The global academic hepatology capacity index (IGCAH): a multi-source assessment reveals profound inequities across Latin America

INTRODUCTION AND OBJECTIVES: Academic hepatology capacity in Latin America is highly heterogeneous, yet no standardized regional framework exists to quantify structural differences across countries. We aimed to develop and apply the Global Academic Hepatology Capacity Index (IGCAH), a composite metric integrating academic, clinical, and research dimensions, to characterize cross-country inequities in the region. MATERIALS AND METHODS: National hepatology societies from 20 Latin American countries completed a 54-item structured survey. Five domain indices: human capacity, academic training, scientific productivity, clinical complexity, and collaboration/networking, were constructed using standardized z-scores and integrated into the IGCAH. Findings were triangulated with bibliometric analysis of PubMed-indexed hepatology publications (2015-2025) and thematic analysis of abstracts submitted to the ALEH 2025 Congress. RESULTS: Complete responses were obtained from all 20 countries. The five highest-performing countries concentrated over 80% of the hepatology workforce, formal training programs, research infrastructure, and access to advanced therapies (IGCAH >0.8). Overall, 55% of countries lacked formal specialty recognition, 45% reported absence of essential laboratory infrastructure, and only 50% met criteria for sufficient diagnostic and therapeutic complexity. Clinical services were centralized in ≤2 major cities in 70% of countries, and ten reported ≤2 national liver disease registries. Scientific productivity was highly concentrated, with four countries accounting for approximately 85% of PubMed-indexed hepatology publications, while more than half produced ≤5 papers annually. ALEH 2025 abstracts mirrored these disparities, with 75% originating from five countries; most were observational and clinical trials were scarce. CONCLUSIONS: Profound asymmetries characterize academic hepatology in Latin America. The IGCAH provides a robust framework to identify structural gaps and guide targeted, stage-specific capacity strengthening.