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Article

Analyzing the Drivers Behind Retractions in Tuberculosis Research

by
Franko O. Garcia-Solorzano
1,2,*,
Shirley M. De la Cruz Anticona
2,
Mario Pezua-Espinoza
2,
Fernando A. Chuquispuma Jesus
2,
Karen D. Sanabria-Pinilla
3,
Christopher Chavez Veliz
2,
Vladimir A. Huayta-Alarcón
2,
Percy Mayta-Tristan
1,2 and
Leonid Lecca
4,5
1
Research Group on Bioethics and Scientific Integrity, Universidad Científica del Sur, Lima 15067, Peru
2
Faculty of Health Sciences, Universidad Científica del Sur, Lima 15067, Peru
3
Department of Outpatient and Inpatient Care, Hospital de Emergencias Villa El Salvador, Lima 15837, Peru
4
Partners In Health—Socios En Salud Sucursal, Lima 15046, Peru
5
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
*
Author to whom correspondence should be addressed.
Publications 2025, 13(1), 4; https://doi.org/10.3390/publications13010004
Submission received: 15 October 2024 / Revised: 27 November 2024 / Accepted: 6 January 2025 / Published: 14 January 2025
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Versions Notes

Abstract

:
Tuberculosis research plays a crucial role in understanding and responding to the necessities of people with this disease, yet the integrity of this research is compromised by frequent retractions. Identifying and analyzing the main reasons for retraction of tuberculosis articles is essential for improving research practices and ensuring reliable scientific output. In this study, we conducted an advanced systematic literature review of retracted original articles on Tuberculosis, utilizing databases such as Web of Science, Embase, Scopus, PubMed, LILACS, and the Retraction Watch Database webpage. We found that falsification and plagiarism were the most frequent reasons for retraction, although 16% of the retracted articles did not declare the drivers behind the retraction. Almost half of the retracted studies received external funding, affecting not only those specific studies but future funding opportunities for this research field. Stronger measures of research integrity are needed to prevent misconduct in this vulnerable population.

1. Introduction

Tuberculosis (TB) remains the infectious disease with the highest mortality rate worldwide. It has already regained its unfortunate global leadership, which was only overtaken in 2020 and 2021 by COVID-19 (World Health Organization [WHO], 2024). Therefore, multiple strategies are required to mitigate this epidemic, and the development and increase in funding for TB research and innovation are among the top priority pillars (Treatment Action Group, 2022).
The promotion of increased research should be aligned with an increase in the scientific and ethical competence of researchers and scientific journals. However, the number of retracted articles per year has increased over the past two decades, although it remains unclear whether this trend is due to heightened attention to retractions in recent years (Van Noorden, 2023; Gaudino et al., 2021).
Recent investigations have shown that scientific misconduct, including practices such as plagiarism and data falsification, represent the predominant cause of retractions in biomedical sciences (Hwang et al., 2023). These findings underscore the critical need for enhanced specificity and standardization in retraction notices to facilitate greater transparency and comprehension of the justification underlying such decisions. Moreover, there has been a substantial increase in scholarly attention directed toward understanding the characteristics and implications of retractions, particularly within the medical field, where compromised research integrity can have profound implications for clinical decision-making processes (Kohl & Faggion, 2024).
Especially during the COVID-19 pandemic, research related to respiratory diseases highly increased due to the demand for information to mitigate the pandemic, and as a consequence, publication processes were accelerated. A trend analysis of retracted articles, before and during the COVID-19 pandemic up until 2023, showed no clear differences for most medical fields. However, an increased trend was found for COVID-19 retracted studies, as well as a slight rise in retracted influenza and TB research, which may be explained by the increased interest in studies related to infectious respiratory diseases during the pandemic (Furuse, 2024).
Previous studies analyzing reasons for the retraction of COVID-19 studies reported data concerns, duplicated publication, and concerns about the peer review process as the main reasons for retraction. Notably, a high proportion of articles were categorized as “no information” regarding the reason for retraction (Shimray, 2023; Khurana et al., 2024; Alexander et al., 2024). This suggests that factors such as social pressure, competition among researchers, and funding institution interests may have increased the susceptibility to scientific misconduct (Schonhaut, 2019).
Tuberculosis often disproportionally affects the most vulnerable populations, such as individuals living in poverty, those with limited access to healthcare, and people living in high-density areas, such as incarcerated and refugee populations (Litvinjenko et al., 2023). This vulnerability also increases the susceptibility to ethical breaches in research (González-Duarte et al., 2019), highlighting the importance of analyzing TB articles with ethical issues related to misconduct.
Moreover, it has been reported that among the five countries with the highest rates of article retraction and increasing trends in retraction globally are China and India (Ataie-Ashtiani, 2018). Notably, these countries also rank among the five countries with the highest TB burden worldwide (World Health Organization [WHO], 2024).
Hence, we aim to evaluate the reasons for the retraction of published studies on TB, which would thereby allow the development of actions to prevent these cases.

