Correspondence

A Decline in the U.S. Share of Research Articles

N Engl J Med 2002; 347:1211-1212October 10, 2002DOI: 10.1056/NEJM200210103471523

Article

To the Editor:

The United States leads all other countries in productivity with respect to medical research.1-3 However, the relative contributions of countries to research are changing over time.

We examined different countries' shares of basic-science and clinical articles in 13 journals. On the basis of categories established by the Institute for Scientific Information4 and journal impact factors, we selected six basic-science journals (Cell, Nature, Nature Genetics, Nature Medicine, Neuron, and Science) and seven clinical journals (the American Journal of Medicine, the Annals of Internal Medicine, the Archives of Internal Medicine, the British Medical Journal, the Journal of the American Medical Association, the Lancet, and the New England Journal of Medicine). We searched the Medline data base in July 2001 to obtain information on the country affiliation for authors of journal articles published during the period from 1991 through 2000. We used the Internet to identify country affiliations when this information was not available in Medline.

From 1991 to 2000, a total of 23,168 articles were published in the six basic-science journals, and 26,945 were published in the seven clinical journals; the authors' affiliation was available for 22,577 (97.4 percent) and 23,807 (88.4 percent) of these articles, respectively. The shares of the top-ranking 20 countries for basic and clinical research articles are shown in Table 1Table 1Shares of Top-Ranking 20 Countries for Basic-Science Articles. and Table 2Table 2Shares of Top-Ranking 20 Countries for Clinical Articles.. In the past decade, the U.S. share declined from 69.7 percent to 58.3 percent (P for trend=0.03) of the total for basic-science articles and from 60.0 percent to 52.1 percent (P for trend=0.01) for clinical articles. We did not find a statistically significant negative trend in the share of articles over time for any other country. We found a statistically significant positive trend in the share of basic-science articles for Australia (P=0.04), Denmark (P=0.04), Japan (P=0.01), and the Netherlands (P=0.03) and in the share of clinical articles for Denmark (P=0.04), Germany (P=0.01), Israel (P=0.04), New Zealand (P=0.03), and Switzerland (P=0.01).

Our findings have some limitations. Although we selected journals with the highest impact factors, we studied only a small subgroup of all basic-science and clinical journals. In addition, some studies are conducted with multinational collaboration, and the Medline data base identifies only the affiliation of the corresponding author.

Our findings indicate that, over the past decade, the proportion of original research articles from the United States has decreased in relation to the proportion from other countries.

Mahbubur Rahman, M.B., B.S., M.P.H., Ph.D.
Tsuguya Fukui, M.D., M.P.H., Ph.D.
Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan

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