Does consideration and assessment of effects on health equity affect the conclusions of systematic reviews? A methodology study.


Welch, V; Petticrew, M; Ueffing, E; Benkhalti Jandu, M; Brand, K; Dhaliwal, B; Kristjansson, E; Smylie, J; Wells, GA; Tugwell, P; (2012) Does consideration and assessment of effects on health equity affect the conclusions of systematic reviews? A methodology study. PLoS One, 7 (3). e31360. ISSN 1932-6203 DOI: https://doi.org/10.1371/journal.pone.0031360

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Abstract

INTRODUCTION Tackling 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. METHODS We 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. RESULTS Of 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. CONCLUSION The 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.

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Social and Environmental Health Research
Research Centre: Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 22427804
Web of Science ID: 303129700002
URI: http://researchonline.lshtm.ac.uk/id/eprint/1229644

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