2. Materials and Methods

2.1. Information Sources and Search Strategy

We performed a bibliometric evaluation of retracted scientific articles about TB from the Web of Science, Embase, Scopus, PubMed, LILACS (Latin American and Caribbean Literature in Health Sciences) and the Retraction Watch Database webpages. A specific advanced search was designed using the keywords “tuberculosis”, “TB”, “Retracted”, and “Retraction”. No filters were applied. The search strategies are presented in Supplementary Material Table S1.

2.2. Eligibility Criteria and Selection Process

All search results were unified into a single file to identify duplicated studies. The deduplication process was performed using the DOI number, and when DOIs were not available, abstracts were compared.
Then, two authors independently revised all the records to include studies that fulfilled the following three criteria: it was an original article, studied any form of TB in humans, and was declared as a retracted article.
Articles studying retraction as a main topic were excluded, as well as articles using the term “retracted” or “retraction” for mechanical movement or other meanings. A study selection flow diagram is presented in Supplementary Material Figure S1.

2.3. Data Collecting Process and Synthesis Methods

We collected the year of publication, affiliation country, topic of study, funding, journal, Scimago quartile, number of citations in Scopus, Scopus h-index of the first and corresponding author, and reason for retraction of each study included.
For statistical analysis, we calculated the frequencies and percentages for categorical variables and the means with respective standard deviations for numeric variables. The number of citations before and after retraction was compared with a paired t-test. All the analyses were performed with Stata version 18.
Temporal trends were analyzed using RStudio and the ggplot2 package. A dataset containing the year of retraction and the percentage of retracted TB articles per year was used to create a time series line plot. A time series line plot was constructed to illustrate these trends, complemented by a smoothed trend line generated using the LOESS method, with a shaded confidence interval.
Ethical approval for this study (057-2023-PRO99) was obtained from the Institutional Research Ethics Committee at Universidad Científica del Sur.

3. Results

We included 61 retracted articles on TB. The main reasons for retraction were falsification (34.4%) and plagiarism (16.4%). Due to the high occurrence of these practices, these two reasons were further divided into three distinct subcategories. For falsification, these included data manipulation (90.5%) and image alteration (9.5%). Plagiarism was subdivided into text plagiarism (55.5%), image plagiarism (33.3%), and results plagiarism (11.2%). Problems with paired revision included the submission of fabricated or inappropriate reviewer identities, manipulated peer reviews, and inappropriate guest-edited issues. Moreover, 16.4% of retracted articles did not specify the reason for retraction.
We found that more than half of the articles were published in high-impact journals, such as Plos One (11.5%). Then, we analyzed the 52 journals included to compare retraction policies. It was observed that most of these journals follow the guidelines of the Committee on Publication Ethics (COPE) for the retraction of articles (15). However, 13.5% of journals did not clearly state what kind of ethical policies they follow for retraction. It was also observed that there was no variation in the frequency of having retraction policies between journal quartiles.
Furthermore, we found that 39.3% of the articles included received external funding, and 45.9% did not declare conflicts of interest (Table 1).
An analysis was performed to categorize the types of article retractions based on the petitioner of retraction. We found that the journal editor initiated the retraction process in 39.3% of the cases, followed by author-initiated retraction (36.1%), with joint-retraction petitions involving both authors and editors being infrequent (9.8%). In 14.6% of the cases, it was clear who had initiated the retraction process.
When analyzing country affiliation, China has the highest number of retracted articles on TB, followed by India. However, considering the national scientific production of TB in SCOPUS, the highest percentage was reported for Egypt, followed by China, with these percentages being even higher than the average world ratio (Figure 1).
The first retraction of an article in the field of TB was reported in 1993. Thereafter, an increasing nonlinear trend was found for the percentage of retracted articles on TB. Nonetheless, over time the percentage of retracted articles has reduced to less than 0.1% of the total scientific production on TB in SCOPUS (Figure 2).
The citation analysis showed a significant reduction in the number of citations after the retraction (p < 0.001), independently of the reason for retraction. Following the retraction of articles due to falsification or duplication, only a few citations were noted (Table 2).

