BRIEF COMMUNICATION 2137

Dissemination of Gastroenterology and Hepatology

Research on Social Media Platforms Is Associated With
Increased Citation Count
Fares Ayoub, MD1, Ahmed Ouni, MD2, Robert Case, MD3, Michael Ladna, MD3, Harsh Shah, MD3 and David T. Rubin, MD1

INTRODUCTION: The purpose of this study was to find out whether dissemination of gastroenterology and hepatology (GI)
research on social media networks correlates with citation count at 5 years.

METHODS: We correlated the Altmetric Attention Score with Web of Science citation counts at 5 years for scholarly
work published in the 10 highest impact factor GI journals in 2014.
RESULTS: In 4,026 analyzed items, the correlation (r) between Altmetric Attention Score and citations at 5 years
was 0.62 (P < 0.001), representing strong correlation. Twitter was the platform with the strongest
correlation with citations.
DISCUSSION: Social media attention garnered by GI scholarly work strongly correlates with the number of citations at
5 years.
SUPPLEMENTARY MATERIAL accompanies this paper at http://links.lww.com/AJG/B948.

Am J Gastroenterol 2021;116:2137–2139. https://doi.org/10.14309/ajg.0000000000001240

INTRODUCTION published material. Scholarly work published in the 10 highest

Social media networks have gained popularity in the gastroen-
terology and hepatology (GI) community for the dissemination of
research. A number of societies and journals maintain successful
Facebook and Twitter pages (1). Altmetrics (alternative metrics of
impact) measure how broadly scholarly work has been men-
tioned outside traditional literature including social media
(Twitter and Facebook), mainstream news, Wikipedia, policy
documents, and other sources (2). The Altmetric Attention Score
(AAS) is a proprietary score (Digital Science Group, United
Kingdom) increasingly used by journals to provide an objective
measure of scholarly work mentions outside traditional literature.
Whether the number of citations a scholarly work receives in
peer-reviewed literature correlates with how widely shared it is on
social media has been investigated in other fields (3–6) but has not
been fully investigated in GI, with the only analysis finding a
significant correlation limited to 1 endoscopy journal (7). We
examined the correlation between AAS, its social media com-
ponents, and citations at 5 years from publication.
METHODS
“Scholarly work” hereby refers to content published in journals
and indexed by Altmetric Explorer (a data exploration tool pro-
vided by Almetric.com) including original articles, editorials,
reviews, conference proceedings, letters to the editor, and other
Web of Science impact factor (IF) journals in 2014 according to
Journal Citation Reports category Gastroenterology and Hep-
atology (Clarivate Analytics, Philadelphia, PA) was included. We
extracted the AAS and citation count in November 2019 (ap-
proximately 5 years after publication). Spearman correlation was
used to study the correlation between AAS, its individual com-
ponents, and citations. For multivariable analysis, logarithmic
transformation of AAS and citations was performed to adjust for
skewness and allow for linear regression.
RESULTS
We analyzed 4,026 scholarly works from the top 10 IF journals in
2014 (Table 1). Most scholarly work was mentioned on at least 1
social media platform (2,198 articles, 54.5%), followed by 2
platforms (509 articles, 12.6%) and $3 platforms (67, 1.7%). The
correlation (r) between AAS and total citations at 5 years for all
scholarly work from the top 10 journals was 0.62 (P , 0.001),
representing strong correlation. Using linear regression, AAS was
a positive predictor of total 5-year citations (P , 0.001) (Figure 1).
In a multivariable model adjusting for journal impact factor
and article open access status, every 1% increase in AAS resulted
in a 0.95% increase in citations at 5 years. AAS, journal impact
factor, and article open-access status were all significant

1
Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Chicago, Illinois, USA; 2Division of Gastroenterology and Hepatology, Mayo Clinic,
Jacksonville, Florida, USA; 3Department of Medicine, University of Florida, Gainesville, Florida, USA. Correspondence: Fares Ayoub, MD. E-mail:
fares.ayoub@uchospitals.edu.
Received August 22, 2020; accepted February 23, 2021; published online March 22, 2021

© 2021 by The American College of Gastroenterology The American Journal of GASTROENTEROLOGY

