Abstract
Objective
To determine the global diversity in geographical and economic class of countries contributed to group of American cardiology meetings in 2019 and 2020 (prior to and during COVID-19 pandemic).
Methods
Cross sectional recording of contributing authors’ countries for abstracts of three American College of Cardiology Congress (ACC), Heart Failure Society of America meeting (HFSA) and Transcatheter Cardiovascular Therapeutics (TCT) meeting. Analysis of these contributions according to continent and World Bank Class of the contributing countries was done.
Results
total 10,609 contributions from 95 countries were analysed. After excluding US, Asia had the highest contribution to ACC meetings in 2019 (45.44%) and 2020 (42.63%), p = 0.0002, while Europe had the highest contributions to both HFSA (58.78% in 2019 and 47.42% in 2020), p = 0.07 and TCT (63.25% in 2019 and 55.86% in 2020), p = 0.0002. Middle income countries (MIC) contributions increased from 14.96%, 10.02%, 6.06% in 2019 (pre COVID19) to 19.29%, 19.34%, 17.52% in 2020 (COVID19 era) in ACC, HFSA and TCT respectively.
Conclusion
Researchers from low- and middle-income countries are under-represented in high impact American cardiology meetings with higher contributions in COVID-19 era. It is pivotal to enhance collaboration with them to reflect the real solidarity for which we are calling during and beyond the pandemic.
Keywords: Equity, COVID-19, Disparity, Developing countries, World Bank
1. Introduction
Cardiovascular disease (CVD) burden is increasing at alarming rate in low- and middle-income countries (LMIC), yet, there is lack of pragmatic evidence-based guidelines for prevention and management of CVD in these countries [1,2]. To bridge this equity gap, we need better representation of researchers from LMIC in cardiology meetings to increase networking to achieve equal career opportunities and to benefit from their overlooked perspectives. During COVID-19 pandemic virtual science becomes a crucial part of scientific collaboration which will further bridge this equity gap in science. Up to our knowledge there is no data in general on global diversity in American cardiology meetings as well as no data in particular on how COVID-19 impacts global diversity in these meetings. In response, we sought to determine the global diversity in term of geographical and economic class of countries contributed to group of American cardiology meetings in two years 2019 (prior to COVID-19 pandemic) and 2020 (in COVID-19 era).
2. Methods
A cross sectional study was conducted to analyse 3 American cardiology meetings: American College of Cardiology Congress (ACC), Heart Failure Society of America meeting (HFSA) and Transcatheter Cardiovascular Therapeutics meeting (TCT). Published abstracts of these meetings were collected for the years of 2019 and 2020. For 2020 all included meetings were held on virtual basis because of COVID-19 pandemic. The following journals were searched for the published abstracts: Journal of American College of Cardiology (for ACC and TCT abstracts) and Journal of Cardiac Failure (for HFSA abstracts). For each abstract; the contributing authors’ countries were recorded. The term contribution in this study determined by the number of countries contribute by authors for each abstract. For example, if five authors from three different countries contribute to one abstract then the number of contributions is 3. We aimed to assess the research contribution from each country rather than from each author, so, when an author from certain country had more than one abstract, we were recording the country for each abstract on its own with no merging of data. The contributing countries were then classified according to their continent and their World Bank economic classification (Low-income countries [LIC], middle-income countries [MIC] and high-income countries [HIC]) [3]. As most contributions were from US and we aimed to assess the global contributions mainly from non-US researchers and in order to validate the analysis, US contributions were expressed in data but was excluded from the analysis of contributions according to the continent or the economic class of author's country.
Data were coded and input into Excel 2019, frequency of authors’ contributions expressed as percentage and compared between groups using Chi square test, statistical significance set at p value less than 0.05. No ethical committee approval was requested for this study.
