Equity and representation in cardiology research: a comprehensive analysis of authorship from low and low-middle income countries in leading cardiology journals

Abstract Background Cardiovascular disease is the leading global cause of mortality, with low-income and low-middle-income countries (LICs/LMICs) bearing a disproportionate burden. Despite this, research output is skewed towards affluent regions. This study aims to assess the authorship trends from LICs/LMICs in cardiology research in 5 of the leading cardiology journals. Methods PubMed authorship affiliation was obtained from 2000-2022 in (1) Journal of the American College of Cardiology (JACC), (2) Circulation, (3) Journal of the American Medical Association (JAMA) Cardiology, (4) Nature Reviews Cardiology, (NRC) and (5) European Heart Journal (EHJ). Countries were classified according to the World Bank. Results 62873 original research, clinical cases, editorials, and reviews were published in all five journals (2000-2022). The percentage of articles with at least one author affiliated with an institution from a LIC or LMIC was 1.03% (N=652): 0.96% (N=190) in JACC, 0.82% (N=198) in Circulation, 2.42% (N=51) in JAMA Cardiology, 0.84% (N=22) in NRC, and 1.33% (N=191) in EHJ. There has been an increase in the representation of authorship from LICs and LMICs in the last decade. However, the distribution of authorship between LMICs and LICs is uneven, represented mainly -by Mozambique, Uganda, Sudan, and Ethiopia for LICs, and India, Iran, Egypt, Pakistan and Lebanon for LMICs. Discussion: Our findings reveal an underrepresentation of authors from institutions from LICs and LMICs in these 5 leading cardiology journals. Efforts to enhance funding, access, and inclusion of authors from LICs and LMICs are imperative to advance global cardiovascular outcomes and promote equity in medical research.