Scientific Output in Septic Shock According to Country Income and Gender: A Meta-Epidemiological Study

Objectives: We aimed to assess trends in septic shock publications by country income and author gender. Data Sources: We systematically searched PubMed, Embase, and Web of Science for articles indexed with “septic shock” between January 2014 and December 2024. Study Selection: All peer-reviewed publication types were eligible. Conference abstracts and non–peer-reviewed material were excluded. Data Extraction: Bibliographic data, first and last author affiliations, country income level (World Bank classification: low- and middle-income countries [LMICs] and high-income countries [HICs]), and journal prestige (SCImago Journal Rank [SJR]) were extracted. Author gender was inferred using the NamSor application programming interface (API). Data Synthesis: Of 10,352 eligible publications, LMIC-affiliated first authors increased over time (+2.13% per year; 95% CI, +1.66 to +2.61; p < 0.001) from 18% in 2014 to 37% in 2024. Women represented 35.6% of first authors and 25.0% of last authors (with around 20% of authors not classifiable by the NamSor API), with higher proportions in LMICs than HICs ( p < 0.001) for both first authors (44.5% vs. 32.5%) and last authors (35.2% vs. 21.5%). Gender concordance was more frequent, with female first authors more often paired with female last authors than male first authors (31.7% vs. 21.1%). Cross-income collaborations, especially involving LMIC last authors, remained rare. Articles led by men in HICs were more often published in higher-SJR journals compared with those led by women ( p < 0.001), whereas no gender differences were observed among LMIC-affiliated authors. Conclusions: Despite encouraging growth in LMIC contributions and female representation, major inequities persist. Strengthening equitable collaborations and supporting underrepresented groups would broaden participation and enhance the global applicability in critical care research.