Who's Contributing Most to American Neuroscience Journals: American or Foreign Authors?

Discussion

We demonstrated the rates of American and non-American authorship in American-published clinical neuroscience journals across neuroradiology, neurology, and neurosurgery specialties during 21 years. As we hypothesized, we found a larger contribution of authors from non-American institutions in neuroradiology compared with neurology and neurosurgery. There was a significantly decreasing trend in American authorship ratios across the 21 years in neuroradiology, but we did not find any such significant trend in neurology and neurosurgery. In addition, Japan was the most frequent non-American country supplying publications in American neuroradiology and neurosurgery journals, while the UK was the leading non-American country in neurology. Nevertheless, the influence of Japan has been decreasing with time in all 3 fields, even as the contributions of China show a significant uptick in publications. Overall, we found that the contributions from Asian institutions have affected neuroradiology and neurosurgery more than neurology. We also found that American articles received more citations per article; this effect was more pronounced in neurology and neurosurgery and was not significant in neuroradiology.

We found that in 15 of 21 years, American neuroradiology journals published more articles with first authors from non-American institutions than American institutions in the May edition. Although this effect can be seen in some years before 2007, it is more pronounced in the past 10 years in the neuroradiology field (Fig 1). Similarly, there was a tendency to publish articles with first authors from non-American institutions in neurology journals (12/21 years), especially in the last 7 years (Fig 1). On the other hand, American neurosurgery journals, for most years, published more articles from American institutions (14/21 years). When we compared the 3 fields, neurology and neurosurgery journals had a higher ratio of America-to-non-American authorship compared with neuroradiology. In addition, we found a decreasing trend in American authorship ratios across the 21 years in neuroradiology. This trend could be due to several factors, including more familiarity with the English language through the universality of the Internet with English the preferred language of communication in the science world.⁸ This facilitates writing articles and the submission process for international authors. The narrowing of what previously was a technology gap between the United States and other countries could be another facilitating factor. Growth in global collaboration would be another reason for the observed result; when we looked at the first author's institution, however, there were articles with authors collaborating from different countries, especially in more recent years. Across the years, changes in research funding in the budget of the National Institutes of Health and in the budgets of foreign countries may affect research participation and publishing trends.⁹ The decline in Medicare reimbursement recently has also led to more emphasis on relative value unit production, even in American academic medical centers, and that may impact academic activities.¹⁰ We also question whether the American millennial generation is less inclined to spend hours outside the traditional work week performing research the way previous generations may have.

The increased contribution of foreign countries can be beneficial to American journals; for example, China has studies with larger sample sizes owing to its massive population. The US literature is benefiting from outstanding researchers who do not live in United States; some studies, because of the regulations placed on American researchers, simply cannot be conducted in the United States. On the other hand, the decreasing trend may be a concern for US academic medical centers. We posit that both the clinical workload and lack of financial support for research could explain decreased American institution contributions in high-impact American journals. The clinical workload as measured by the relative value unit continues to increase¹¹ in radiology, which may mean less time for research unless funded by grant support. Devoting more internal and extramural funds to the neurosciences and radiology has been recommended in the past.¹² It is estimated, however, that National Institutes of Health support for diagnostic radiology will decrease in 2018.¹³ Inadequate funding would eventually lead to less education on clinical research for students, residents, fellows, and young faculty, setting the stage for a negative impact in the years ahead.¹⁰ Publishing in high-impact journals can be a bonus to attract younger, talented radiologists to academic settings as they decide between private and academic jobs. Increasing the funding resources and not relying on only government support are crucial to expanding the research activity. We also suggest that incorporating more training in research methodology in residency and fellowship programs may help overcome some hurdles that may prevent academic contributions by trainees. At a local level, more recognition by department chairs for manuscript publication/grant procurement rather than clinical activity could be accomplished by shifting monetary incentives, awards, public commendation, and advancement in rank in favor of academic output, not relative value unit production. Universities can educate the younger generation on the benefits of high-impact research and the occasional need for effort beyond the standard work week to accomplish those goals. Adding funded research years to residencies and offering these tracks as a separate Accreditation Council for Graduate Medical Education–approved program have been successful in such programs initiated at the University of Pennsylvania and Johns Hopkins.

Few studies have addressed the authorship trends based on nationality in the neuroscience fields. Lim et al¹⁴ assessed the first author nationality of 2 radiology journals, Radiology and the American Journal of Roentgenology, for a 10-year period. They found that the Japanese are the leading authors after Americans in these 2 general radiology journals. Our study also had this finding in neuroradiology. Lim et al also showed that authors from other Asian countries including Korea increased significantly in this period.¹⁴ In our study, we showed that of Asian countries, China is on the rise while Japan had a decreasing contribution trend in American literature.

The national origin of the institution may impact the publication and citation rates if the authors are from nondeveloped and non-English-speaking countries because there are barriers to access to advanced technology and language proficiency.^15⇓–17 We found that from non-American countries, European followed by Asian institutions had the most articles in the American neurology and neuroradiology literature. In American neurosurgery journals, articles from Asia had an equal or greater number of contributions compared with European institutions. Most interesting, we observed an increasing contribution trend from Australia in all 3 fields of neuroscience.

We found that from 1997 to 2017, articles originating in the United States had higher average numbers of citations than articles originating in other countries for most years in all 3 fields and significantly in neurosurgery and neurology. Our results are in line with those of previous studies showing that the most cited articles usually originated in the United States.^18⇓–20

As other studies indicated, several factors are associated with a higher number of citations for articles originating in the United States, including the following: 1) the large size of the scientific and especially radiology community in the United States, 2) massive financial resources in the United States, and 3) American authors' tendencies to cite articles that originate in the United States rather than abroad,^18,21,22 which may represent unconscious or implicit bias. This bias is defined as attitudes that affect understanding, actions, and decisions in an unconscious manner, favoring American publications. Journal editors confront implicit bias in peer review; though a large proportion of submissions to American journals come from China and other countries in Asia, these countries remain underrepresented in terms of manuscripts accepted.²³

Several limitations are noteworthy. First, we collected data from only 2 journals in each of the 3 fields and only 1 month (May issue) in each year. The 2 journals were selected on the basis of the Internet references provided for American journals that had the highest Impact Factor. The bias is that these are journals published in America. This might limit our generalizability, though we believe we collected many articles compared with other similar bibliometric studies. Second, regarding the number of citations in an article, we recognize that there is a direct relationship between publication year and the number of citations accumulated. The number of citations expected by 2017 for an article published in 2015 is likely much less than one that has 10–15 years to accumulate citations. Nonetheless, this factor holds true for all articles and all 3 journals and would not be biased between American and non-American authors.