The Global Imbalance in Telemedicine Research: An Analysis of Knowledge Production and Socioeconomic Drivers

Abstract Background This study aims to explore disparities in telemedicine research, investigate the impact of the COVID-19 pandemic on these inequalities, and examine the association between various socioeconomic factors and telemedicine research output across Low- and Middle-Income Countries (LMIC) and High-Income Countries (HIC), and World Health Organization (WHO) regions. Methods A comprehensive search strategy was developed to identify telemedicine-related documents (2018–2022) in Scopus and SciVal, with false positives and negatives resolved. Mann-Whitney U and Wilcoxon Signed Rank tests compared publication volume and Field-Weighted Citation Impact (FWCI). A novel metric, Research Interest (RI), was calculated by dividing telemedicine publications by total outputs in medicine and life sciences. WHO regions were ranked using TOPSIS. Spearman Rank Correlation assessed links between socioeconomic variables and research output separately in HIC and LMIC. Analyses were conducted using R (v4.3.2). Results We retrieved 16,584 telemedicine-related articles: 4,244 from 58 LMIC and 13,622 from 47 HIC, including 1,282 collaborative publications (30% of LMIC and 9.4% of HIC outputs). HIC consistently produced more publications than LMIC. While FWCI differences were significant in the pre-COVID era (Cliff’s Delta = 0.48), no significant difference was observed post-COVID. RI for telemedicine showed no significant difference between HIC and LMIC in any timeframe. The Western Pacific led in quality metrics, while the Americas ranked highest overall. Southeast Asia ranked lowest in both. Exclusively among HIC, Health Expenditure (Purchasing Power Parity adjusted) (r = 0.63, r = 0.45) and Human Development Index (r = 0.50, r = 0.47) were moderately, and ICT service exports (USD) (r = 0.72, r = 0.33) were strongly correlated with both telemedicine scientific output and RI. Conclusion Global inequalities in telemedicine research favor HIC, though the gap narrowed post-COVID. Among HIC, telemedicine research patterns more proportionately reflect socioeconomic indicators, research capacity, infrastructure, and domestic health needs.