Clinical research lags behind biomedical, population-based health, and health services research at multiple levels.

PURPOSE Concerns regarding a decline in clinical research have been raised internationally. In this study, research initiatives and competitiveness of investigators seeking funding for clinical research were compared with those for three other health research themes in Canada, namely, biomedical, population-based, and health services research. METHODS A retrospective, multi-level descriptive study was conducted using administrative data from the Canadian Institutes for Health Research (CIHR) research grants program. Annual growth rates in numbers of proposals submitted since year 2000 (level I of comparison), success rates of submissions (level II), and growth rates in funding received since fiscal-year 1999-00 (level III) were compared across themes. RESULTS Proposal submission (Level I): The average annual rate of growth in proposal submissions for biomedical, clinical, population-based and health services research was 11.8%, 6.3%, 105.0% and 43.2%, respectively. Success rate (Level II) was lower in clinical research (24%; P-value < 0.001) compared with biomedical (34%), population-based (29%), and health services (28%) research. Funding (Level III) grew at an average rate of 16.1% per year for biomedical, 28.2% for clinical, 65.9% for population-based, and 86.2% for health services research. However, the median amount funded for clinical projects (CAD $154,535) was less (P-value < 0.0001) than that for biomedical projects ($225,346). CONCLUSION The overall growth of research activities in clinical theme was slower than with research in other themes-fewer proposals were submitted and lower proportion of submissions was successful. Smaller amounts of funding were received for clinical projects compared with biomedical projects, but a handful of large-scale clinical projects influenced the growth rate in funding for all clinical research. This report underscores the concern that multi-level problems plague clinical research.