Is health equity considered in systematic reviews of the cochrane musculoskeletal group?

Abstract

Objective. To determine whether Cochrane Musculoskeletal Group (CMSG) systematic reviews and corresponding primary studies of rheumatoid arthritis interventions report and analyze the data needed to assess the effectiveness of interventions in reducing socioeconomic differences in health and/or improving the health of the poor. Methods. We selected all CMSG reviews on rheumatoid arthritis published since issue 1, 2003. Fourteen reviews were identified; 147 of the 156 primary studies included in these reviews were obtained and assessed. We extracted data on whether the dimensions place of residence, race/ethnicity/culture, occupation, gender, religion, education, socioeconomic status, and social capital and networks (PROGRESS) were reported or analyzed, and whether any interventions were aimed at disadvantaged or low-and middle-income country populations. Results. Among the dimensions of PROGRESS reported at baseline in 147 primary studies, gender (89%) was the most commonly reported, followed by education (25%) and race/ethnicity (18%). Less than 50% of the systematic reviews reported dimensions of PROGRESS even when they had been reported in the primary study. Of 147 primary studies, 6 (5%) were aimed specifically at disadvantaged populations; another 6 reported on effectiveness by at least 1 dimension of PROGRESS. Conclusion. Primary studies of interventions for rheumatoid arthritis generally reported few variables necessary to answer questions about health inequalities. Most CMSG systematic reviews failed to assess those variables even when described in the primary studies. The Cochrane Health Equity Field welcomes the opportunity to provide guidance to systematic review authors on incorporating equity considerations into their reviews.

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

“…Another limitation is that we excluded non-English systematic reviews. In two previous methods study, non-English studies were not qualitatively or quantitatively different from English studies in how they considered health equity or reported results [13], [21]. Thus, it is unlikely that this exclusion would affect the conclusions of this study.…”

“…Three other studies have found that approximately 10% of primary studies report data disaggregated by one or more of the PROGRESS-Plus factors [13], [21], [26]. We addressed this weakness by explicitly assessing whether systematic reviews described availability of data in primary studies.…”

“…The search was limited to English-language due to resource implications of including non-English articles [19]. There is no evidence from two previous studies that non-English language papers are likely to assess impacts on equity in health status differently or more frequently [13], [21]. The search retrieved 300 systematic reviews.…”

Assessing equity in systematic reviews: realising the recommendations of the Commission on Social Determinants of Health

“…The Measurement and Evidence Knowledge Network report stresses key axes of social stratification (class, status, education, occupation, income and assets, gender, race, ethnicity, caste, tribes, religion, national origins, age, and residence), while the Campbell and Cochrane Equity Methods Group and the Cochrane Public Health Review Group use the acronym PROGRESS (place of residence, race/ethnicity, occupation, gender, religion, education, socioeconomic status, and social capital). [17][18][19] Additional PROGRESS axes such as age, sexual orientation, and disability have been proposed. 20 These stratifiers interact, overlap, and cluster together in their implications.…”

Equity, Efficiency and Research Synthesis

“…An analysis of Cochrane Musculoskeletal Group systematic reviews found that they have so far failed to document basic differences in health equity in terms of demographic and socio-economic factors, even when such information was available in primary studies. 50 Another review of smoking cessation studies, which found some evidence that smoking bans and youth access restrictions reduce social inequalities in smoking, was nevertheless restricted by differing contexts, leading to a recommendation for more explicit incorporation of equity in future reviews. 51 Such limitations have provided the impetus for explicit discussion of equity within the Cochrane and Campbell Collaborations.…”