Does health and medical research consider geographic factors affecting study participants: a retrospective snapshot analysis of 11 leading journals

  • Stuart WarkEmail author
  • Natasha Hardikar
  • Martin Wensing
  • Bonnie Lau
  • Joanne Anugerah
  • Gary Wallace
  • Destiny Powell
  • Henry Thai
  • Jessica Zhou
  • Alycia Senthinathan
  • Ann Le
Original Article



Research has identified that rurally located persons face health inequities when compared to their urban peers. While health policies and practice frameworks to address the needs of rural people are largely developed on the principles of evidence-based medicine, it is not clear whether this evidence base appropriately considers geographic factors that may impact participant outcomes. The purpose of this project was to examine whether research within leading health and medical journals identified the geographic classification (location) of their participants, thus enabling the original authors and subsequent readers to appropriately consider this factor in the making of policy and practice recommendations.


A retrospective analysis of study participants’ geographic identifiers within articles from medical and health journals was carried out in this project. Eleven journals were chosen for evaluation, with 300 consecutive eligible papers from each journal retrospectively reviewed. All 3300 papers were analyzed to determine whether the research participants’ geographic location was identified. This classification was then stratified into varying categories of rural or urban, as appropriate.


It was not possible to identify participants’ geographic location in 2193 (66%) of the 3300 reviewed articles. A total of 121 papers (4%) had sole focus on rural residents, with another 95 articles (3%) comparing outcomes between rural and urban locations. Slightly more than a quarter (27%) of the articles either just featured urban participants or made no distinction between rural and urban locations.


These findings indicate that insufficient attention is given to the geographic location of participants. This failure means that the outcomes and recommendations of the research base may be invalid for a large section of the world’s population and result in inequities in healthcare services. There is an emerging concern about using this evidence base for developing health guidelines and policy frameworks, as the needs of a substantial proportion of the population may not have been appropriately captured.


Rural Urban Geographic inequity Evidence-based medicine Health guidelines Health practice 


Author contributions

Conceptualization, S.W.; methodology, S.W.; data collection, S.W., N.H., M.W., B.L., J.A., G.W., D.P., H.T., J.Z., A.S., A.L.; validation, S.W., N.H., M.W., B.L., J.A., G.W., D.P., H.T., J.Z., A.S., A.L.; formal analysis, S.W., N.H., M.W., B.L., J.A., G.W., D.P., H.T., J.Z., A.S., A.L.; investigation, S.W., N.H., M.W., B.L., J.A., G.W., D.P., H.T., J.Z., A.S., A.L.; writing – original draft preparation, S.W..; writing – review and editing, S.W., N.H., M.W., B.L., J.A., G.W., D.P., H.T., J.Z., A.S., A.L.; project administration, S.W.


There was no funding to declare.

Compliance with ethical standards

Ethics approval and consent to participate

This study did not require ethical approval as it was a retrospective analysis of journal articles published in 11 leading medical and health journals.

Consent for publication

Not applicable.

Conflict of interest

The authors declare that they have no competing interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Stuart Wark
    • 1
    Email author
  • Natasha Hardikar
    • 1
  • Martin Wensing
    • 1
  • Bonnie Lau
    • 1
  • Joanne Anugerah
    • 1
  • Gary Wallace
    • 1
  • Destiny Powell
    • 1
  • Henry Thai
    • 1
  • Jessica Zhou
    • 1
  • Alycia Senthinathan
    • 1
  • Ann Le
    • 1
  1. 1.School of Rural MedicineUniversity of New EnglandArmidaleAustralia

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