Improving the reporting on health equity in observational research (STROBE-Equity): extension checklist and elaboration

Omar Dewidar^{1

2}, Larissa Shamseer³, G J Melendez-Torres⁴, Elie A Akl^{5

6}, Jacqueline Ramke^{7

8}, Xiaoqin Wang⁹, Oyekola Oloyede¹⁰, Taryn Young¹¹, Stuart G Nicholls¹², Zack Marshall¹³, Michelle Kennedy¹⁴, Billie-Jo Hardy^{15

16}, Anita Rizvi¹⁷, Elizabeth Ghogomu², Tamara Rader¹⁸, Hugh Sharma Waddington¹⁹, Beverley Shea²⁰, Miriam Nkangu^{2

20}, Holly Ellingwood^{21

22}, Luke Wolfenden²³, Janice Tufte^{24

25}, Tanya Horsley^{20

26}, Kevin Pottie²⁷, Luis Gabriel Cuervo^{28

29}, Clara Juando-Prats^{15

30

31}, Cindy Feng^{32

33}, Melissa K Sharp³⁴, Julian Little²⁰, Ebenezer Owusu-Addo³⁵, Damian Francis³⁶, Tamara Kredo^{11

37}, Michael Johnson Mahande³⁸, Catherine Chamberlain^{39

40}, Tomás Pantoja⁴¹, Erik von Elm⁴², Zulfiqar A Bhutta^{43

44}, Peter Tugwell^{2

20

45

46}, Charles S Wiysonge^{11

37}, Sarah Funnell^{47

48}, Janet Jull^{49

50}, Lawrence Mbuagbaw⁶, Vivian Welch^{2

20}

Affiliations

¹ Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² Bruyère Health Research Institute, University of Ottawa, Ottawa, ON, Canada.
³ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
⁴ Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
⁵ Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
⁶ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁷ International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.
⁸ School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand.
⁹ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
¹⁰ Sefako Makgatho Health Sciences University, Pretoria, South Africa.
¹¹ Centre for Evidence Based Health Care, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
¹² Methodological and Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
¹³ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁴ School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.
¹⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹⁶ Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
¹⁷ School of Psychology, University of Ottawa, Ottawa, ON, Canada.
¹⁸ Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada.
¹⁹ Planetary Health Group, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
²⁰ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
²¹ Department of Law and Legal Studies, Carleton University, Ottawa, ON, Canada.
²² Public representative, Ottawa, ON, Canada.
²³ The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.
²⁴ Hassanah Consulting, Seattle, WA, USA.
²⁵ Public representative, Seattle, WA, USA.
²⁶ Royal College of Physicians and Surgeons of Canada, Research, Ottawa, ON, Canada.
²⁷ Family Medicine, Dalhousie University, Halifax, NS, Canada.
²⁸ Unit of Science and Knowledge for Impact, Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, Washington, DC, USA.
²⁹ Doctoral Programme on Methodology of Biomedical Research and Public Health, Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine and Public Health, Autonomous University of Barcelona, Bellaterra, Cataluña, Spain.
³⁰ School of Nursing, Faculty of Health and Behavioral Sciences, Lakehead University, Toronto, ON, Canada.
³¹ Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
³² Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
³³ School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada.
³⁴ Department of Public Health and Epidemiology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
³⁵ Institute for Rural Development and Innovation Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
³⁶ School of Health and Human Performance, Center for Health and Social Issues, Georgia College and State University, Milledgeville, GA, USA.
³⁷ Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
³⁸ Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical College, Moshi, Tanzania.
³⁹ Indigenous Health Equity Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VC, Australia.
⁴⁰ Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VC, Australia.
⁴¹ Family Medicine Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
⁴² Cochrane Switzerland, and Cochrane Germany Foundation, Freiburg, Germany.
⁴³ Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada.
⁴⁴ Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.
⁴⁵ Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁴⁶ Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁴⁷ Department of Family Medicine, Queen's University, Kingston, ON, Canada.
⁴⁸ Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁴⁹ Department of Health Sciences, Carleton University, Ottawa, ON, Canada.
⁵⁰ Faculty of Health Sciences, School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.

PMID: 40903054
PMCID: PMC12406149
DOI: 10.1136/bmj-2024-083882

Improving the reporting on health equity in observational research (STROBE-Equity): extension checklist and elaboration

Omar Dewidar et al. BMJ. 2025.

. 2025 Sep 3:390:e083882.

doi: 10.1136/bmj-2024-083882.

