Global disparities in pediatric neurosurgery research: a 20-year bibliometric analysis by country income group

Purpose Pediatric neurosurgical diseases are most prevalent in low-income (LICs) and low-middle-income countries (LMICs), yet these regions have limited representation in global neurosurgical workforce. To assess whether scholarly output reflects this burden, we conducted a 20-year bibliometric analysis of pediatric neurosurgery publications, evaluating trends by country income level. Methods We analyzed publications on “pediatric neurosurgery” indexed in Web of Science from 2005–2024. Author affiliations were categorized by World Bank income groups: high-income (HIC), upper-middle-income (UMIC), LMIC, and LIC. Lorenz curves and Gini coefficients assessed authorship inequality, with Mann–Kendall test evaluating trends over time. Results Of 3,014 publications from 116 countries, HICs contributed 84.18% of overall authorship. In contrast, UMIC, LMIC, and LIC contributed to 16.70%, 9.59%, and 3.05%, respectively. Multi-country collaborations accounted for 23.79% of all publications, with HIC only (48.43%) partnerships most common, followed by HIC-UMIC (17.09%), and HIC-LMIC (16.24%). No LIC only partnerships were identified. HIC authorship declined from 86.82% to 77.78% over study period (p < 0.001). In contrast, UMIC, LMIC, and LIC share rose from 11.50% to 21.72%, 5.43% to 13.20%, 0.90% to 3.68%, respectively. First authorship trends mirrored overall authorship, although LIC representation remained unchanged (p = 0.138). Gini coefficients declined, indicating reduced research inequality over time (tau = − 0.66, p < 0.001). Conclusion Despite growing international collaborations and a gradual shift towards more equitable authorship, contributions from LICs and LMICs, particularly in first and corresponding author roles, remain limited. Investment in research capacity, mentorship, and inclusive partnerships is critical to ensure the literature reflects the populations most affected by pediatric neurosurgical disease.