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. 2012;7(3):e31360.
doi: 10.1371/journal.pone.0031360. Epub 2012 Mar 13.

Does consideration and assessment of effects on health equity affect the conclusions of systematic reviews? A methodology study

Vivian Welch  1 , Mark Petticrew, Erin Ueffing, Maria Benkhalti Jandu, Kevin Brand, Bharbhoor Dhaliwal, Elizabeth Kristjansson, Janet Smylie, George Anthony Wells, Peter Tugwell
Affiliations

Does consideration and assessment of effects on health equity affect the conclusions of systematic reviews? A methodology study

Vivian Welch et al. PLoS One. 2012.

Abstract

Introduction: Tackling health inequities both within and between countries remains high on the agenda of international organizations including the World Health Organization and local, regional and national governments. Systematic reviews can be a useful tool to assess effects on equity in health status because they include studies conducted in a variety of settings and populations. This study aims to describe the extent to which the impacts of health interventions on equity in health status are considered in systematic reviews, describe methods used, and assess the implications of their equity related findings for policy, practice and research.

Methods: We conducted a methodology study of equity assessment in systematic reviews. Two independent reviewers extracted information on the reporting and analysis of impacts of health interventions on equity in health status in a group of 300 systematic reviews collected from all systematic reviews indexed in one month of MEDLINE, using a pre-tested data collection form. Any differences in data extraction were resolved by discussion.

Results: Of the 300 systematic reviews, 224 assessed the effectiveness of interventions on health outcomes. Of these 224 reviews, 29 systematic reviews assessed effects on equity in health status using subgroup analysis or targeted analyses of vulnerable populations. Of these, seven conducted subgroup analyses related to health equity which were reported in insufficient detail to judge their credibility. Of these 29 reviews, 18 described implications for policy and practice based on assessment of effects on health equity.

Conclusion: The quality and completeness of reporting should be enhanced as a priority, because without this policymakers and practitioners will continue lack the evidence base they need to inform decision-making about health inequity. Furthermore, there is a need to develop methods to systematically consider impacts on equity in health status that is currently lacking in systematic reviews.

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Conflict of interest statement

Competing Interests: The authors have read the journal's policy and have the following conflicts: MP and PT are co-convenors of the Campbell and Cochrane Equity Methods Group; EU is a salaried employee of the Campbell and Cochrane Equity Methods Group. No other authors have relationships with companies that might have an interest in the submitted work in the previous three years; their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and no authors have non-financial interests that may be relevant to the submitted work. This does not alter the authors' adherence to all the PLoS ONE policies on sharing data and materials.

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