A 20-Year Analysis of Global Authorship Trends in Craniofacial Literature: is the United States Falling Behind?

Introduction: Recent advances in craniofacial surgery have occurred in conjunction with a global proliferation of research. Although previous studies have examined geographic publication trends, little is known about these trends in the craniofacial literature. Methods: All craniofacial articles published from 2000 to 2020 in 3 premier craniofacial surgery journals were evaluated in 5-year increments. Geographic origin, manuscript type, and authorship characteristics were collected. Changes in publication output, geographic origin, and content were analyzed. Results: In total 3864 articles were analyzed, with the United States (U.S.) (33.46%) accounting for the majority, followed by Asia (27.04%), the Middle East (16.23%), and Europe (14.65%). The proportion of articles from the U.S. decreased significantly in the in the 20-year span (48.28% versus 33.53%, P < 0.001), whereas those originating from Asia and the Middle East increased significantly (18.62% versus 31.41% and 10.34% versus 15.66%, respectively, P < 0.001). After stratifying and selecting for regions with the greatest changes in publication output, the authors observed significant trends for the number of original investigations from 2000 to 2020 in the U.S. (Odds Ratio [OR] 1 versus 2.4, P < 0.001) and in Asia (OR 1 versus 1.8, P = 0.0052). Additionally, a significant trend in editorial/correspondence publications originating in the U.S. (OR 1 versus 0.74, P = 0.0102), Europe (OR 1 versus 0.38, P = 0.0186), and Asia (OR 1 versus 0.48, P = 0.0051) was observed. Conclusions: Despite rising craniofacial publications over the past 2 decades, there has been a diminishing proportion originating from the U.S.