Does Consideration and Assessment of Effects on Health Equity Affect the Conclusions of Systematic Reviews? A Methodology Study

Abstract

IntroductionTackling 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.MethodsWe 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.ResultsOf 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.ConclusionThe 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.

Grommets for Otitis Media With Effusion in Children With Cleft Palate: A Systematic Review

“…However, it is probable that no qualitative or quantitative differences exist between studies written in English or any other language with regard to how the authors deal with health equity or report their results. 49 Egger et al 50 claimed that a search for English literature in PubMed is sufficient for most systematic reviews. Furthermore, Cochrane reviews do not impose language restrictions; however, all their studies are published in English.…”

Extending the PRISMA statement to equity-focused systematic reviews (PRISMA-E 2012): explanation and elaboration

“…The study setting was described as a boarding school exclusively for American Indian youth and promoting academic excellence.' (Jull et al 2013) Explanation -Approximately 50 per cent of systematic reviews report the effect of sex/ gender on outcomes, and less than 15 per cent report other PROGRESS-Plus characteristics, which may be important (Tsikata et al 2003;Welch et al 2012c;Tugwell et al 2008). PROGRESS-Plus information is reported in primary studies more often than in systematic reviews (Tsikata et al 2003;Tugwell et al 2008).…”

“…The first step was to identify need and review the literature. We conducted a systematic review and a methodological study (Welch et al 2010a(Welch et al , 2012c. Next, we conducted an online survey whose respondents included systematic review authors, policymakers, and systematic review funders (Welch et al 2012b).…”

“…We support PROGRESS-Plus because it is easy to remember and is inclusive of all factors that may indicate disadvantage. About 68 per cent of systematic reviews describe the included population using one or more of the PROGRESS-Plus criteria and 13 per cent assess the effects of interventions disaggregated across one or more of these characteristics (Welch et al 2012c). ) for each meta-analysis.…”

A Literary Analysis of Global Female Identity, Health, and Equity

“…Current methods of assessing the effects of equity on health status are weak, using socioeconomic status and national incomes as proxies for equity instead of true measures of (un)fairness of the distribution of health resources by social groups. 20 Moreover, public health interventions to improve gender health equity do not always incorporate the socio-political context in which their target population exists, and may serve to reinforce rather than ameliorate health inequalities and inequities. 21,22 …”