Factors Related to Biomedical Research Productivity in Asian Countries

By and large, biomedical research is not a priority sector in Asian countries due to many factors. Lack of resources and trained manpower are certainly among these factors. We investigated the factors related to biomedical research productivity in Asian countries based on Medline data. The number of biomedical articles published in the indexed journals from each country of Asia and Oceania during 1990-1998 was used as a surrogate of total biomedical research productivity. Multiple regression analysis revealed that low gross national product per capita (p<0.013), insufficient number of physicians (p<0.047), and inadequate public spending on the health sector (p<0.049) were responsible for the meager number of biomedical publications in Asian countries. J Epidemiol, 2001 ; 11 : 199-202


INTRODUCTION
The reports on the number of biomedical publications of 20 top-ranking countries in the world, European union countries, and Asian countries have already been published 1-4).It is a harsh reality that most of the developing countries have neither adequate resources nor trained personnel for conducting sound biomedical research.Among Asian countries, Israel was ranked top on the list when the number of biomedical articles were normalized to per million population and per billion dollar (US$) gross domestic product (GDP) per year, while Singapore was on the top when it was normalized to number of physicians (Table 1) 4).However, factors related to volume of biomedical publications are not examined yet.We considered Medline database as the reflection of standard research activities in each country as it is very difficult to quantify it by other means.The objective of this study is to elicit factors associated with low biomedical research productivity in Asian countries with a view to suggest macro level change to improve it.There are wide variations in gross national product (GNP) per capita in Asian countries.Asia is probably the only continent where low-income, middle-income and high-income countries are well-represented.Therefore, we included this region to exam-ine the factors related to biomedical research productivity.

MATERIALS AND METHODS
Medline database was searched in October, 1999 to obtain research volume in Asian countries (including Oceania) with the use of the internet provider PubMed, according to the method described by Thompson 5).First, advanced-search option was selected and, then "publication date" (1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998) was entered to find out the total number of publications published during 1990-1998.After that, "affiliation" field was searched for each country of Asia and Oceania.Data obtained by this process were normalized to publication per million population per year for each of the countries.We selected 1990 as the first year for the search, because reliable data on authors' affiliations were not available through PubMed before 1990 .The data on population, GNP per capita, public expenditure on the health sector (% of GDP), number of physicians , and the number of indexed journal (s) published in each country were obtained from the reports published by World Bank (http://www.worldbank.org/data/countrydata/countrydata.html),United Nation Development Programme (http://www.undp.org/hdro/health.htm),and National Library of Medicine (http://www.nlm.nih.gov/tsd/serials/Iji.html).Multiple regression analysis was performed to elicit significant factors related to biomedical research productivity.Publications per million population per year was considered as dependent variable in logarithm scale.The independent variables were GNP per capita, public expenditure on the health sector (% of GDP), physician size per thousand population, and the number of indexed journal (s) published from each country.Besides, Spearman rank correlation coefficient procedure was also performed to see the relationship of each of the independent variables with the dependent variable.All data were analyzed using STATA statistical software 6).

RESULTS
Information on all the variables was available regarding 31 Asian and Oceania countries.Publications per year were ranged from 0.2 to 24,735 (0.13 to 587.9 per million population per year).GNP per capita and the number of physicians per thousand population were US$ 220-38,160 and 0.05-4.59,respectively.Variations were also observed regarding the number of indexed journal(s) published from each of the countries (0 to 123) and public expenditure on the health sector (0.7 to 5.7%).Multiple regression analysis showed that GNP per capita (p<0.013),number of physicians per thousand population (p<0.047), and public expenditure on the health sector (% of GDP) (p<0.049) were significantly related to biomedical research productivity (r2 = 0.75) (Table 2).Relationship of publications per million population per year with GNP per capita, physician(s) per thousand population, public expenditure on the health sector (% of GDP), and number of indexed journal(s) published from each country are shown in Figure 1.

DISCUSSION
The number of publications elicited from Medline is only a gross estimate of research productivity irrespective of their quality.Besides, many local journals are being published in each country and many of those are not cited in Medline.In particular, in Japan and China, many journals are being published in their respective languages and most of them are not included in Medline database.On the other hand, in many countries, journals are being published in English but not included in Medline database, although most of these Jourrals are recognized by respective country's research council.Besides, possibly in every country, researches are also con-  ducted at non-governmental and international organizations and then remain as intramural reports rather than to be published in peer-reviewed journals.So, if these were included, actual number of research output could be much higher than In conclusion, low GNP per capita, insufficient number of physicians, and inadequate public spending on the health sector are related to the meager number of biomedical publications in Asian countries.

Figure 1 .
Figure 1.Relationship of publications per million populations per year (with Spearman's rank correlation coefficient and p values) withGNP per capita (in US$), physician(s) per thousand population, public expenditure on the health sector (% of GDP) , and the number of indexed journal (s) published from each of the countries.
the current results.There may be other factors related to bio-policy, and general attitude towards research, might have some linkage with research output.However, no systematic data exist on these factors at the present time.It is therefore worthwhile to have a gross impression about the probable factors related to biomedical research productivity.

Table 1 .
Top ten countries in Asia and Oceania region based on publications

Table 2 .
Results of multiple regression.
R-squared value = 0.75 Dependent variable = Biomedical publications per million population per year (in logarithm scale)