3. Results
Number of included abstracts was 8695, a total 10,609 contributions from 95 countries were analysed. Highest contributions after excluding US were from Japan, UK, China and Canada, Fig. 1. After excluding US, Asia had the highest contribution to ACC meetings in 2019 (45.44%) and 2020 (42.63%), p = 0.0002, while Europe had the highest contributions to both HFSA (58.78% in 2019 and 47.42% in 2020), p = 0.07 and TCT (63.25% in 2019 and 55.86% in 2020), p = 0.0002. Most contributions to all the included meetings were from HIC, however, MIC contributions increased from 14.96%, 10.02%, 6.06% in 2019 (pre COVID19) to 19.29%, 19.34%, 17.52% in 2020 (COVID19 era) in ACC, HFSA and TCT respectively with TCT and HFSA had statistical difference according to economic class of the contributing author's country, Fig. 2.
Fig. 1.
Global scientific contributions in American cardiology meetings in pre- and during COVID-19 era*.
*US was presented in the top figure as most contributions were from US, so to change the scale the non-US contributions were presented in bottom figure.
Fig. 2.
Global scientific contributions in American cardiology meetings in pre- and during COVID-19 era according to authors' continent and authors' country economic class*.
*As most contributions were from US, US was excluded from the analysis so to validate the analysis and to view precisely the global contribution proportions.
4. Discussion
Current analysis brought into view the global diversity in scientific contributions to sample of high impact American cardiology meetings with results showing remarkable equity gap in representing LIC and MIC in these meetings. Yet we observed an increase in contributions from MIC countries in all included meetings in 2020 compared to 2019, which indicates that virtual meetings can overcome some of the previously reported barriers faced by researchers from these countries like VISA issues, travel expenses and conference fees [2,4,5].
The economic class of authors countries impacted significantly their contributions to both TCT and HFSA meetings but not ACC congress. Unlike TCT and HFSA; the submission of abstracts to ACC 2020 was prior to the pandemic and initiation of virtual meetings, so the authors from LMIC did not submit more abstracts compared to ACC 2019, however, there is non-significant increase in their contributions to ACC 2020 compared to ACC 2019 which might be explained by the ability of the authors to attend meetings in 2020 by virtual science so their abstracts got published in contrast to ACC 2019.
One of the main barriers for attending international meetings for researchers from these countries is VISA obstacles which are faced by researchers from Asia then Africa in 40% and 34% respectively compared to 9% by researchers from Europe or North America [2,6].
Researchers from LMIC are having unimaginable difficulties in conducting clinical researches especially in absence of clear institutional policies and protocols, collapsed healthcare infrastructure, absent electronic database, lack of mentorship, lack of funding and credits for research work, absent educational or travel grants, yet, many of them are doing their best and are engaging by all means with scientifically sound researches that have been accepted in high impact international congresses which are well recognized for the rigorous peer reviewing of submitted researches. After the hard journey of conducting clinical researches and getting their work accepted, those researchers start pursuing the endless bureaucratic steps of VISA application process with VISA rejection are continuing to become an excruciating result. This calls for urgent actions by cardiology societies to step forward to collaborate by every way including scientific networking, hybrid meetings and providing educational grants to achieve the conference equity that should be a fact not a fiction.
Main limitation of study is that we included only the published abstracts as representation for scientific contributions while other forms of contributions like oral presentations and workshops were not included.
5. Conclusion
There is a remarkable diversity gap in representing researchers from low- and middle-income countries in high impact American cardiology meetings, yet there is significant increase in their representation during COVID-19 era compared to prior to the pandemic, probably due to virtual meetings. Considering the high burden of CVD in LMIC, it is pivotal to enhance collaboration with researchers from those countries in recognized cardiology meetings which can reflect the real solidarity for which we are calling during and beyond the pandemic.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
CRediT authorship contribution statement
Zainab Dakhil: Conceptualization, Methodology, Data Collection, Statistical analysis, Drafting original manuscript.
Hind Saeed: Data collection, Critical Revision and Editing.
Hala Alzubaidi: Data Collection, Critical Revision and Editing.
All authors revised and approved final manuscript.
Declaration of competing interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgments
Acknowledgement
None.
References
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