4. Discussion

The present study found that the main reason for the retraction of TB research articles was falsification, especially in articles related to basic science topics and published in high-impact journals. However, 16.4% of retracted articles did not specify the reason for retraction and 13.5% of journals failed to clearly state the ethical policies followed for retraction. Furthermore, Egypt and China accumulated the highest percentage of retracted studies on TB.
Scientific fraud has classically been highlighted among the main triad of reasons for retraction, i.e., plagiarism, falsification, and fabrication. However, in recent studies in the general biomedical literature, the top causes of retraction were falsification and plagiarism (Gaudino et al., 2021; Wang et al., 2019), which is consistent with our study results. We believe that the frequency of fabrication has likely decreased not only because of better ethical practices but also because data fabrication is difficult to prove.
On the other hand, studies evaluating scientific production in other respiratory infectious diseases, such as COVID-19, have identified the most common type of retraction as being unrelated to scientific misconduct or undeclared (Shi et al., 2022; Syed et al., 2023). However, in the pandemic scenario, the pressure on scientific journals to publish quickly and, thus, often neglecting the quality of peer review could explain these differences.
Previous studies on general biomedical research have reported increased trends in retracted articles until 2014–2015, with a subsequent decline until 2020 (Gaudino et al., 2021), which is consistent with our results. However, after 2020, a new increase in trends was noted in our analysis that may be related to the COVID-19 pandemic and its reported vulnerability to misconduct (Alexander et al., 2023, 2024).
We found that 50% of the retracted articles were published in high-impact journals (Q1). This is consistent with the analysis of general retracted biomedical articles published in PubMed. A possible explanation for this might be the high visibility of these journals, making them more susceptible to being corrected (Ataie-Ashtiani, 2018).
In our study, Plos One had the highest number of retracted articles. This result is consistent with the report of the Retraction Watch Database, which evaluates not only articles in the field of TB but also biomedical literature in general, indicating that this journal had more than the average number of retracted articles. The main reasons for retraction were methodological errors, falsification of data, and plagiarism (Retraction Watch, 2024).
High-impact journals commonly accumulate many citations and, thus, we considered it would be interesting to assess whether there is a variation in the number of citations before and after retraction, and indeed, we found a 95.3% reduction in the total number of citations following retraction. One study of randomized trials showed a significant reduction in the number of citations after retraction (Mott et al., 2019). Furthermore, while citations substantially decrease after retraction, there is still a small persistence of citations. It has been suggested that these citations may be due to studies assessing retracted articles or as references to the need for new and better studies on the topic studied (Hsiao & Schneider, 2022). However, it has also been reported that these persistent citations are correlated with self-citation (Madlock-Brown & Eichmann, 2015).
Interestingly, we found that the average number of citations before retraction (31.8 citations) exceeded the overall average number of citations of previously reported TB articles (13.2 citations) (Abdullah et al., 2022). This is alarming because although citations fall after retraction, the retracted study was likely already used to create new studies based on this misinformation.
On the other hand, in lower quartile journals, we suggest that the lower number of retracted articles is not necessarily due to the better quality of the studies and reviews published, but rather to an under-reporting of retractions. This could also be consistent with the very low number of retracted articles reported from low- and middle-income countries, such as those from the African and South American regions, which represent only 3% of the total global number of retracted articles in the biomedical scientific literature (Gaudino et al., 2021). Moreover, countries with a lack of policies on scientific integrity, publication bonuses, and oppressive scientific publications are the most susceptible to high rates of retraction (Fanelli et al., 2015).
The country with the highest number of retracted articles was China, which is consistent with an analysis of the general biomedical literature (Wang et al., 2019). It has been reported that most of the articles that were retracted due to a fake peer review process included Chinese authors; however, in the field of medicine, this proportion might be lower (Sebo, 2024). Since Chinese scholars play a significant role in global research production, analysis of the in-depth reasons behind retractions is important. A study described two major reasons behind retracted Chinese articles; the first was a combination of time constraints and language barriers, as physicians are often overworked, leaving insufficient time for thorough research. Additionally, limited proficiency in English caused by great differences with the Chinese language creates vulnerability to conducting studies with third-party companies. The second reason was related to social pressure to publish, since the scientific citation index is overemphasized for obtaining a graduate title, and most medical awards are not related to medical practice expertise but rather to the number of articles published (Xiao et al., 2022).
On the other hand, when considering national scientific production, we found that Egypt had the highest number, just before China. A previous study reported Egypt and China as the top countries with the highest proportion of retracted articles (Campos-Varela & Ruano-Raviña, 2019). Egypt has the highest proportion of retracted articles in the African continent, especially in the field of medicine and basic sciences. According to a study (Rossouw et al., 2020), although national-level interventions were applied to improve awareness of plagiarism in several African countries, no interventions at this level were reported in Egypt. In addition, basic sciences were the most frequent area of retracted TB articles in Egypt, yet this country is the most productive country in this field (Langerudi & Chamazcoti, 2022).
In regard to the fact that basic science studies often require research funding to be performed, our study found that almost half of the retracted TB studies had received funding. This result is comparable to an analysis performed in China, which reported that around 60% of retracted biomedical articles had external funding (Tang et al., 2023). The retraction of a scientific article not only results in the misspending of research funds, but also limits funding for further research, which is of particular concern for the field of TB as research funding is known to fall far short of what is needed to meet the health needs of the population with this disease (Venkatesan, 2022). Another study on the retraction of articles funded by entities in the United States showed that the retracted studies resulted in a waste of $58 million from the NIH budget and that, on average, each article cost $392,582 (Stern et al., 2014). On the other hand, it is worth noting that 35.3% did not provide any information on the source of funding, a fact that should be specified for study transparency.
One strength of our study was the systematic and advanced scientific literature review of retracted TB articles, which precludes the underrepresentation of study countries, study areas, or author expertise. On the other hand, one limitation of our study was the possibility of some journals avoiding retraction, which may result in an underrepresentation of the total number of reported retracted studies. However, the main drivers of retraction among the TB articles studied were consistent with previous studies in general biomedical research, thus, retraction reasons in that group likely do not differ from those found in our analysis.

