Research on subgroups is not research on equity attributes: Evidence from an overview of systematic reviews on vaccination

Abstract

BackgroundEquity remains a priority in the international health development agenda. However, major inequities in vaccination coverage jeopardise the achievement of the Sustainable Development Goals. We aim at comprehensively describing how research has addressed equity issues related to vaccination.MethodsWe carried out an overview of systematic reviews (SRs) that explicitly explored the effects of interventions to improve vaccination in any context; for any vaccine and, in any language. We followed standard research synthesis methods to systematically search for SR, assess them for inclusion and extracting relevant data, particularly on vaccination related outcomes. To gather evidence on equity issues addressed in the SR, we used the PROGRESS-plus framework.FindingsOur search obtained 2,003 hits which resulted in 54 included SRs, published between 1994 and 2014. The quality of SRs was generally poor, with less than half complying with most of the quality criteria. Reported vaccines included, by order of frequency, influenza and Expanded Programme on Immunisation vaccines. The types of interventions more frequently reported were related to vaccination delivery strategies, financial support and information, education and communication. Most of the SRs suggested effects favouring intervention groups as opposed to comparison groups. The most frequently reported equity attribute was ‘place of residence’ and the least reported equity attributes were sexual orientation and religion. Very few estimates of effects actually measured differences or changes between groups having those attributes and all of them referred to the place of residence. No data was found about reducing equity gaps for vulnerable groups or minorities, or attributes such as sexual orientation, education or specific religious groups.ConclusionsAlthough research on vulnerable populations as a subgroup is abundant, it fails to report on the interventions that will actually reduce inequities and consider how redistribution of health care resources could shrink the gap between the privileged and most vulnerable groups including minorities. Research, if aiming at being responsive to global health policy trends, needs to report not only on specific attributes but also on how a better redistribution of health care resources could contribute to alleviating the unjust situation of the most vulnerable populations.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-017-0587-x) contains supplementary material, which is available to authorized users.

Conceptual framework of equity-focused implementation research for health programs (EquIR)

“…We found in the literature a few frameworks that consider equity in research and reporting. One example is the PROGRESS Plus framework, which focuses on highlighting unfair differences in disease burden and interventions in order to reduce these differential effects, but which does not explicitly involve implementation considerations [37, 42]. A proposal has been made and implemented with the Development of Equity focused Clinical Practice Guidelines under the GRADE approach [43–47], although it does not relate specifically to implementation research for health programs or interventions.…”

Searching for health equity: validation of a search filter for ethnic and socioeconomic inequalities in transport

“…However, this could lead to a review that identified few or no eligible studies [2] or may exclude other subtopics that are of interest. A third strategy is to carry out a review or overview of systematic reviews (also called umbrella reviews), drawing on equity-relevant papers that were included within previous non-equity specific reviews [3]. However, these overviews may struggle to provide an effective synthesis if different systematic reviews have focused on different populations, outcomes, or quality appraisal methods [4].…”

Which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases amongst children in low-income and middle-income countries (LMICs): protocol for an umbrella review

“…Globally, the evidence base on the effect of public health interventions on health inequalities in children is growing but gaps remain 15 17 18. Previous work has suggested that the available evidence is disproportionally coming from high-income countries 17 19 20.…”

“…Globally, the evidence base on the effect of public health interventions on health inequalities in children is growing but gaps remain 15 17 18. Previous work has suggested that the available evidence is disproportionally coming from high-income countries 17 19 20. A 2018 mapping of the evidence available on LMICs regarding interventions to improve child well-being,21 22 also found that while reviews may provide data disaggregated by population group, very few explicitly focus on the potential equity issues raised by the differences between groups.…”

“…A 2018 mapping of the evidence available on LMICs regarding interventions to improve child well-being,21 22 also found that while reviews may provide data disaggregated by population group, very few explicitly focus on the potential equity issues raised by the differences between groups. Finally, most of the reviews available focus exclusively on targeted interventions towards disadvantaged groups without necessarily addressing the gap between or across different groups 17 23. Therefore, the impact of such interventions may not be reflected across or between different population groups.…”