Systematic reviews play a crucial role in informing healthcare decisions, but how well do they account for health equity? A recent analysis delves into the methods used by systematic reviewers to address health equity, highlighting both progress and persistent challenges. The study identifies five distinct methodological approaches, yet it emphasizes that the optimal submission of these approaches remains unclear.

The central question addressed by the review was to examine the methods employed by systematic reviewers when considering health equity in effectiveness reviews. This is particularly significant given the increasing global emphasis on reducing health inequities – those avoidable and unfair differences in health status.

The analysis focused on empirical studies of systematic review collections that assessed methods for measuring effects on health inequalities. Health inequalities were defined as unfair and avoidable differences across socially stratifying factors. These factors align with the PROGRESS-Plus framework, encompassing Place of residence, race/ethnicity/culture/language, Occupation, Gender or sex, Religion, Education, Socioeconomic status, and Social capital. The “Plus” category includes other factors linked to discrimination, exclusion, marginalization, or vulnerability, such as age, disability, relationships, and environmental conditions.

Key Findings on Health Equity Assessment

The most appropriate way to address any of these approaches is unclear.

The updated review incorporated 158 collections of systematic reviews. Among these, 108 focused on evidence relevant to populations experiencing inequity, 26 assessed subgroup analysis across PROGRESS-Plus factors, two analyzed a gradient in effect across PROGRESS-Plus, and 20 used a combination of subgroup analysis and focused approaches. The most frequently assessed PROGRESS-Plus factors were age (43 studies),socioeconomic status (35 studies),and low- and middle-income countries (24 studies). Notably, four studies evaluated multiple factors contributing to health inequity.

The review identified five methodological approaches for incorporating health equity into systematic reviews: descriptive assessment in the reviews, descriptive assessment of the included studies, analytic approaches, applicability assessment, and stakeholder engagement. However, the study points out that the most effective way to implement these approaches remains uncertain. It stresses that analyses of effects on specific populations must be justified and reported transparently to ensure credibility. Moreover, there is a need for improved openness in judgments regarding applicability and relevance to disadvantaged populations. The Cochrane Handbook offers guidance on equity and specific populations.

Implications for future Research

The findings underscore the need for clearer guidelines and standardized methods for incorporating health equity into systematic reviews. This includes developing robust strategies for identifying and addressing the diverse factors that contribute to health inequalities, as well as ensuring that the results of these reviews are relevant and applicable to disadvantaged populations. By improving the way health equity is assessed in systematic reviews, decision-makers can be better equipped to address health inequities and promote more equitable health outcomes.