5. Conclusions

The main reason for the retraction of TB articles was falsification due to data manipulation, followed by text plagiarism. However, a quarter of the retracted articles do not declare the drivers behind retraction. Finally, 13.5% of journals in which retracted articles on TB were found did not clearly state the ethical policies followed for retraction.

6. Recommendations

Since data manipulation was the most frequent reason for the retraction of TB articles, we suggest that editors ask authors to publish databases in public repositories to improve the transparency of the results. Additionally, an important proportion of reasons for article retraction was related to plagiarism, especially text plagiarism, and, thus, we suggest that editors include both semantic and structural detection methods in the initial review of the publication process (JavadiMoghaddam et al., 2022). Furthermore, nearly one-quarter of the studies included did not specify the reasons for retraction, and, therefore, it is necessary for editors to follow the guidelines of the Committee on Publication Ethics (COPE) for the retraction of articles (Committee on Publication Ethics (COPE), 2019), and periodically analyze—either in-house or through an open forum—the articles published, looking for errors or oversights, and publish notices of corrections or retractions and the reasons for these (Xiao et al., 2022).

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/publications13010004/s1, Table S1: Full Search Strategy, Figure S1: Prisma flow diagram.

Author Contributions

All authors conceptualized the study and developed the research question and design. Data collection was performed by S.M.D.l.C.A., M.P.-E., F.A.C.J., K.D.S.-P., C.C.V. and V.A.H.-A., F.O.G.-S., P.M.-T. and L.L. performed the statistical analysis. All authors contributed to the discussion and interpretation of the results. All authors have read and agreed to the published version of the manuscript.

Funding

This research did not receive external funding.