Authors

Affiliations

¹ Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
² Bruyère Health Research Institute, University of Ottawa, Ottawa, ON, Canada.
³ Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
⁴ Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
⁵ Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
⁶ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
⁷ International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.
⁸ School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand.
⁹ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
¹⁰ Sefako Makgatho Health Sciences University, Pretoria, South Africa.
¹¹ Centre for Evidence Based Health Care, Department of Global Health, Stellenbosch University, Cape Town, South Africa.
¹² Methodological and Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
¹³ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁴ School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia.
¹⁵ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹⁶ Well Living House, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
¹⁷ School of Psychology, University of Ottawa, Ottawa, ON, Canada.
¹⁸ Canadian Agency for Drugs and Technologies in Health, Ottawa, ON, Canada.
¹⁹ Planetary Health Group, Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
²⁰ School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
²¹ Department of Law and Legal Studies, Carleton University, Ottawa, ON, Canada.
²² Public representative, Ottawa, ON, Canada.
²³ The University of Newcastle, School of Medicine and Public Health, Callaghan, NSW, Australia.
²⁴ Hassanah Consulting, Seattle, WA, USA.
²⁵ Public representative, Seattle, WA, USA.
²⁶ Royal College of Physicians and Surgeons of Canada, Research, Ottawa, ON, Canada.
²⁷ Family Medicine, Dalhousie University, Halifax, NS, Canada.
²⁸ Unit of Science and Knowledge for Impact, Department of Evidence and Intelligence for Action in Health, Pan American Health Organization, Washington, DC, USA.
²⁹ Doctoral Programme on Methodology of Biomedical Research and Public Health, Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine and Public Health, Autonomous University of Barcelona, Bellaterra, Cataluña, Spain.
³⁰ School of Nursing, Faculty of Health and Behavioral Sciences, Lakehead University, Toronto, ON, Canada.
³¹ Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
³² Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
³³ School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada.
³⁴ Department of Public Health and Epidemiology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
³⁵ Institute for Rural Development and Innovation Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
³⁶ School of Health and Human Performance, Center for Health and Social Issues, Georgia College and State University, Milledgeville, GA, USA.
³⁷ Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
³⁸ Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical College, Moshi, Tanzania.
³⁹ Indigenous Health Equity Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VC, Australia.
⁴⁰ Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, VC, Australia.
⁴¹ Family Medicine Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
⁴² Cochrane Switzerland, and Cochrane Germany Foundation, Freiburg, Germany.
⁴³ Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada.
⁴⁴ Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.
⁴⁵ Ottawa Hospital Research Institute, Ottawa, ON, Canada.
⁴⁶ Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁴⁷ Department of Family Medicine, Queen's University, Kingston, ON, Canada.
⁴⁸ Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
⁴⁹ Department of Health Sciences, Carleton University, Ottawa, ON, Canada.
⁵⁰ Faculty of Health Sciences, School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.

PMID: 40903054
PMCID: PMC12406149
DOI: 10.1136/bmj-2024-083882

Abstract

Data on health equity to inform societally relevant evidence based decisions and policy making are lacking in the research literature. Observational studies have the potential to provide data on health equity. Yet, guidance on how to report health equity data and considerations in observational research is inadequate. The STROBE-Equity extension addresses this gap by providing a structured set of criteria to enhance the reporting of health equity data and considerations.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest and declare: VW and SF received support from the Canadian Institutes of Health Research (CIHR) for the submitted work. Payments were made to Bruyère Health Research Institute. SF serves as a board member on the College of Family Physicians of Canada and National Circle of Indigenous Medical Education. LGC declares no support from any organisation for the submitted work. He has no financial relationships with organisations that might have an interest in the submitted work. He serves as an advisor and editorial board member for journals as a voluntary contribution, with details listed in his curriculum vitae and ORCID profile. His employer, the Pan American Health Organization/World Health Organization (PAHO/WHO), has covered travel incurred as part of his full time position, and a copyright agreement was submitted through the corresponding author. He holds a retirement fund with the British Medical Association and the United Nations Joint Staff Pension Fund, over which he has no control. His views expressed in this article do not necessarily represent PAHO or WHO policies, and reproduction of the article must avoid implying endorsement by these organisations. GJMT received support from the National Institute for Health and Care Research through a senior investigator award for the submitted work. EvE notes his role as an author of the original STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) statement. KP reports grants from the Public Health Agency of Canada and CIHR and has been involved in multiple funded research projects related to covid-19 and health equity, with payments made to Western University. He received consulting fees from CSL Behring for Ferinject clinical consultancy, honorariums for a guest lecture in Community Diabetes Continuing Medical Education, and holds a pending patent related to health information based communities and knowledge incentive systems. He also holds leadership roles in The Canadian Collaboration for Immigrant and Refugee Health, Cochrane Canada, and MSF Canada, all of which are unpaid. MKS serves in a leadership role on the scientific advisory board of the Endometriosis Association of Ireland, unpaid. TY reports receiving grants from the Fogarty International Center of the National Institutes of Health; the Research, Evidence, and Development Initiative (READ-It) project funded by UK Aid; and the GELA project funded by the European Union, all supporting research activities. She also participates in a data safety monitoring board for a study on health systems strengthening in South Africa.

Figures

**Fig 1**
Flow of proposed STROBE-Equity extension items. For items where no extension to the STROBE reporting guideline was proposed, survey participants were able to provide feedback on their level of agreement. “Items combined” refers to collapsing at least two items into a single item to enhance clarity and reduce redundancy. *Methods review aimed to inform current reporting practices in observational studies, whereas key informant interviews identified principles to guide the consensus meeting and finalise the extension checklist, but neither were intended to identify new items. STROBE=STrengthening the Reporting of OBservational studies in Epidemiology

See this image and copyright information in PMC

References

1. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative . Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007;335:806-8. 10.1136/bmj.39335.541782.AD - DOI - PMC - PubMed
1. Antequera A, Lawson DO, Noorduyn SG, et al. Improving Social Justice in COVID-19 Health Research: Interim Guidelines for Reporting Health Equity in Observational Studies. Int J Environ Res Public Health 2021;18:9357. 10.3390/ijerph18179357 - DOI - PMC - PubMed
1. World Health Organization. Health equity. WHO, 2010. https://www.who.int/health-topics/health-equity#tab=tab_1.
1. Khazanchi R, Evans CT, Marcelin JR. Racism, Not Race, Drives Inequity Across the COVID-19 Continuum. JAMA Netw Open 2020;3:e2019933. 10.1001/jamanetworkopen.2020.19933 - DOI - PubMed
1. Pagel C. There is a real danger that covid-19 will become entrenched as a disease of poverty. BMJ 2021;373:n986. 10.1136/bmj.n986 - DOI - PubMed

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Improving the reporting on health equity in observational research (STROBE-Equity): extension checklist and elaboration

Affiliations

Improving the reporting on health equity in observational research (STROBE-Equity): extension checklist and elaboration

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Miscellaneous