Under Disclosure of Conflicts of Interest Is Less Frequent in Senior Authors: A Cross-sectional Review of All Authors Submitting to JAAOS Between 2014 and 2018.

The interactions between physicians and industry are necessary for advancement of clinical practice and improvement in medical devices. Physician-industry relationships also introduces financial conflicts of interest into research publications. Payments to physicians do not inherently introduce bias in research, but failure to disclose potential conflicts of interest can negatively impact the perceived integrity of authors, editors, and journals. The conflict of interest disclosure statement in all articles published in the Journal of the American Academy of Orthopaedic Surgery between 2014 and 2018 were compared to the financial payments indexed in the Center for Open Payments Database. Payment type, magnitude, and payer were obtained for each payment meeting inclusion criteria. Statistical comparisons were made using Mann-Whitney comparisons due to non-normal distribution of payment amounts. 704 articles involving 2596 authors were reviewed, with 1268 authors meeting inclusion criteria. 634 authors had accurate disclosure statements. The total amount of disclosed payments was $169 million, whereas undisclosed payments were $14.2 million. The amount of disclosed payments on a per-author basis, $55,844 ($12,559, $186,129), was significantly greater than undisclosed payments, $2,171 ($568, $7,238). The lowest rates of correct disclosure were in education (29.2%), gifts (38.7%) and honoraria (57.8%). First and middle authors disclosed correctly at a significantly lower rate than last authors. The magnitude of undisclosed payments was significantly lower than disclosed payments, indicating that these payments do not register with authors as significant enough to disclose.