Background: Gender and geographic inequities persist in academic medicine. This study examined the gender and country of affiliation of editors-in-chief (EICs) of general internal medicine journals and assessed disparities across journal impact levels.

Methods: We conducted a cross-sectional analysis of all journals indexed in the 2024 Journal Citation Reports under "MEDICINE, GENERAL & INTERNAL" with an impact factor ≥ 0.2. Gender and country of affiliation of EICs were extracted from journal websites, and journal country from the SCImago Journal & Country Rank. Countries were categorized by World Bank income level. Descriptive statistics and weighted logistic regression models examined differences across impact quartiles (Q1-Q4). To contextualize findings, gender and geographic distributions of EICs in Q1 journals were compared with previously published authorship benchmarks from 202,092 publications in the 50 highest-impact journals (2012-2021).

Results: Among 304 eligible journals, 347 EICs were identified; 77.8% were men and 22.2% were women, with no significant variation across impact quartiles. Most EICs were affiliated with high-income countries (67.2%), decreasing with journal impact (Q1: 85.9%; Q2: 75.7%; Q3-Q4: 48.6%; p < 0.001). In Q1 journals, 25.0% of EICs were women versus 40.6% female first authors and 33.0% female last authors in the benchmark study, indicating a more pronounced gender imbalance at the leadership level, while geographic patterns were similar.

Conclusion: EICs of general internal medicine journals are predominantly men and mainly affiliated with institutions in high-income countries, especially in high-impact journals. Initiatives promoting equity in scientific publishing should include editorial leadership, where disparities remain substantial.