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. 2010 Dec 8;2010(12):MR000028.
doi: 10.1002/14651858.MR000028.pub2.

How effects on health equity are assessed in systematic reviews of interventions

Vivian Welch  1 , Peter Tugwell, Mark Petticrew, Joanne de Montigny, Erin Ueffing, Betsy Kristjansson, Jessie McGowan, Maria Benkhalti Jandu, George A Wells, Kevin Brand, Janet Smylie
Affiliations

How effects on health equity are assessed in systematic reviews of interventions

Vivian Welch et al. Cochrane Database Syst Rev. .

Update in

  • How effects on health equity are assessed in systematic reviews of interventions.
    Welch V, Dewidar O, Tanjong Ghogomu E, Abdisalam S, Al Ameer A, Barbeau VI, Brand K, Kebedom K, Benkhalti M, Kristjansson E, Madani MT, Antequera Martín AM, Mathew CM, McGowan J, McLeod W, Park HA, Petkovic J, Riddle A, Tugwell P, Petticrew M, Trawin J, Wells GA. Welch V, et al. Cochrane Database Syst Rev. 2022 Jan 18;1(1):MR000028. doi: 10.1002/14651858.MR000028.pub3. Cochrane Database Syst Rev. 2022. PMID: 35040487 Free PMC article.

Abstract

Background: Enhancing health equity has now achieved international political importance with endorsement from the World Health Assembly in 2009. The failure of systematic reviews to consider effects on health equity is cited by decision-makers as a limitation to their ability to inform policy and program decisions.

Objectives: To systematically review methods to assess effects on health equity in systematic reviews of effectiveness.

Search strategy: We searched the following databases up to July 2 2010: MEDLINE, PsychINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Index to Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on October 7 2010.

Selection criteria: We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities.

Data collection and analysis: Data were extracted using a pre-tested form by two independent reviewers. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews.

Main results: Thirty-four methodological studies were included. The methods used by these included studies were: 1) Targeted approaches (n=22); 2) gap approaches (n=12) and gradient approach (n=1). Gender or sex was assessed in eight out of 34 studies, socioeconomic status in ten studies, race/ethnicity in seven studies, age in seven studies, low and middle income countries in 14 studies, and two studies assessed multiple factors across health inequity may exist.Only three studies provided a definition of health equity. Four methodological approaches to assessing effects on health equity were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (all 34 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (12/34 studies); 3) analytic approaches (10/34 studies); and 4) applicability assessment (11/34 studies). Both analytic and applicability approaches were not reported transparently nor in sufficient detail to judge their credibility.

Authors' conclusions: There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to assess and report effects on health equity in systematic reviews.

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Conflict of interest statement

BK, EU, MP, PT, and VW are members of the Cochrane and Campbell Equity Methods Group. MP and PT are Co‐Conveners of the Cochrane and Campbell Equity Methods Group; EU is the Field Administrator.

Some of the authors of this review team are authors on one or more of the empirical studies included in this review (PT, MP, EK, EU, VW, JM, GW). We sought to minimize the possible bias of analysis and synthesis of these studies by having studies co‐authored by authors of this review team extracted by a review author who was not a co‐author (JdM or MB).

Figures

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Figure 2: PRISMA Chart
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2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
See this image and copyright information in PMC

References

References to studies included in this review

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