How effects on health equity are assessed in systematic reviews of interventions
- 8 December 2010
- journal article
- review article
- Published by Wiley in Emergencias
- Vol. 2010 (12), MR000028
- https://doi.org/10.1002/14651858.mr000028.pub2
Abstract
Background Enhancing health equity has now achieved international political importance with endorsement from the World Health Assembly in 2009. The failure of systematic reviews to consider effects on health equity is cited by decision‐makers as a limitation to their ability to inform policy and program decisions. Objectives To systematically review methods to assess effects on health equity in systematic reviews of effectiveness. Search methods We searched the following databases up to July 2 2010: MEDLINE, PsychINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Index to Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on October 7 2010. Selection criteria We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities. Data collection and analysis Data were extracted using a pre‐tested form by two independent reviewers. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews. Main results Thirty‐four methodological studies were included. The methods used by these included studies were: 1) Targeted approaches (n=22); 2) gap approaches (n=12) and gradient approach (n=1). Gender or sex was assessed in eight out of 34 studies, socioeconomic status in ten studies, race/ethnicity in seven studies, age in seven studies, low and middle income countries in 14 studies, and two studies assessed multiple factors across health inequity may exist. Only three studies provided a definition of health equity. Four methodological approaches to assessing effects on health equity were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (all 34 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (12/34 studies); 3) analytic approaches (10/34 studies); and 4) applicability assessment (11/34 studies). Both analytic and applicability approaches were not reported transparently nor in sufficient detail to judge their credibility. Authors' conclusions There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to assess and report effects on health equity in systematic reviews.Keywords
This publication has 70 references indexed in Scilit:
- Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: a systematic analysisThe Lancet, 2010
- Systematic reviews reveal unrepresentative evidence for the development of drug formularies for poor and nonwhite populationsJournal of Clinical Epidemiology, 2009
- Closing the gap in a generation: health equity through action on the social determinants of healthThe Lancet, 2008
- Is health equity considered in systematic reviews of the cochrane musculoskeletal group?Arthritis Care & Research, 2008
- Interventions to address maternal, newborn, and child survival: what difference can integrated primary health care strategies make?The Lancet, 2008
- Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviewsThe Lancet, 2008
- Effects of policy options for human resources for health: an analysis of systematic reviewsThe Lancet, 2008
- What works? Interventions for maternal and child undernutrition and survivalThe Lancet, 2008
- Empirical Evidence for Selective Reporting of Outcomes in Randomized TrialsJAMA, 2004