Data Availability Statement

The data used in this analysis is included in the Supplementary Materials.

Conflicts of Interest

The authors declare no conflict of interest.

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Publications 13 00004 g001
Figure 1. Country ranking by percentage of retracted TB articles. * Number of retracted TB articles × 100/number of published TB articles in SCOPUS by country.
Figure 1. Country ranking by percentage of retracted TB articles. * Number of retracted TB articles × 100/number of published TB articles in SCOPUS by country.
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Figure 2. Retraction trends over time in the field of tuberculosis. %Retracted TB Articles = Number of retracted TB articles × 100/number of published TB articles in SCOPUS by year.
Figure 2. Retraction trends over time in the field of tuberculosis. %Retracted TB Articles = Number of retracted TB articles × 100/number of published TB articles in SCOPUS by year.
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Table 1. Characteristics of retracted articles on tuberculosis.
Table 1. Characteristics of retracted articles on tuberculosis.
CharacteristicsRetracted
(n = 61)
Reason for retraction
Falsification21 (34.4%)
Plagiarism10 (16.4%)
Problems with paired revision7 (11.45%)
Duplicated publication5 (8.2%)
Fabrication2 (3.3%)
Others6 (9.8%)
Not specified10 (16.4%)
Topic
Basic science30 (49.1%)
Epidemiology11 (18.0%)
Diagnostic8 (13.1%)
Treatment4 (6.6%)
Others8 (13.1%)
Funding
External funding24 (39.3%)
Self-funding11 (18.1%)
Not declared26 (42.6%)
Conflict of interest
No conflict of interest33 (54.1%)
Not declared28 (45.9%)
Journal quartile
Q131 (50.8%)
Q215 (24.5%)
Q36 (9.84%)
Q47 (11.4%)
Non-quartile journal2 (3.28%)
Table 2. Citation analysis of reasons for article retraction.
Table 2. Citation analysis of reasons for article retraction.
ReasonCitations Before RetractionCitations After Retraction
Mean (SD)Mean (SD)
Falsification51.48 ± 102.292.48 ± 6.33
Plagiarism27.23 ± 70.460.62 ± 1.94
Duplicated publication11.13 ± 13.272.25 ± 6.36
Others11.46 ± 8.180.31 ± 0.85
Not specified11.83 ± 8.160.00 ± 0.00
SD: standard deviation.
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Garcia-Solorzano, F.O.; De la Cruz Anticona, S.M.; Pezua-Espinoza, M.; Chuquispuma Jesus, F.A.; Sanabria-Pinilla, K.D.; Chavez Veliz, C.; Huayta-Alarcón, V.A.; Mayta-Tristan, P.; Lecca, L. Analyzing the Drivers Behind Retractions in Tuberculosis Research. Publications 2025, 13, 4. https://doi.org/10.3390/publications13010004

AMA Style

Garcia-Solorzano FO, De la Cruz Anticona SM, Pezua-Espinoza M, Chuquispuma Jesus FA, Sanabria-Pinilla KD, Chavez Veliz C, Huayta-Alarcón VA, Mayta-Tristan P, Lecca L. Analyzing the Drivers Behind Retractions in Tuberculosis Research. Publications. 2025; 13(1):4. https://doi.org/10.3390/publications13010004

Chicago/Turabian Style

Garcia-Solorzano, Franko O., Shirley M. De la Cruz Anticona, Mario Pezua-Espinoza, Fernando A. Chuquispuma Jesus, Karen D. Sanabria-Pinilla, Christopher Chavez Veliz, Vladimir A. Huayta-Alarcón, Percy Mayta-Tristan, and Leonid Lecca. 2025. "Analyzing the Drivers Behind Retractions in Tuberculosis Research" Publications 13, no. 1: 4. https://doi.org/10.3390/publications13010004

APA Style

Garcia-Solorzano, F. O., De la Cruz Anticona, S. M., Pezua-Espinoza, M., Chuquispuma Jesus, F. A., Sanabria-Pinilla, K. D., Chavez Veliz, C., Huayta-Alarcón, V. A., Mayta-Tristan, P., & Lecca, L. (2025). Analyzing the Drivers Behind Retractions in Tuberculosis Research. Publications, 13(1), 4. https://doi.org/10.3390/publications13010004

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