Equity Considerations in COVID‐19 Vaccination Studies of Individuals With Autoimmune Inflammatory Rheumatic Diseases

Abstract

Objective We sought to examine the extent to which populations experiencing inequities were considered in studies of COVID‐19 vaccination in individuals with autoimmune inflammatory rheumatic diseases (AIRDs). Methods We included all studies (n = 19) from an ongoing Cochrane living systematic review on COVID‐19 vaccination in patients with AIRDs. We used the PROGRESS‐Plus framework (place of residence, race/ethnicity, occupation, gender/sex, religion, education, socioeconomic status, and social capital, plus: age, multimorbidity, and health literacy) to identify factors that stratify health outcomes. We assessed equity considerations in relation to differences in COVID‐19 baseline risk, eligibility criteria, description of participant characteristics and attrition, controlling for confounding factors, subgroup analyses, and applicability of findings. Results All 19 studies were cohort studies that followed individuals with AIRDs after vaccination. Three studies (16%) described differences in baseline risk for COVID‐19 across age. Two studies (11%) defined eligibility criteria based on occupation and age. All 19 studies described participant age and sex. Twelve studies (67%) controlled for age and/or sex as confounders. Eight studies (47%) conducted subgroup analyses across at least 1 PROGRESS‐Plus factor, most commonly age. Ten studies (53%) interpreted applicability in relation to at least 1 PROGRESS‐Plus factor, most commonly age (47%), then ethnicity (16%), sex (16%), and multimorbidity (11%). Conclusion Sex and age were the most frequently considered PROGRESS‐Plus factors in studies of COVID‐19 vaccination in individuals with AIRDs. The generalizability of evidence to populations experiencing inequities is uncertain. Future COVID‐19 vaccine studies should report participant characteristics in more detail to inform guideline recommendations.