Provenance and Funding of Extremely Cited Biomedical Articles Published Between 2003 and 2024

Importance It is important to monitor changes in the biomedical literature and its funding. China has surpassed the US in publications and, in some analyses, in some impact indicators. Objective To evaluate changes over time in the profiles of the most highly cited biomedical publications. Design, Setting, and Participants This cross-sectional study assessed 100 top-cited biomedical articles (based on Scopus) published in each of 3 time periods (2003-2004, 2013-2014, and 2023-2024) for corresponding authors, types of publications represented, and funding sources, with an emphasis on funding from the US National Institutes of Health (NIH), which has been traditionally considered the major funder of biomedical research. Main Outcomes and Measures The main outcomes of interest are descriptive and include provenance (country of corresponding author), type of publication, type of funding, overall NIH funding, and NIH funding as the sole funding source. Results Among 100 top-cited biomedical publications, corresponding authors from the US decreased over time (59 of 100 articles in 2003-2004, 58 of 100 in 2013-2014, 45 of 100 in 2023-2024). Corresponding authors from China represented 0 top-cited publications in 2003-2004, 1 in 2013-2014, and 4 in 2023-2024. There was an increase in consensus articles (10 in 2003-2004 vs 24 in 2023-2024) and in reference statistics articles (1 in 2003-2004, 10 in 2013-2014, and 11 in 2023-2024). Reviews remained common among top-cited articles, but almost always were nonsystematic. NIH funding was listed in 45 publications in 2003-2004, 50 in 2013-2014, and 23 in 2023-2024. All other countries combined surpassed US public funding in 2023-2024. Funding by NIH in combination with other funders increased from 13 articles in 2003-2204 to 22 and 21, respectively, in 2013-2014 and 2023-2024, but funding by NIH alone decreased in the last decade (32 of 100 in 2002-2003, 28 of 100 in 2013-2014, and 2 of 100 in 2023-2024). More commonly listed funding from nonprofit organizations, societies, and institutions complemented the NIH funding decline. The first authors of 7 of 45 and the corresponding authors of 14 of 45 top-cited US-based articles of 2023-2024 were listed as leaders of active NIH grants in RePORTER as of February 2025. Citation gaming became more obvious in 2023-2024 with the advent of some atypical highly cited papers and a larger share of nonsystematic reviews and consensus documents. Conclusions and Relevance Results of this study suggest that, overall, the US remains a world leader regarding the most highly cited biomedical research and NIH funding retains a substantial presence among top-cited articles. However, NIH influence had decreased overall, and top-cited articles funded exclusively by NIH have almost disappeared. Strengthening public funding is essential to secure research that serves the common good.