Copyright © 2021 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited.
2138 Ayoub et al.
Table 1. Ten highest Web of Science impact factor journals in 2014, impact factor in 2014, and number of mentioned scholarly works
included in analysis
Name
Highest 10 impact factor journals in 2014
Gastroenterology
Gut
Journal of Hepatology
Hepatology
The American Journal of Gastroenterology
Clinical Gastroenterology and Hepatology
Journal of Crohn’s and Colitis
Alimentary Pharmacology & Therapeutics
Gastrointestinal Endoscopy
Endoscopy
predictors of 5-year citations in the multivariable model (see
Supplementary Table 1, http://links.lww.com/AJG/B948).
Correlation between individual sources of mentions and citations
The strongest correlation between mentions and 5-year citations
was for Twitter r 5 0.54 (P , 0.001), followed by Facebook
r 5 0.24 (P , 0.001), suggesting that Twitter is the primary driver
of social media–related mentions and associated correlation with
citation counts (Table 2).
Sensitivity analyses
The association between AAS and 5-year citations remained
strong when we excluded outliers (citations .300, AAS.100)
[r 5 0.61], studied only hepatology-focused journals [r 5 0.55],
and when excluding open access articles [r 5 0.64]. However, in
an analysis of scholarly work published in the 10 lowest IF GI
journals (see supplementary Table 2, http://links.lww.com/AJG/
B948), r decreased to 0.12 indicating weak correlation between
the AAS and citations at 5 years in this subset of journals.
DISCUSSION
In this analysis of all scholarly work published in the top 10 IF GI
journals in 2014, we found a strong correlation between AAS (as a
measure of social media dissemination) and citations at 5 years.
Our findings suggest that the degree of social media attention
garnered by scholarly work published in leading GI journals
strongly correlates with the number of citations in subsequent
years.
We found that 73% of the included scholarly work was
mentioned at least once outside of peer-reviewed literature since
publication, demonstrating an increasing reach across non-
traditional media platforms. Twitter was the strongest driver of
mentions on social media (and 5-year citations) when analyzing
the individual components of the AAS, consistent with other
studies (5). This further supports the dominance of Twitter as a
prime venue for sharing scholarly work outside of traditional
peer-reviewed literature. In an analysis by Chang et al. of pediatric
surgery literature, the length of time a journal’s Twitter account
had been established directly influenced the strength of correla-
tion between AAS and citation count (6).
The American Journal of GASTROENTEROLOGY
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Impact factor Mentioned scholarly works (%)
16.716 789 (19.6)
14.660 434 (10.8)
11.336 427 (10.6)
11.055 532 (13.2)
10.755 253 (6.3)
7.896 332 (8.3)
6.234 323 (8)
5.727 343 (8.5)
5.369 326 (8.1)
5.104 267 (6.6)
The correlation between AAS and citations has been in-
vestigated in other fields with conflicting results. Strong correla-
tion was found in high IF pediatric surgery journals (6), weak
correlation in cardiology (8), emergency medicine (4), and no
correlation in plastic surgery literature (9). The strength of as-
sociation may be specialty-specific, particularly if article content
appeals to a broader readership. For example, an analysis of ar-
ticles published in top radiology journals found a significantly
lower number of articles mentioned outside of peer-reviewed
literature (10). Case in point: The highest AAS article ‘A Diet Low
in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome’
discusses a dietary approach to the management of irritable bowel
syndrome, a highly prevalent disorder present in 11% of the
general population (11). This would arguably appeal to a lay
audience more than the most cited article ‘Global epidemiology
and genotype distribution of the hepatitis C virus infection’. In
addition, studying articles published in earlier years compared
Figure 1. Scatter plot examining the relationship between log (Altmetric
Attention Score 1 1) and log (total 5-year citations 1 1); fitted line repre-
sents the linear regression model and 95% confidence interval (CI). Log
(Altmetric Attention Score 11) was a positive predictor of log (total 5-year
citations 11) (P , 0.001); the overall model was statistically significant
(P , 0.001), explaining 35% of the relationship (R2 5 0.35).
VOLUME 116 | OCTOBER 2021 www.amjgastro.com
 Research and Social Media 2139

Table 2. Summary statistics and correlation coefficients between individual components of the Altmetric Attention Score (nonweighted)
and 5-year citations

Component Mean number of mentions SD Range Correlation coefficient [r]b Strength of correlation
a
Aggregate social media 4.02 12.34 0–321 0.56 Strong
Twitter 3.61 10.74 0–277 0.55 Strong
Facebook 0.37 1.93 0–64 0.24 Moderate
News media 0.34 3.01 0–142 0.27 Moderate
Blogs 0.08 0.51 0–13 0.22 Moderate
Patents 0.08 0.70 0–20 0.14 Weak
Policy documents 0.07 0.35 0–6 0.25 Moderate
F1000 0.06 0.27 0–6 0.24 Moderate
Google1 0.04 0.27 0–9 0.16 Weak
Wikipedia 0.03 0.23 0–6 0.16 Weak
Online video 0.02 0.20 0–5 0.10 Weak
Weibo 0.01 0.16 0–5 — No correlation
Peer review 0 0.10 0–5 — No correlation
Reddit 0 0.07 0–2 — No correlation
Pinterest 0 0 0 — No correlation
Q&A 0 0 0 — No correlation
Syllabi 0 0 0 — No correlation
a
Sum of mentions on the following platforms (Facebook, Twitter, Google1, and Reddit).
b
Only statistically significant (P , 0.05) correlation coefficients are included.

with contemporary articles is less likely to yield a strong associ-
ation, since social media adoption by the medical community has
only recently increased considerably (6).
Our results remained robust to several sensitivity analyses.
However, studying articles published in the lowest 10 IF journals
the correlation became weak with r 5 0.12. One explanation may
be that at the time of writing, only 2 of these journals had official
social media pages as compared to most top 10 journals, limiting
their social media reach. Journal characteristics or article quality
may have also influenced the results.
Our analysis has limitations. First, we only focused on the top 10
journals limiting the generalizability of our findings. We selected
a follow-up period of 5 years to avoid citation lag, but the nature
of the correlation between AAS and citations may change over
longer periods of follow-up. Altmetric uses proprietary indexing
methods, and as a result, our analysis includes work beyond orig-
inal research, including editorials and reviews, limiting generaliz-
ability. Finally, controversial articles highlighted on social media
(e.g., criticized for lack of robust methodology) may yield a higher
AAS, highlighting that not all attention may be positive.
In conclusion, we found a strong correlation between AAS and
scholarly work citation counts at 5 years, suggesting a growing
role for social media platforms in the dissemination of GI
scholarly work.
CONFLICTS OF INTEREST
Guarantor of the article: Fares Ayoub, MD.
Specific author contributions: F.A.: study conception and design,
analysis and interpretation of data, manuscript drafting, manuscript
revision, and study supervision. A.O., M.L., R.C., and H.S.: study
conception and design, analysis and interpretation of data, and
manuscript revision. D.T.R.: study conception, manuscript revision,
and study supervision.
Financial support: No grant support was used for this work. The
authors wish to thank Altmetric for providing this study’s data free of
charge for research purposes.
Potential competing interests: None to report.
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© 2021 by The American College of Gastroenterology The American Journal of GASTROENTEROLOGY

Copyright © 2021 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited.