Is there an association between the behavioural risk factor burden at a given World Bank income level with research output?

Objectives: Alcohol & drug use (A&D) and dietary risks are two increasingly important risk factors. This study examines whether there is an association between the burden of these risk factors in countries of specific income bands as defined by the World Bank, and the number of primary studies included in Cochrane Systematic Reviews (CSRs) conducted in those countries.

Methods: We extracted data from primary studies included in CSRs assessing these two risk factors as outcomes. For each, we obtained data on its overall burden in disability-adjusted life years (DALYs) by World Bank Income Levels and tested for an association between DALYs and the number of primary studies and also their participants.

Results: We included 1601 studies from 96 CSRs. Only 18.3% of the global burden for A&D is in high income-countries (HICs) but they produced 90.5 % of primary studies and 99.5% participants. Only 14.2% of the dietary risk burden is in HICs but they produced 80.5% of primary studies and 98.1% participants.

Conclusion: This study demonstrates the significant imbalance of research heavily weighted towards HICs. More initiatives are required to address this inequality and promote health research in low and middle-income countries.