middle income countries (UMIC), lower-middle income countries (LMIC), and low-income countries (LIC) were severely underrepresented (11%, 3%, 0%, respectively). Over time, non-USA representation increased (+0.5%, 95% CI [+0.13%, +0.92%] per year), HIC representation decreased (-0.45% [-0.77%, -0.12%]), UMIC representation remained stable (0.19% [-0.13%, 0.51%]), LMIC representation mildly increased (0.26% [0.16%, 0.35%]), and LIC representation remained absent (0%). UMIC author-led trials (aIRR 0.80 [0.68, 0.94]) received significantly fewer citations compared to HIC author-led trials regardless of study design and publication year. Conclusions: The clinical trial literature in the four most widely circulated OHNS journals is dominated by HIC authorship, with only marginal growth in LMIC contributions and no representation from LICs over the past two decades. This underrepresentation may impact the applicability of clinical guidelines in lower-income regions.